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Article History

Received: 26 November 2024

Revised: 7 April 2025

Accepted: 22 April 2025

First Online: 24 May 2025

Compliance with ethical standards

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: The scientific guarantor of this publication is Marc Dewey.

: M.B., M.M., K.N., M.E., A.M.M., H.D., S.H., V.B., and T.R. have nothing to disclose. N.R. reported to be PI in a trial supported by grants (no own salary) from the German Ministry of Education and Research (NAVICARE 01GY1911) outside the submitted work. M.D. reported grants from the Heisenberg Programme of the German Research Foundation, grants for fractal analysis of myocardial perfusion from the German Research Foundation, and a grant from the Berlin University Alliance (GC_SC_PC 27) outside the submitted work. In addition, M.D. holds a joint patent with Florian Michallek on dynamic perfusion analysis using fractal analysis (PCT/EP2016/071551 and USPTO 2021 10,991,109 approved), and M.D. is European Society of Radiology (ESR) Research Chair (2019–2022) and ESR Publications Chair (2022–2025); the opinions expressed in this article are the author’s own and do not represent the view of ESR. Per the guiding principles of ESR, the work as Research and Publications Chair is on a voluntary basis, and only remuneration of travel expenses occurs. M.D. is also the editor of Cardiac CT , published by Springer Nature, and offers hands-on courses on CT imaging ( ). Institutional master research agreements exist with Siemens, General Electric, Philips and Canon. The terms of these arrangements are managed by the legal department of Charité – Universitätsmedizin Berlin.

: Five of the authors have significant statistical expertise.

: Written informed consent was obtained from all participants in this trial before randomisation.

: This trial was approved by the ethics committee of the Charité – Universitätsmedizin Berlin (EA1-1-080-08) and by the German Federal Office for Radiation Protection (Z5–22462/2–2008-048).

: Since it is a prespecified cost-utility analysis, all study subjects have been previously reported in CAD-MAN clinical trial (NCT00844220).

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