Contrast-to-noise ratio and low-contrast object resolution on full- and low-dose MDCT: SAFIRE versus filtered back projection in a low-contrast object phantom and in the liver. AJR Am J Roentgenol. 2012;199:8-18. [PMID: 22733888 DOI: 10.2214/ajr.11.7421]

Low Tube Voltage Liver MDCT with Sinogram-Affirmed Iterative Reconstructions for the Detection of Hepatocellular Carcinoma

Aim of this study was to compare low tube voltage computed tomography (80 kV) of the liver using iterative image reconstruction (SAFIRE) with standard computed tomography (120 kV) using filtered back-projection (FBP) for the detection of hepatocellular carcinoma (HCC). 46 patients (43 men) with 93 HCC confirmed by 3 T MRI with Gd-EOB-DPTA, in inconclusive cases combined with contrast-enhanced ultrasound, underwent dual-energy CT. The raw data of the 80 kV tube was reconstructed using the iterative reconstruction algorithm SAFIRE with two strengths (I3 and I5). The virtual 120 kV image data set was reconstructed using FBP. The CT images were reviewed to determine the lesion-to-liver contrast (LLC), the lesion contrast-to-noise ratio (CNR) and the sensitivity. The LLC (57.1/54.3 [I3/I5] vs. 34.9 [FBP]; p ≤ 0.01), CNR (3.67/4.45 [I3/I5] vs. 2.48 [FBP]; p < 0.01) and sensitivity (91.4%/88.2% [I3/I5] vs. 72.0% [FBP]; p ≤ 0.01) were significantly higher in the low-voltage protocol using SAFIRE. Therefore, low tube voltage CT using SAFIRE results in an increased lesion-to-liver contrast as well as an improved lesion contrast-to-noise ratio compared to FBP at 120 kV which results in a higher sensitivity for the detection of HCC.

Size-based quality-informed framework for quantitative optimization of pediatric CT

The purpose of this study was to formulate a systematic, evidence-based method to relate quantitative diagnostic performance to radiation dose, enabling a multidimensional system to optimize computed tomography imaging across pediatric populations. Based on two prior foundational studies, radiation dose was assessed in terms of organ doses, effective dose ([Formula: see text]), and risk index for 30 patients within nine color-coded pediatric age-size groups as a function of imaging parameters. The cases, supplemented with added noise and simulated lesions, were assessed in terms of nodule detection accuracy in an observer receiving operating characteristic study. The resulting continuous accuracy-dose relationships were used to optimize individual scan parameters. Before optimization, the nine protocols had a similar [Formula: see text] of [Formula: see text] with accuracy decreasing from 0.89 for the youngest patients to 0.67 for the oldest. After optimization, a consistent target accuracy of 0.83 was established for all patient categories with [Formula: see text] ranging from 1 to 10 mSv. Alternatively, isogradient operating points targeted a consistent ratio of accuracy-per-unit-dose across the patient categories. The developed model can be used to optimize individual scan parameters and provide for consistent diagnostic performance across the broad range of body sizes in children.

Image quality, diagnostic accuracy, and potential for radiation dose reduction in thoracoabdominal CT, using Sinogram Affirmed Iterative Reconstruction (SAFIRE) technique in a longitudinal study

Objective

To step-wise evaluate image quality of sinogram-affirmed iterative reconstruction (SAFIRE) in reduced-dose (RD) thoracoabdominal computed tomography (CT) compared to full-dose (FD) and RD filtered back projection (FBP) in a longitudinal study.

Materials and methods

122 patients were included in this prospective study. 49 patients (14 men: mean age ± SD, 56±0.4 years; 35 women: 58±1.3 years) completed FD, RD1 (80%-dose) and RD2 (60%-dose) thoracoabdominal CT. Each CT dataset was reconstructed with FBP and SAFIRE. For quantitative image analysis image noise was measured in defined tissue regions. Qualitative image evaluation was performed according to the European Guidelines on Quality criteria for CT. Additionally artifacts, lesion conspicuity, and edge sharpness were assessed.

Results

Compared to FD-FBP noise in soft tissue increased by 12% in RD1-FBP and 27% in RD2-FBP reconstructions, whereas SAFIRE lead to a decrease of 28% (RD1) and 17% (RD2), respectively (all p <0.001). Visually sharp reproduction, lesion conspicuity, edge sharpness of pathologic findings, and overall image quality did not differ statistically significant between FD-FBP and RD-SAFIRE datasets. Image quality decreased in RD1- and RD2-FBP compared to FD-FBP, reaching statistically significance in RD2 datasets (p <0.001). In RD1- and RD2-FBP (p <0.001) streak artifacts were noted.

Conclusion

Using SAFIRE the reference mAs in thoracoabdominal CT can be reduced by at least 30% in clinical routine without loss of image quality or diagnostic information.

An effective noise reduction method for multi-energy CT images that exploit spatio-spectral features

PURPOSE

To develop and evaluate an image-domain noise reduction method for multi-energy CT (MECT) data.

METHODS

Multi-Energy Non-Local Means (MENLM) is a technique that uses the redundant information in MECT images to achieve noise reduction. In this method, spatio-spectral features are used to determine the similarity between pixels, making the similarity evaluation more robust to image noise. The performance of this MENLM filter was tested on images acquired on a whole-body research photon counting CT system. The impact of filtering on image quality was quantitatively evaluated in phantom studies in terms of image noise level (standard deviation of pixel values), noise power spectrum (NPS), in-plane and cross-plane spatial resolution, CT number accuracy, material decomposition performance, and subjective low-contrast spatial resolution using the American College of Radiology (ACR) CT accreditation phantom. Clinical feasibility was assessed by performing MENLM on contrast-enhanced swine images and unenhanced cadaver head images using clinically relevant doses and dose rates.

RESULTS

The phantom studies demonstrated that the MENLM filter reduced noise substantially and still preserved the shape and peak frequency of the NPS. With 80% noise reduction, MENLM filtering caused no degradation of high-contrast spatial resolution, as illustrated by the modulation transfer function (MTF) and slice sensitivity profile (SSP). CT number accuracy was also maintained for all energy channels, demonstrating that energy resolution was not affected by filtering. Material decomposition performance was improved with MENLM filtering. The subjective evaluation using the ACR phantom demonstrated an improvement in low-contrast performance. MENLM achieved effective noise reduction in both contrast-enhanced swine images and unenhanced cadaver head images, resulting in improved detection of subtle vascular structures and the differentiation of white/gray matter.

