title: Dose reduction with iterative reconstruction for coronary CT angiography: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate the achievable radiation dose reduction for coronary CT angiography (CCTA) with iterative reconstruction (IR) in adults and the effects on image quality.
  
  
  METHODS
  PubMed and EMBASE were searched, and original articles concerning IR for CCTA in adults using prospective electrocardiogram triggering were included. Primary outcome was the effective dose using filtered back projection (FBP) and IR. Secondary outcome was the effect of IR on objective and subjective image quality.
  
  
  RESULTS
  The search yielded 1616 unique articles, of which 10 studies (1042 patients) were included. The pooled routine effective dose with FBP was 4.2 mSv [95% confidence interval (CI) 3.5-5.0]. A dose reduction of 48% to a pooled effective dose of 2.2 mSv (95% CI 1.3-3.1) using IR was reported. Noise, contrast-to-noise ratio and subjective image quality were equal or improved in all but one study, whereas signal-to-noise ratio was decreased in two studies with IR at reduced dose.
  
  
  CONCLUSIONS
  IR allows for CCTA acquisition with an effective dose of 2.2 mSv with preserved objective and subjective image quality.
authors.affiliation: 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Annemarie M
authors.initials: AM
authors.lastname: Den Harder
authors.affiliation: 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Willemink
authors.affiliation: 2 Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Quirina M B
authors.initials: QM
authors.lastname: De Ruiter
authors.affiliation: 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Pim A
authors.initials: PA
authors.lastname: De Jong
authors.affiliation: 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Arnold M R
authors.initials: AM
authors.lastname: Schilham
authors.affiliation: 3 Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
authors.affiliation: 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Leiner
authors.affiliation: 3 Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Ricardo P J
authors.initials: RP
authors.lastname: Budde
mesh_terms: D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D006801:Humans; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D059629:Signal-To-Noise Ratio; D014057:Tomography, X-Ray Computed / Q000379:methods*