Abstract: Objective: To analyze the factors affecting the objective image quality of third-generation high-pitch dual-source coronary CT angiography, optimize the scanning protocol to enhance image quality, and reduce radiation dose and iodine intake. Methods: A total of 684 consecutive patients who underwent third-generation high-pitch dual-source coronary CT angiography were divided into two groups based on objective image quality (poor or good). Differences in basic clinical information and scanning parameters between the two groups were analyzed, and a prediction model was developed. Results: Significant differences were observed between the two groups in body mass index (BMI) (P < 0.001), contrast concentration (P=0.001, P < 0.05), contrast dosage (P=0.005, P < 0.05), injection rate (P=0.010, P < 0.05), and tube voltage (P < 0.001). A binary logistic regression model was constructed, yielding a sensitivity of 61.32% and a specificity of 83.54%. The model was further transformed into a nomogram prediction model. Conclusion: Individualized scanning protocols for third-generation high-pitch dual-source coronary CT angiography can help achieve high-quality imaging while minimizing radiation dose and iodine intake.