Arq Bras Cardiol: Imagem cardiovasc. 2025; 38(2): e20250041

“Triple Rule-Out”: Including the Abdominal Aorta With a Clear Conscience?

Tiago A.

Magalhães

DOI: 10.36660/abcimg.20250041i

This Short Editorial is referred by the Research article "Conventional and Partially ECG-Gated Triple Rule-Out Computed Tomography Angiography with Extension to Abdominal Aorta: Comparative Radiation Dose and Imaging Quality".

Less is More – Less Radiation Dose, More Patient Safety

The main strength of the study lies in its methodological approach. The authors selected patients who had previously undergone the TRO CTA protocol including the abdominal aorta with full electrocardiographic synchronization. After obtaining consent, they performed a new examination using the partial electrocardiographic synchronization protocol, enabling a robust comparison through a “matched case-control” model. This approach minimizes bias related to anatomical and technical variability among different individuals.

The results were interesting. The dose reduction was significant: the mean effective dose of the protocol with partial ECG synchronization was 47.9% lower than that of the protocol with full synchronization (17.0 mSv vs. 32.6 mSv, p<0.001). It is noteworthy that this reduction in radiation dose was not accompanied by a compromise in image quality. The quantitative assessment of attenuation values in critical vascular regions – such as the ascending aorta, descending aorta, abdominal aorta, and pulmonary trunk – showed no statistically significant differences. Similarly, the subjective qualitative evaluation demonstrated equivalence between the two protocols in terms of image quality of the assessed anatomical structures.

[…]