Purpose: To investigate the image quality and radiation dose of low radiation dose CT coronary angiography (CTCA) using sinogram affirmed iterative reconstruction (SAFIRE) compared with standard dose CTCA using filtered back-projection (FBP) in obese patients. Materials and methods: Seventy-eight consecutive obese patients were randomized into two groups and scanned using a prospectively ECG-triggered step-and-shot (SAS) CTCA protocol on a dual-source CT scanner. Thirty-nine patients (protocol A) were examined using a routine radiation dose protocol at 120 kV and images were reconstructed with FBP (protocol A). Thirty-nine patients (protocol B) were examined using a low dose protocol at 100 kV and images were reconstructed with SAFIRE. Two blinded observers independently assessed the image quality of each coronary segment using a 4-point scale (1 = non-diagnostic, 4 = excellent) and measured the objective parameters image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Radiation dose was calculated. Results: The coronary artery image quality scores, image noise, SNR and CNR were not significantly different between protocols A and B (all p > 0.05), with image quality scores of 3.51 +/- 0.70 versus 3.55 +/- 0.47, respectively. The effective radiation dose was significantly lower in protocol B (4.41 +/- 0.83 mSv) than that in protocol A (8.83 +/- 1.74 mSv, p < 0.01). Conclusion: Compared with standard dose CTCA using FBP, low dose CTCA using SAFIRE can maintain diagnostic image quality with 50% reduction of radiation dose. (C) 2012 Elsevier Ireland Ltd. All rights reserved