CONCLUSION

In MECT, MENLM achieved around 80% noise reduction and greatly improved material decomposition performance and the detection of subtle anatomical/low-contrast features while maintaining spatial and energy resolution. MENLM filtering may improve diagnostic or functional analysis accuracy and facilitate radiation dose and contrast media reduction for MECT.

Effect of Radiation Dose Reduction and Reconstruction Algorithm on Image Noise, Contrast, Resolution, and Detectability of Subtle Hypoattenuating Liver Lesions at Multidetector CT: Filtered Back Projection versus a Commercial Model-based Iterative Reconstruction Algorithm

Purpose To determine the effect of radiation dose and iterative reconstruction (IR) on noise, contrast, resolution, and observer-based detectability of subtle hypoattenuating liver lesions and to estimate the dose reduction potential of the IR algorithm in question. Materials and Methods This prospective, single-center, HIPAA-compliant study was approved by the institutional review board. A dual-source computed tomography (CT) system was used to reconstruct CT projection data from 21 patients into six radiation dose levels (12.5%, 25%, 37.5%, 50%, 75%, and 100%) on the basis of two CT acquisitions. A series of virtual liver lesions (five per patient, 105 total, lesion-to-liver prereconstruction contrast of -15 HU, 12-mm diameter) were inserted into the raw CT projection data and images were reconstructed with filtered back projection (FBP) (B31f kernel) and sinogram-affirmed IR (SAFIRE) (I31f-5 kernel). Image noise (pixel standard deviation), lesion contrast (after reconstruction), lesion boundary sharpness (average normalized gradient at lesion boundary), and contrast-to-noise ratio (CNR) were compared. Next, a two-alternative forced choice perception experiment was performed (16 readers [six radiologists, 10 medical physicists]). A linear mixed-effects statistical model was used to compare detection accuracy between FBP and SAFIRE and to estimate the radiation dose reduction potential of SAFIRE. Results Compared with FBP, SAFIRE reduced noise by a mean of 53% ± 5, lesion contrast by 12% ± 4, and lesion sharpness by 13% ± 10 but increased CNR by 89% ± 19. Detection accuracy was 2% higher on average with SAFIRE than with FBP (P = .03), which translated into an estimated radiation dose reduction potential (±95% confidence interval) of 16% ± 13. Conclusion SAFIRE increases detectability at a given radiation dose (approximately 2% increase in detection accuracy) and allows for imaging at reduced radiation dose (16% ± 13), while maintaining low-contrast detectability of subtle hypoattenuating focal liver lesions. This estimated dose reduction is somewhat smaller than that suggested by past studies. ^© RSNA, 2017 Online supplemental material is available for this article.

A limit on dose reduction possible with CT reconstruction algorithms without prior knowledge of the scan subject

PURPOSE

To find an upper bound on the maximum dose reduction possible for any reconstruction algorithm, analytic or iterative, that result from the inclusion of the data statistics. The authors do not analyze noise reduction possible from prior knowledge or assumptions about the object.

METHODS

The authors examined the task of estimating the density of a circular lesion in a cross section. Raw data were simulated by forward projection of existing images and numerical phantoms. To assess an upper bound on the achievable dose reduction by any algorithm, the authors assume that both the background and the shape of the lesion are completely known. Under these conditions, the best possible estimate of the density can be determined by solving a weighted least squares problem directly in the raw data domain. Any possible reconstruction algorithm that does not use prior knowledge or make assumptions about the object, including filtered backprojection (FBP) or iterative reconstruction methods with this constraint, must be no better than this least squares solution. The authors simulated 10,000 sets of noisy data and compared the variance in density from the least squares solution with those from FBP. Density was estimated from FBP images using either averaging within a ROI, or streak-adaptive averaging with better noise performance.

RESULTS

The bound on the possible dose reduction depends on the degree to which the observer can read through the possibly streaky noise. For the described low contrast detection task with the signal shape and background known exactly, the average dose reduction possible compared to FBP with streak-adaptive averaging was 42% and it was 64% if only the ROI average is used with FBP. The exact amount of dose reduction also depends on the background anatomy, with statistically inhomogeneous backgrounds showing greater benefits.

CONCLUSIONS

The dose reductions from new, statistical reconstruction methods can be bounded. Larger dose reductions in the density estimation task studied here are only possible with the introduction of prior knowledge, which can introduce bias.

Dual-Source Single-Energy Multidetector CT Used to Obtain Multiple Radiation Exposure Levels within the Same Patient: Phantom Development and Clinical Validation

Purpose To develop, in a phantom environment, a method to obtain multidetector computed tomographic (CT) data sets at multiple radiation exposure levels within the same patient and to validate its use for potential dose reduction by using different image reconstruction algorithms for the detection of liver metastases. Materials and Methods The American College of Radiology CT accreditation phantom was scanned by using a dual-source multidetector CT platform. By adjusting the radiation output of each tube, data sets at six radiation exposure levels (100%, 75%, 50%, 37.5%, 25%, and 12.5%) were reconstructed from two consecutive dual-source single-energy (DSSE) acquisitions, as well as a conventional single-source acquisition. A prospective, HIPAA-compliant, institutional review board-approved study was performed by using the same DSSE strategy in 19 patients who underwent multidetector CT of the liver for metastatic colorectal cancer. All images were reconstructed by using conventional weighted filtered back projection (FBP) and sinogram-affirmed iterative reconstruction with strength level of 3 (SAFIRE-3). Objective image quality metrics were compared in the phantom experiment by using multiple linear regression analysis. Generalized linear mixed-effects models were used to analyze image quality metrics and diagnostic performance for lesion detection by readers. Results The phantom experiment showed comparable image quality between DSSE and conventional single-source acquisition. In the patient study, the mean size-specific dose estimates for the six radiation exposure levels were 13.0, 9.8, 5.8, 4.4, 3.2, and 1.4 mGy. For each radiation exposure level, readers' perception of image quality and lesion conspicuity was consistently ranked superior with SAFIRE-3 when compared with FBP (P ≤ .05 for all comparisons). Reduction of up to 62.5% in radiation exposure by using SAFIRE-3 yielded similar reader rankings of image quality and lesion conspicuity when compared with routine-dose FBP. Conclusion A method was developed and validated to synthesize multidetector CT data sets at multiple radiation exposure levels within the same patient. This technique may provide a foundation for future clinical trials aimed at estimating potential radiation dose reduction by using iterative reconstructions. ^© RSNA, 2016 Online supplemental material is available for this article.

