Low-dose cardiovascular computed tomography: where are the limits?

Since its introduction in the 1970s, diagnostic computed tomography (CT) imaging has grown rapidly and developed into a standard diagnostic test for a wide variety of cardiovascular conditions. Although this has undoubtedly led to improved medical care, it has also been associated with a significant increase in population-based radiation exposure and the potential downstream increase in cancer is a justified concern. For cardiovascular CT, new CT scanner technologies were initially directed toward maximizing image quality rather than minimizing radiation exposure. Only more recently have technologic advances yielded dose-saving protocols for cardiovascular applications, with impressive reduction of radiation exposure. The achievable limits of population-based exposure are dependent on responsible, evidence-based use of CT for cardiovascular imaging as well as exploitation of available and emerging dose-saving strategies.