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Objectives Deep-learning image reconstruction (DLIR) offers unique opportunities for reducing image noise without degrading image quality or diagnostic accuracy in coronary CT angiography (CCTA). The present study aimed at exploiting the capabilities of DLIR to reduce radiation dose and assess its impact on stenosis severity, plaque composition analysis, and plaque volume quantification. Methods This prospective study includes 50 patients who underwent two sequential CCTA scans at normal-dose (ND) and lower-dose (LD). ND scans were reconstructed with Adaptive Statistical Iterative Reconstruction-Veo (ASiR-V) 100%, and LD scans with DLIR. Image noise (in Hounsfield units, HU) and quantitative plaque volumes (in mm 3 ) were assessed quantitatively. Stenosis severity was visually categorized into no stenosis (0%), stenosis (&lt; 20%, 20–50%, 51–70%, 71–90%, 91–99%), and occlusion (100%). Plaque composition was classified as calcified, non-calcified, or mixed. Results Reduction of radiation dose from ND scans with ASiR-V 100% to LD scans with DLIR at the highest level (DLIR-H; 1.4 mSv vs. 0.8 mSv,  p  &lt; 0.001) had no impact on image noise (28 vs. 27 HU,  p  = 0.598). Reliability of stenosis severity and plaque composition was excellent between ND scans with ASiR-V 100% and LD scans with DLIR-H (intraclass correlation coefficients of 0.995 and 0.974, respectively). Comparison of plaque volumes using Bland–Altman analysis revealed a mean difference of − 0.8 mm 3  (± 2.5 mm 3 ) and limits of agreement between − 5.8 and + 4.1 mm 3 . Conclusion DLIR enables a reduction in radiation dose from CCTA by 43% without significant impact on image noise, stenosis severity, plaque composition, and quantitative plaque volume. Key Points • Deep-learning image reconstruction (DLIR) enables radiation dose reduction by over 40% for coronary computed tomography angiography (CCTA) . • Image noise remains unchanged between a normal-dose CCTA reconstructed by ASiR-V and a lower-dose CCTA reconstructed by DLIR . • There is no impact on the assessment of stenosis severity, plaque composition, and quantitative plaque volume between the two scans .

Radiation dose reduction with deep-learning image reconstruction for coronary computed tomography angiography