A robust noise reduction technique for time resolved CT

PURPOSE

To develop a noise reduction method for time resolved CT data, especially those with significant patient motion.

METHODS

PArtial TEmporal Nonlocal (PATEN) means is a technique that uses the redundant information in time-resolved CT data to achieve noise reduction. In this method, partial temporal profiles are used to determine the similarity (or weight) between pixels, and the similarity search makes use of both spatial and temporal information, providing robustness to patient motion. The performance of the PATEN filter was qualitatively and quantitatively evaluated with nine cardiac CT patient data sets and five CT brain perfusion patient data sets. In cardiac CT, PATEN was applied to reduce noise primarily in the reduced-dose phases created with electrocardiographic (ECG) pulsing. CT number accuracy and noise reduction were evaluated in both full-dose phases and reduced-dose phases between filtered backprojection images and PATEN filtered images. In CT brain perfusion, simulated quarter dose data were obtained by adding noise to the raw data of a routine dose scan. PATEN was applied to the simulated low-dose images. Image noise, time-intensity profile accuracy, and perfusion parameter maps were compared among low-dose, low-dose+PATEN filter, and full-dose images. The noise reduction performance of PATEN was compared to a previously proposed noise reduction method, time-intensity profile similarity (TIPS) bilateral filtering.

RESULTS

In 4D cardiac CT, after PATEN filtering, the image noise in the reduced-dose phases was greatly reduced, making anatomical structures easier to identify. The mean decreases in noise values between the original and PATEN images were 11.0% and 53.8% for the full and reduced-dose phases of the cardiac cycle, respectively. TIPS could not achieve effective noise reduction. In CT brain perfusion, PATEN achieved a 55.8%-66.3% decrease in image noise in the low-dose images. The contrast to noise ratio in the axial images was increased and was comparable to the full-dose images. Differentiation of anatomical structure in the PATEN images and corresponding quantitative perfusion parameter maps were preferred by two neuroradiologists compared to the simulated low-dose and TIPS results. The mean perfusion parameters calculated from the PATEN images agreed with those determined from full-dose data to within 12% and 20% for normal and diseased regions.

CONCLUSIONS

In ECG-gated cardiac CT, where the dose had already been reduced by a factor of 5 in the reduced-dose phases, PATEN achieved a 53.8% noise reduction, which decreased the noise level in the reduced-dose phases close to that of the full-dose phases. In CT brain perfusion, a fourfold dose reduction was demonstrated to be achievable by PATEN filtering, which improved quantitative perfusion analysis. PATEN can be used to effectively reduce image noise to improve image quality, even when significant motion occurred between temporal samples.

Indirect CT Venography at 80 kVp with Sinogram-Affirmed Iterative Reconstruction Compared to 120 kVp with Filtered Back Projection: Assessment of Image Quality and Radiation Dose

Objective

To evaluate the image quality and radiation dose of indirect computed tomographic venography (CTV) using 80 kVp with sinogram-affirmed iterative reconstruction (SAFIRE) and 120 kVp with filtered back projection (FBP).

Materials and Methods

This retrospective study was approved by our institution and informed consent was waived. Sixty-one consecutive patients (M: F = 27: 34, mean age 60 ± 16, mean BMI 23.6 ± 3.6 kg/m²) underwent pelvic and lower extremity CTVs [group A (n = 31, 120 kVp, reconstructed with FBP) vs. group B (n = 30, 80 kVp, reconstructed with SAFIRE)]. The vascular enhancement, image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were compared. Subjective image analysis for image quality and noise was performed by two radiologists. Radiation dose was compared between the two groups.

Results

Compared with group A, higher mean vascular enhancement was observed in the group B (group A vs. B, 118.8 ± 15.7 HU vs. 178.6 ± 39.6 HU, p < 0.001), as well as image noise (12.0 ± 3.8 HU vs. 17.9 ± 6.1 HU, p < 0.001) and CNR (5.1 ± 1.9 vs. 7.6 ± 3.0, p < 0.001). The SNRs were not significantly different in both groups (11.2 ± 4.8 vs. 10.8 ± 3.7, p = 0.617). There was no significant difference in subjective image quality between the two groups (all p > 0.05). The subjective image noise was higher in the group B (p = 0.036 in reader 1, p = 0.005 in reader 2). The inter-observer reliability for assessing subjective image quality was good (ICC 0.746~0.784, p < 0.001). The mean CT dose index volume (CTDIvol) and mean dose length product (DLP) were significantly lower in group B than group A [CTDIvol, 6.4 ± 1.3 vs. 2.2 ± 2.2 mGy (p < 0.001); DLP, 499.1 ± 116.0 vs. 133.1 ± 45.7 mGy × cm (p < 0.001)].

Conclusions

CTV using 80 kVp combined with SAFIRE provides lower radiation dose and improved CNR compared to CTV using 120 kVp with FBP.

Correlation between human detection accuracy and observer model-based image quality metrics in computed tomography

The purpose of this study was to compare computed tomography (CT) low-contrast detectability from human readers with observer model-based surrogates of image quality. A phantom with a range of low-contrast signals (five contrasts, three sizes) was imaged on a state-of-the-art CT scanner (Siemens' force). Images were reconstructed using filtered back projection and advanced modeled iterative reconstruction and were assessed by 11 readers using a two alternative forced choice method. Concurrently, contrast-to-noise ratio (CNR), area-weighted CNR (CNRA), and observer model-based metrics were estimated, including nonprewhitening (NPW) matched filter, NPW with eye filter (NPWE), NPW with internal noise, NPW with an eye filter and internal noise (NPWEi), channelized Hotelling observer (CHO), and CHO with internal noise (CHOi). The correlation coefficients (Pearson and Spearman), linear discriminator error, [Formula: see text], and magnitude of confidence intervals, [Formula: see text], were used to determine correlation, proper characterization of the reconstruction algorithms, and model precision, respectively. Pearson (Spearman) correlation was 0.36 (0.33), 0.83 (0.84), 0.84 (0.86), 0.86 (0.88), 0.86 (0.91), 0.88 (0.90), 0.85 (0.89), and 0.87 (0.84), [Formula: see text] was 0.25, 0.15, 0.2, 0.25, 0.3, 0.25, 0.4, and 0.45, and [Formula: see text] was [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] for CNR, CNRA, NPW, NPWE, NPWi, NPWEi, CHO, and CHOi, respectively.

