Introduction: Radiation exposure is one of the major limitations of computed tomographic coronary angiography (CTA). The purpose of this study was to compare the objective and subjective image quality and radiation dose using prospective ECG gating (PGA) versus ECG-controlled tube current modulation (ECTCM) scanning techniques. Methods: A prospective, single-center study was performed at Prince Sultan Cardiac Centre, Qassim, Saudi Arabia. A total of 104 patients with low-to- intermediate probability of coronary artery disease (CAD) underwent CTA with either PGA or ECTCM acquisition. PGA was performed during the study period and compared with the last 50 CTAs previously done using ECTCM. A 4-point scale was used to assess the image quality subjectively. Objective image quality was assessed using image signal, noise, and signal-to-noise ratio (SNR). Results: Patient's Baseline characteristics were not different between the two scanning protocols. The 4-point score of subjective image quality showed no significant differences between the PGA and ECTCM scans (2.9. ± 0.7, 2.96 ± 0.7, respectively; p= 0.87). The objective image quality showed significantly higher noise and lower SNR with PGA compared with ECTCM (31 ± 9, 27 ± 9, respectively; p< 0.001 for noise) and (15 ± 5, 17. ± 7, respectively; p< 0.001 for SNR), with no statistical difference in the image signal (434 ± 123, 425 ± 103 HU, respectively, p= 0.7).Radiation exposure was significantly lower with PGA than with ECTCM. The dose-length product (DLP) for PGA was 334 ± 130. mGy, compared with 822 ± 286. mGy for the ECTCM. This corresponds to a 59% reduction in radiation exposure (p< 0.0001). Conclusions: Although prospective ECG-triggered axial scanning increased image noise, it maintained subjective image quality and was associated with a 59% reduction in radiation exposure when compared with ECTCM.