Background: To investigate the optimal monoenergetic level of spectral reconstructions in coronary computed tomography angiography (coronary CTA) on a dual-layer spectral detector computed tomography (SDCT) with half-dose contrast media.Methods: Two hundred patients with suspected coronary artery disease (CAD) were enrolled in this prospective coronary CTA study and randomly divided into a routine-dose contrast media group and a half-dose contrast media group (each n=100). Coronary CTA was performed using SDCT with prospective electrocardiogram (ECG)-gated mode. A tube voltage of 120 kVp was used, along with an automated tube current modulation. A dose of iodixanol 270 mgI/mL of 0.8 and 0.4 mL/kg was administered to the routine and half-dose groups, respectively. For the routine-dose group, 120 kVp polychromatic images with a model-based iterative reconstruction (IMR) (Group A) were reconstructed. For the half-dose group, three monoenergetic levels of images were reconstructed (Group B, 45 keV; Group C, 50 keV; and Group D, 55 keV).Objective indicators [mean CT values; noise; signal-to-noise ratio (SNR); and contrast-to-noise ratio (CNR)] and subjective indicators (contrast, sharpness, subjective noise, and acceptability) in each group were compared.Results: There were no significant differences in demographics or radiation dose (1.83±0.51 vs. 1.80± 0.53 mSv, P=0.78) between the routine-and half-dose groups. The average iodine loads were 15.33±2.26 and 7.48±1.14 g, respectively. Mean CT values, SNR, CNR, and subjective contrast in Group C were higher than those in Group A (P<0.05), and there were no significant differences in other indicators between Group C and Group A (P>0.05). The objective and subjective noise in Group B were worse than those in Group A (P<0.05). The contrast, sharpness, and acceptability of Group D were all worse than those of Group A (P<0.05).Conclusions: Compared to routine polychromatic images, 50 keV monoenergetic images can provide equivalent or improved coronary image quality in coronary CTA performed on SDCT with half the amount of contrast media.