Reaching for better image quality and lower radiation dose in head and neck CT: advanced modeled and sinogram-affirmed iterative reconstruction in combination with tube voltage adaptation

OBJECTIVES

The aim of this study was to evaluate image quality and radiation dose in low-dose head and neck CT comparing two different commercially available iterative reconstruction algorithms: sinogram-affirmed iterative reconstruction (SAFIRE) and advanced modeled iterative reconstruction (ADMIRE) with fixed and automated tube voltage adaptation (TVA).

METHODS

CT examinations of 103 patients were analysed. 58 patients were examined on a single-source CT at fixed tube voltage of 120 kV and reconstructed with filtered back projection (FBP) and SAFIRE (Strength Level 3). 45 patients were examined in a single-source mode on a dual-source CT with automated TVA and reconstructed with FBP and ADMIRE (Strength Levels 2 and 3). Image noise was calculated in seven anatomical volumes of interest. Subjective evaluation of the CT images was performed using a four-grade scale.

RESULTS

Mean CT numbers of FBP and the corresponding iterative reconstruction did not differ significantly (p = 0.74-0.99). Image noise was lower with both iterative reconstruction techniques than with FBP (SAFIRE 3: -22.3%; ADMIRE 2: -14.9%; ADMIRE 3: -24.2%; all p < 0.05); hence, the signal-to-noise ratio and the contrast-to-noise values were higher. Subjective image quality revealed a more favourable result for the iterative reconstruction. ADMIRE 3 in combination with automated TVA showed 14.4% (p < 0.05) less image noise with a 7.5% lower radiation dose than SAFIRE 3 with fixed tube voltage.

CONCLUSIONS

Higher image quality at lower radiation dose can be achieved using ADMIRE in combination with automated TVA.

Prospective Evaluation of Reduced Dose Computed Tomography for the Detection of Low-Contrast Liver Lesions: Direct Comparison with Concurrent Standard Dose Imaging

OBJECTIVES

To prospectively compare the diagnostic performance of reduced-dose (RD) contrast-enhanced CT (CECT) with standard-dose (SD) CECT for detection of low-contrast liver lesions.

METHODS

Seventy adults with non-liver primary malignancies underwent abdominal SD-CECT immediately followed by RD-CECT, aggressively targeted at 60-70 % dose reduction. SD series were reconstructed using FBP. RD series were reconstructed with FBP, ASIR, and MBIR (Veo). Three readers-blinded to clinical history and comparison studies-reviewed all series, identifying liver lesions ≥4 mm. Non-blinded review by two experienced abdominal radiologists-assessing SD against available clinical and radiologic information-established the reference standard.

RESULTS

RD-CECT mean effective dose was 2.01 ± 1.36 mSv (median, 1.71), a 64.1 ± 8.8 % reduction. Pooled per-patient performance data were (sensitivity/specificity/PPV/NPV/accuracy) 0.91/0.78/0.60/0.96/0.81 for SD-FBP compared with RD-FBP 0.79/0.75/0.54/0.91/0.76; RD-ASIR 0.84/0.75/0.56/0.93/0.78; and RD-MBIR 0.84/0.68/0.49/0.92/0.72. ROC AUC values were 0.896/0.834/0.858/0.854 for SD-FBP/RD-FBP/RD-ASIR/RD-MBIR, respectively. RD-FBP (P = 0.002) and RD-MBIR (P = 0.032) AUCs were significantly lower than those of SD-FBP; RD-ASIR was not (P = 0.052). Reader confidence was lower for all RD series (P < 0.001) compared with SD-FBP, especially when calling patients entirely negative.

CONCLUSIONS

Aggressive CT dose reduction resulted in inferior diagnostic performance and reader confidence for detection of low-contrast liver lesions compared to SD. Relative to RD-ASIR, RD-FBP showed decreased sensitivity and RD-MBIR showed decreased specificity.

KEY POINTS

• Reduced-dose CECT demonstrates inferior diagnostic performance for detecting low-contrast liver lesions. • Reader confidence is lower with reduced-dose CECT compared to standard-dose CECT. • Overly aggressive dose reduction may result in misdiagnosis, regardless of reconstruction algorithm. • Careful consideration of perceived risks versus benefits of dose reduction is crucial.

Impact of iterative reconstructions on image noise and low-contrast object detection in low kVp simulated abdominal CT: a phantom study

BACKGROUND

Low kilovoltage (kVp) computed tomography (CT) may be used to reduce contrast medium dose in patients at risk of contrast nephropathy, at the cost of increased image noise.

PURPOSE

To evaluate: (i) the impact of iterative reconstructions (Siemens SAFIRE) on low-contrast object detection to compensate for increased noise instead of increased tube loading when decreasing tube potential; and (ii) the change in iodine attenuation in simulated abdominal CT.

MATERIAL AND METHODS

A phantom was scanned at 70, 80, 100, and 120 kVp at fixed effective tube loading (170 mAsEFF) and fixed radiation dose (CTDIVOL 10 mGy). Images were reconstructed with filtered back-projection (FBP) and SAFIRE strengths S1-S5. Iodine attenuation, objective image noise, contrast-to-noise ratio (CNR), noise power spectrum (NPS), spatial resolution, and subjective detectability of low-contrast objects were evaluated.

RESULTS

Compared with 120 kVp iodine attenuation increased by a factor 1.6 and 2.0, and image noise increased by a factor 1.9 and 2.5 at 80 and 70 kVp, respectively. Compared with FBP, SAFIRE showed objective reduction in image noise and increased CNR without loss of spatial resolution or any significant NPS alteration, with general tendency to improve subjective detectability of low-contrast objects. At 170 mAsEFF the number of discernible 1.0% contrast objects at 70 kVp/S5 and 80 kVp/S5 was similar to that at 120 kVp/FBP.

