Background:
The NAEOTOM Alpha.Peak (Siemens Healthineers) represents the next generation of photon-counting computed tomography (PCCT) and currently the most advanced CT technology worldwide. Owing to its superior spatial resolution and spectral differentiation capability, it is particularly well suited for the detection and quantification of coronary plaques, providing new opportunities for early diagnosis and prevention of coronary artery disease (CAD). The first two systems were delivered on June 23, 2025, with the Cardioangiological Center Bethanien (CCB), Frankfurt am Main, receiving the very first scanner (serial number 1). This analysis aimed to report our initial clinical experience with the implementation and routine use of the NAEOTOM Alpha.Peak PCCT system at the MVZ CCB Frankfurt and Main-Taunus, focusing on coronary computed angiography (CCTA) scan protocols, and radiation exposure.
Methods: All patients who underwent CCTA using the NAEOTOM Alpha.Peak system at the CCB between its commissioning on June 30 and October 20, 2025, were included in this analysis. Data were evaluated with respect to the applied scan protocols and radiation exposure, expressed as the volume CT dose index (CTDIvol).
Results: During the above-mentioned period, a total of 1,775 CCTA examinations were performed (average 21.7 per day; after the initial adjustment phase starting August 1, 27.1 per day). The most frequently used protocol was the axial acquisition using prospective triggering “sequential or prospective triggering“ (71,6 %; mean CTDIvol 13,2 mGy). The high-pitch helical “FLASH” mode was applied in 21.7% of cases, yielding the lowest average dose (3.2 mGy). The helical acquisition using retrospective gating (= “Spiral” mode) was conducted in 6.7% of examinations (mean CTDIvol 12.9 mGy). The ultra-high-resolution (UHR) mode, associated with higher radiation exposure, was required for clinical decision-making only in isolated cases (n = 7, 0.4%; mean CTDIvol 15,5 mGy).
Conclusion: The NAEOTOM Alpha.Peak photon-counting CT demonstrated excellent image quality at remarkably low radiation doses in routine clinical use. Even during the early implementation phase, the system achieved high diagnostic reliability and efficiency in CCTA. These findings highlight the strong potential of PCCT technology to advance non-invasive coronary imaging and preventive cardiology.
