Exploring double low-dose CT technology for achieving coronary mixed reality radiation dose reduction: a preliminary study in coronary artery disease patients.

BACKGROUND

Coronary artery disease (CAD) is a leading global health concern; however, coronary computed tomography (CT) angiography (CCTA) is constrained by two-dimensional interpretation. Mixed reality enhances three-dimensional (3D) visualisation and interventional guidance, but conventional-dose CT acquisition raises concerns about radiation exposure. It is unknown whether double low-dose CT can generate adequate digital imaging and communications in medicine (DICOM) data for coronary mixed reality; we therefore evaluated its feasibility, dose reduction, diagnostic performance, and clinical utility.

METHODS

A total of 192 consecutive patients with suspected CAD were prospectively enrolled and randomised to the double low-dose mixed reality group (Group A), the conventional-dose mixed reality group (Group B), or the conventional-dose CT group (Group C). Radiation dose, contrast media dose, and coronary mixed reality quality were compared between Group A and Group B. With coronary angiography (CAG) as the reference standard, receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of coronary mixed reality in detecting coronary stenosis. Perioperative outcomes of coronary mixed reality-assisted CAG were recorded and compared.

RESULTS

Compared with Group B, Group A reduced the effective radiation dose by approximately 82% and the contrast media dose by approximately 47%; the quality of coronary mixed reality showed no significant difference between the two groups. The artificial intelligence (AI)-assisted coronary mixed reality workflow demonstrated an area under the curve (AUC) of 0.92, a specificity of 0.90, a sensitivity of 0.94, and an accuracy of 0.92 for detecting coronary stenosis. Coronary mixed reality-assisted CAG effectively reduced the time to localise CAD, total radiation time, total radiation exposure, and contrast media dose by approximately 36%, 45%, 28%, and 40%, respectively.

CONCLUSIONS

In non-obese patients [body mass index (BMI) <30 kg/m2] imaged using a specific CT platform [dual-source, sinogram-affirmed iterative reconstruction (SAFIRE)] and commercial 3D software, double low-dose CT reduced the radiation dose by 82% without compromising coronary mixed reality quality. The AI-assisted mixed reality workflow showed promising diagnostic performance (AUC =0.92); however, these findings are preliminary and require validation in broader populations and settings.