CONCLUSION

With the SAFIRE algorithm image noise, CNR and detectability of low-contrast objects may be kept unchanged without increased tube loading when using low kVp settings to reduce contrast medium dose in azotemic patients.

Ultra-low-dose chest CT with iterative reconstruction does not alter anatomical image quality

PURPOSE

To evaluate the effect of dose reduction with iterative reconstruction (IR) on image quality of chest CT scan.

MATERIALS AND METHODS

Eighteen human cadavers had chest CT with one reference CT protocol (RP-CT; 120kVp/200mAs) and two protocols with dose reduction: low-dose-CT (LD-CT; 120kVp/40mAs) and ultra-low-dose CT (ULD-CT; 120kVp/10mAs). Data were reconstructed with filter-back-projection (FBP) for RP-CT and with FBP and IR (sinogram affirmed iterative reconstruction [SAFIRE^®]) algorithm for LD-CT and ULD-CT. Volume CT dose index (CTDIvol) were recorded. The signal-to-noise (SNR), contrast-to-noise (CNR) ratios of LD-CT and ULD-CT and quantitative parameters were compared to RP-CT. Two radiologists reviewed the CT examinations assessed independently the quality of anatomical structures and expressed a confidence level using a 2-point scale (50% and 95%).

RESULTS

CTDIvol was 2.69 mGy for LD-CT (-80%; P<0.01) and 0.67 mGy for ULD-CT (-95%; P<0.01) as compared to 13.42 mGy for RP-CT. SNR and CNR were significantly decreased (P<0.01) for LD-CT and ULD-CT, but IR improved these values satisfactorily. No significant differences were observed for quantitative measurements. Radiologists rated excellent/good the RP-CT and LD-CT images, whereas good/fair the ULD-CT images. Confidence level for subjective anatomical analysis was 95% for all protocols.

CONCLUSIONS

Dose reduction with a dose lower than 1 mGy, used in conjunction with IR allows performing chest CT examinations that provide a high quality of anatomical structures.

Construction of realistic phantoms from patient images and a commercial three-dimensional printer

The purpose of this study was to use three-dimensional (3-D) printing techniques to construct liver and brain phantoms having realistic pathologies, anatomic structures, and heterogeneous backgrounds. Patient liver and head computed tomography (CT) images were segmented into tissue, vessels, liver lesion, white and gray matter, and cerebrospinal fluid (CSF). Stereolithography files of each object were created and imported into a commercial 3-D printer. Printing materials were assigned to each object after test scans, which showed that the printing materials had CT numbers ranging from 70 to 121 HU at 120 kV. Printed phantoms were scanned on a CT scanner and images were evaluated. CT images of the liver phantom had measured CT numbers of 77.8 and 96.6 HU for the lesion and background, and 137.5 to 428.4 HU for the vessels channels, which were filled with iodine solutions. The difference in CT numbers between lesions and background (18.8 HU) was representative of the low-contrast values needed for optimization tasks. The liver phantom background was evaluated with Haralick features and showed similar texture between patient and phantom images. CT images of the brain phantom had CT numbers of 125, 134, and 108 HU for white matter, gray matter, and CSF, respectively. The CT number differences were similar to those in patient images.

Low contrast detectability and spatial resolution with model-based Iterative reconstructions of MDCT images: a phantom and cadaveric study

OBJECTIVES

To compare image quality [low contrast (LC) detectability, noise, contrast-to-noise (CNR) and spatial resolution (SR)] of MDCT images reconstructed with an iterative reconstruction (IR) algorithm and a filtered back projection (FBP) algorithm.

METHODS

The experimental study was performed on a 256-slice MDCT. LC detectability, noise, CNR and SR were measured on a Catphan phantom scanned with decreasing doses (48.8 down to 0.7 mGy) and parameters typical of a chest CT examination. Images were reconstructed with FBP and a model-based IR algorithm. Additionally, human chest cadavers were scanned and reconstructed using the same technical parameters. Images were analyzed to illustrate the phantom results.

RESULTS

LC detectability and noise were statistically significantly different between the techniques, supporting model-based IR algorithm (p < 0.0001). At low doses, the noise in FBP images only enabled SR measurements of high contrast objects. The superior CNR of model-based IR algorithm enabled lower dose measurements, which showed that SR was dose and contrast dependent. Cadaver images reconstructed with model-based IR illustrated that visibility and delineation of anatomical structure edges could be deteriorated at low doses.

CONCLUSION

Model-based IR improved LC detectability and enabled dose reduction. At low dose, SR became dose and contrast dependent.

KEY POINTS

• Model- based Iterative Reconstruction improves detectability of low contrast object. • With model- based Iterative Reconstruction, spatial resolution is dose and contrast dependent. • Model-based Iterative Reconstruction algorithms enable improved IQ combined with dose-reduction possibilities. • Improvement of SR and LC detectability on the same IMR data set would reduce reconstructions.

Double-low protocol for hepatic dynamic CT scan: Effect of low tube voltage and low-dose iodine contrast agent on image quality

The radiation-induced carcinogenesis from computed tomography (CT) and iodine contrast agent induced nephropathy has attracted international attention. The reduction of the radiation dose and iodine intake in CT scan is always a direction for researchers to strive. The purpose of this study was to evaluate the feasibility of a "double-low" (i.e., low tube voltage and low-dose iodine contrast agent) scanning protocol for dynamic hepatic CT with the adaptive statistical iterative reconstruction (ASIR) in patients with a body mass index (BMI) of 18.5 to 27.9 kg/m.A total of 128 consecutive patients with a BMI between 18.5 and 27.9 kg/m were randomly assigned into 3 groups according to tube voltage, iodine contrast agent, and reconstruction algorithms. Group A (the "double-low" protocol): 100 kVp tube voltage with 40% ASIR, iodixanol at 270 mg I/mL, group B: 120 kVp tube voltage with filtered back projection (FBP), iodixanol at 270 mg I/ mL, and group C: 120 kVp tube voltage with FBP, ioversol at 350 mg I/ mL.The volume CT dose index (CTDIvol) and effective dose (ED) in group A were lower than those in group B and C (all P < 0.01). The iodine intake in group A was decreased by approximately 26.5% than group C, whereas no statistical difference was observed between group A and B (P > 0.05). There was no significant difference of the CT values between group A and C (P > 0.05), which both showed higher CT values than that in group B (P < 0.001). However, no statistic difference was observed in the contrast-to-noise ratio (CNR), the signal-to-noise ratio (SNR), and image-quality scores among the 3 groups (all P > 0.05). Near-perfect consistency of the evaluation for group A, B, and C (Kenall's W = 0.921, 0.874, and 0.949, respectively) was obtained by the 4 readers with respect to the overall image quality.These results suggested that the "double-low" protocol with ASIR algorithm for multi-phase hepatic CT scan can dramatically decrease radiation dose and iodine intake with adequate image quality in patients with BMI of 18.5 to 27.9 kg/m.

Characteristic image quality of a third generation dual-source MDCT scanner: Noise, resolution, and detectability

PURPOSE

The purpose of this work was to assess the inherent image quality characteristics of a new multidetector computed tomography system in terms of noise, resolution, and detectability index as a function of image acquisition and reconstruction for a range of clinically relevant settings.

METHODS

A multisized image quality phantom (37, 30, 23, 18.5, and 12 cm physical diameter) was imaged on a SOMATOM Force scanner (Siemens Medical Solutions) under variable dose, kVp, and tube current modulation settings. Images were reconstructed with filtered back projection (FBP) and with advanced modeled iterative reconstruction (ADMIRE) with iterative strengths of 3, 4, and 5. Image quality was assessed in terms of the noise power spectrum (NPS), task transfer function (TTF), and detectability index for a range of detection tasks (contrasts of approximately 45, 90, 300, -900, and 1000 HU, and 2-20 mm diameter) based on a non-prewhitening matched filter model observer with eye filter.

RESULTS

Image noise magnitude decreased with decreasing phantom size, increasing dose, and increasing ADMIRE strength, offering up to 64% noise reduction relative to FBP. Noise texture in terms of the NPS was similar between FBP and ADMIRE (<5% shift in peak frequency). The resolution, based on the TTF, improved with increased ADMIRE strength by an average of 15% in the TTF 50% frequency for ADMIRE-5. The detectability index increased with increasing dose and ADMIRE strength by an average of 55%, 90%, and 163% for ADMIRE 3, 4, and 5, respectively. Assessing the impact of mA modulation for a fixed average dose over the length of the phantom, detectability was up to 49% lower in smaller phantom sections and up to 26% higher in larger phantom sections for the modulated scan compared to a fixed tube current scan. Overall, the detectability exhibited less variability with phantom size for modulated scans compared to fixed tube current scans.

CONCLUSIONS

Image quality increased with increasing dose and decreasing phantom size. The CT system exhibited nonlinear noise and resolution properties, especially at very low-doses, large phantom sizes, and for low-contrast objects. Objective image quality metrics generally increased with increasing dose and ADMIRE strength, and with decreasing phantom size. The ADMIRE algorithm could offer comparable image quality at reduced doses or improved image quality at the same dose. The use of tube current modulation resulted in more consistent image quality with changing phantom size.

Observer performance for adaptive, image-based denoising and filtered back projection compared to scanner-based iterative reconstruction for lower dose CT enterography

PURPOSE

The purpose of this study was to compare observer performance for detection of intestinal inflammation for low-dose CT enterography (LD-CTE) using scanner-based iterative reconstruction (IR) vs. vendor-independent, adaptive image-based noise reduction (ANLM) or filtered back projection (FBP).

METHODS

Sixty-two LD-CTE exams were performed. LD-CTE images were reconstructed using IR, ANLM, and FBP. Three readers, blinded to image type, marked intestinal inflammation directly on patient images using a specialized workstation over three sessions, interpreting one image type/patient/session. Reference standard was created by a gastroenterologist and radiologist, who reviewed all available data including dismissal Gastroenterology records, and who marked all inflamed bowel segments on the same workstation. Reader and reference localizations were then compared. Non-inferiority was tested using Jackknife free-response ROC (JAFROC) figures of merit (FOM) for ANLM and FBP compared to IR. Patient-level analyses for the presence or absence of inflammation were also conducted.

RESULTS

There were 46 inflamed bowel segments in 24/62 patients (CTDIvol interquartile range 6.9-10.1 mGy). JAFROC FOM for ANLM and FBP were 0.84 (95% CI 0.75-0.92) and 0.84 (95% CI 0.75-0.92), and were statistically non-inferior to IR (FOM 0.84; 95% CI 0.76-0.93). Patient-level pooled confidence intervals for sensitivity widely overlapped, as did specificities. Image quality was rated as better with IR and AMLM compared to FBP (p < 0.0001), with no difference in reading times (p = 0.89).

CONCLUSIONS

Vendor-independent adaptive image-based noise reduction and FBP provided observer performance that was non-inferior to scanner-based IR methods. Adaptive image-based noise reduction maintained or improved upon image quality ratings compared to FBP when performing CTE at lower dose levels.

Lowering radiation dose during dedicated colorectal cancer MDCT: comparison of low tube voltage and sinogram-affirmed iterative reconstruction at 80 kVp versus blended dual-energy images in a population of patients with low body mass index

PURPOSE

To assess the diagnostic accuracy, cancer staging, image quality, and radiation dose of 80-kVp computed tomography (CT) images for patients with colorectal cancers (CRCs) using sinogram-affirmed iterative reconstruction (SAFIRE).

METHODS

Sixty-four consecutive patients (mean weight 62.5  ±  11.3 kg, mean BMI 24.1  ±  3.3 kg/m(2)) with known CRC underwent dual-energy CT. Data were reconstructed as a weighted average (WA) 120-kVp dataset. Both filtered back projection (FBP) and SAFIRE were applied to reconstruct the WA 120-Kvp (Protocol A, B) and 80-kVp (Protocol C, D) image sets. The image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the cancers, the normal reference tissues, and the effective dose for each protocol were assessed. The cancer detection, staging, and image quality were evaluated. Analysis of variance was used for statistical analysis.

RESULTS

Compared with the FBP datasets at WA 120-kVp (Protocol A) and 80-kVp (Protocol C), the SAFIRE-reconstructed images (Protocols B, D) demonstrated significantly lower image noise (P  <  0.0083). Protocol D yielded significantly higher CNRs and SNRs for the CRCs and normal reference tissues than did Protocols A and C (P  <  0.0083). Protocol D also exhibited a significantly higher CNR for the CRC and some normal reference tissues than did Protocol B (P  <  0.0083). For hypovascular liver metastases (n  =  10), Protocol D yielded better SNRs and significantly higher CNRs than did Protocol A (P  <  0.0083). Overall, accuracy for tumor staging and liver metastasis was 95.3% (61/64) and 100%, respectively, in all of the 4 protocols. The mean effective dose decreased 41% from the WA 120-kVp to the 80-kVp protocols (6.23 vs. 3.68 mSv).

CONCLUSIONS

The 80-kVp technique with SAFIRE provided high SNR, high CNR, and good accuracy for staging in nonobese patients with CRC. Our study results should be extrapolated to patient populations with a high BMI with caution. Further studies of high BMI patients are therefore warranted.

Liver detection algorithm: its efficacy for CT noise reduction in the liver

OBJECTIVES

This study was performed to evaluate the efficacy of a novel computed tomography (CT) liver detection algorithm (LDA), which allows for targeted increase of radiation dose to the upper abdomen, on image quality of the liver.

METHODS

We retrospectively evaluated the LDA by comparing 40 consecutive patients who had portal venous CT abdomen performed without use of the algorithm, to 40 patients in whom the algorithm was used. Image quality was assessed objectively by comparing the standard deviation (SD) of attenuation values in Hounsfield units (HU) of the abdominal organs. Qualitative analysis was performed by two blinded radiologists who independently graded the image quality of abdominal organs

RESULTS

There was significant noise reduction in the liver (P < 0.001) and spleen (P < 0.001) in the LDA group compared to the conventional group. There was also a significant improvement in image quality of the liver (P < 0.001), kidney (P < 0.001), spleen (P < 0.001), pancreas (P < 0.001), and psoas (P = 0.005) in the LDA group compared to the conventional group. Overall dose between the two groups was similar.

CONCLUSIONS

This liver detection algorithm improves the subjective image quality of upper abdominal organs, in particular the liver, without increasing overall radiation dose.

Split-Bolus Portal Venous Phase Dual-Energy CT Urography: Protocol Design, Image Quality, and Dose Reduction

OBJECTIVE

The purpose of this study is to evaluate the image quality of split-bolus portal venous phase urography and the potential reduction of radiation dose by using a second-generation dual-source dual-energy CT (DECT) scanner.

MATERIALS AND METHODS

DECT urography was performed in 84 patients. Unenhanced CT was performed 20 minutes after drinking 800 mL of water. The split-bolus protocol consisted of a sequence of injections, as follows: 200 mL of normal saline (2.0 mL/s), 50 mL of contrast medium (2.5 mL/s) at 0 second, 70 mL of contrast medium (2.5 mL/s) at 360 seconds, and a saline flush of 25 mL. The scan was started at 420 seconds. Virtual unenhanced images were reconstructed from contrast-enhanced images. The mean CT density and signal-to-noise ratio (SNR) of the renal parenchyma, vessels, upper urinary tract, normal reference tissues, and tumors were measured for image quantitative analysis. Image quality and opacification of the collecting systems were rated by two radiologists using 3- or 4-point scales.

RESULTS

The SNR of all measured sites, except the renal pelvis, showed a statistically significant correlation (p < 0.001) between the true unenhanced and virtual unenhanced images. The overall sensitivity of stone detection was 87.5% (28/32) in virtual unenhanced images. Image quality of the renal parenchyma, arteries, and veins was excellent in 59.5%, 75.0%, and 97.6% of cases, respectively. Opacification of the intrarenal collecting systems, proximal, middle, and distal ureters, and bladder was complete in 92.9%, 83.9%, 78.6%, 77.4%, and 26.2% of patients, respectively. Omitting the unenhanced scan can reduce the mean radiation dose from 15.6 to 6.7 mSv.

CONCLUSION

Portal venous phase split-bolus DECT urography provides sufficient image quality with potential to reduce radiation exposure.

[Examination of Visual Effect in Low-dose Cerebral CT Perfusion Phantom Image Using Iterative Reconstruction]

CT perfusion (CTP) is obtained cerebrovascular circulation image for assessment of stroke patients; however, at the expense of increased radiation dose by dynamic scan. Iterative reconstruction (IR) method is possible to decrease image noise, it has the potential to reduce radiation dose. The purpose of this study is to assess the visual effect of IR method by using a digital perfusion phantom. The digital perfusion phantom was created by reconstructed filtered back projection (FBP) method and IR method CT images that had five exposure doses. Various exposure dose cerebral blood flow (CBF) images were derived from deconvolution algorithm. Contrast-to-noise ratio (CNR) and visual assessment were compared among the various exposure dose and each reconstructions. Result of low exposure dose with IR method showed, compared with FBP method, high CNR in severe ischemic area, and visual assessment was significantly improvement. IR method is useful for improving image quality of low-dose CTP.

Methods for clinical evaluation of noise reduction techniques in abdominopelvic CT

Most noise reduction methods involve nonlinear processes, and objective evaluation of image quality can be challenging, since image noise cannot be fully characterized on the sole basis of the noise level at computed tomography (CT). Noise spatial correlation (or noise texture) is closely related to the detection and characterization of low-contrast objects and may be quantified by analyzing the noise power spectrum. High-contrast spatial resolution can be measured using the modulation transfer function and section sensitivity profile and is generally unaffected by noise reduction. Detectability of low-contrast lesions can be evaluated subjectively at varying dose levels using phantoms containing low-contrast objects. Clinical applications with inherent high-contrast abnormalities (eg, CT for renal calculi, CT enterography) permit larger dose reductions with denoising techniques. In low-contrast tasks such as detection of metastases in solid organs, dose reduction is substantially more limited by loss of lesion conspicuity due to loss of low-contrast spatial resolution and coarsening of noise texture. Existing noise reduction strategies for dose reduction have a substantial impact on lowering the radiation dose at CT. To preserve the diagnostic benefit of CT examination, thoughtful utilization of these strategies must be based on the inherent lesion-to-background contrast and the anatomy of interest. The authors provide an overview of existing noise reduction strategies for low-dose abdominopelvic CT, including analytic reconstruction, image and projection space denoising, and iterative reconstruction; review qualitative and quantitative tools for evaluating these strategies; and discuss the strengths and limitations of individual noise reduction methods.

Iterative Reconstruction Leads to Increased Subjective and Objective Image Quality in Cranial CT in Patients With Stroke

OBJECTIVE

The purpose of this study was to determine whether iterative reconstruction improves the quality of cranial CT (CCT) images of stroke patients.

MATERIALS AND METHODS

Fifty-one CCT studies of patients with infarction performed with either a low (260 mAs; n = 21) or standard (340 mAs; n = 30) dose were reconstructed with both filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) with five strength levels (S1-S5). The resulting six image sets (one FBP and one each for SAFIRE levels S1-S5) were rated separately by two blinded radiologists in terms of conspicuity of infarcted areas on a 5-point scale. Noise and infarct-to-normal brain as well as medullary-to-cortical contrast-to-noise ratios (CNRs) were measured. Ratings, noise, and CNRs were intraindividually compared within the same dose group (Fisher exact test) and interindividually between the different dose groups (Wilcoxon-Mann-Whitney U test).

RESULTS

The strength level S4 showed the best conspicuity of infarcted areas. Compared with FBP, SAFIRE S4 statistically significantly (p < 0.01) reduced noise and improved CNRs without statistically significant differences in all subjective and objective criteria (p > 0.01) when the dose was reduced. Patients examined with a 260-mAs low-dose were exposed to a statistically significantly lower dose (1.77 vs 2.33 mSv; p < 0.01).

CONCLUSION

Iterative reconstruction (SAFIRE at strength level S4) leads to increased subjective and objective image quality in CCT and allows dose reduction (-24%) without losses in the demarcation of ischemic lesions.

Low contrast media volume in pre-TAVI CT examinations

PURPOSE

To evaluate image quality using reduced contrast media (CM) volume in pre-TAVI assessment.

METHODS

Forty-seven consecutive patients referred for pre-TAVI examination were evaluated. Patients were divided into two groups: group 1 BMI < 28 kg/m(2) (n = 29); and group 2 BMI > 28 kg/m(2) (n = 18). Patients received a combined scan protocol: retrospective ECG-gated helical CTA of the aortic root (80kVp) followed by a high-pitch spiral CTA (group 1: 70 kV; group 2: 80 kVp) from aortic arch to femoral arteries. All patients received one bolus of CM (300 mgI/ml): group 1: volume = 40 ml; flow rate = 3 ml/s, group 2: volume = 53 ml; flow rate = 4 ml/s. Attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the levels of the aortic root (helical) and peripheral arteries (high-pitch). Diagnostic image quality was considered sufficient at attenuation values > 250HU and CNR > 10.

RESULTS

Diagnostic image quality for TAVI measurements was obtained in 46 patients. Mean attenuation values and CNR (HU ± SD) at the aortic root (helical) were: group 1: 381 ± 65HU and 13 ± 8; group 2: 442 ± 68HU and 10 ± 5. At the peripheral arteries (high-pitch), mean values were: group 1: 430 ± 117HU and 11 ± 6; group 2: 389 ± 102HU and 13 ± 6.

CONCLUSION

CM volume can be substantially reduced using low kVp protocols, while maintaining sufficient image quality for the evaluation of aortic root and peripheral access sites.

KEY POINTS

• Image quality could be maintained using low kVp scan protocols. • Low kVp protocols reduce contrast media volume by 34-67 %. • Less contrast media volume lowers the risk of contrast-induced nephropathy.

Evaluating iterative reconstruction performance in computed tomography

PURPOSE

Iterative reconstruction (IR) offers notable advantages in computed tomography (CT). However, its performance characterization is complicated by its potentially nonlinear behavior, impacting performance in terms of specific tasks. This study aimed to evaluate the performance of IR with both task-specific and task-generic strategies.

METHODS

The performance of IR in CT was mathematically assessed with an observer model that predicted the detection accuracy in terms of the detectability index (d'). d' was calculated based on the properties of the image noise and resolution, the observer, and the detection task. The characterizations of image noise and resolution were extended to accommodate the nonlinearity of IR. A library of tasks was mathematically modeled at a range of sizes (radius 1-4 mm), contrast levels (10-100 HU), and edge profiles (sharp and soft). Unique d' values were calculated for each task with respect to five radiation exposure levels (volume CT dose index, CTDIvol: 3.4-64.8 mGy) and four reconstruction algorithms (filtered backprojection reconstruction, FBP; iterative reconstruction in imaging space, IRIS; and sinogram affirmed iterative reconstruction with strengths of 3 and 5, SAFIRE3 and SAFIRE5; all provided by Siemens Healthcare, Forchheim, Germany). The d' values were translated into the areas under the receiver operating characteristic curve (AUC) to represent human observer performance. For each task and reconstruction algorithm, a threshold dose was derived as the minimum dose required to achieve a threshold AUC of 0.9. A task-specific dose reduction potential of IR was calculated as the difference between the threshold doses for IR and FBP. A task-generic comparison was further made between IR and FBP in terms of the percent of all tasks yielding an AUC higher than the threshold.

RESULTS

IR required less dose than FBP to achieve the threshold AUC. In general, SAFIRE5 showed the most significant dose reduction potentials (11-54 mGy, 77%-84%), followed by SAFIRE3 (7-36 mGy, 50%-61%) and IRIS (6-26 mGy, 37%-50%). The dose reduction potentials highly depended on task size and task contrast, with tasks of lower contrasts and smaller sizes, i.e., more challenging tasks, indicating higher dose reductions. Softer edge profile showed higher dose reduction potentials with SAFIRE3 and SAFIRE5, but not with IRIS. The task-generic comparison between IR and FBP demonstrated the overall superiority of IR performance, as IR allowed a larger percent of tasks to exceed the threshold AUC: IRIS, 8%-12%; SAFIRE3, 10%-16%; and SAFIRE5, 20%-33%. The improvement with IR was generally more pronounced at lower dose levels.

CONCLUSIONS

Expanding beyond traditional contrast and noise based assessments of IR, we performed both task-specific and task-generic evaluations of IR performance. The task-specific evaluation demonstrated the dependency of IR's dose reduction potential on task attributes, which can be employed to optimize IR for clinical indications with specific range of size and contrast. The task-generic evaluation demonstrated IR's overall superiority over FBP in terms of the range of tasks exceeding a threshold performance level, which can be employed for general comparisons between algorithms.

Benefits of sinogram-affirmed iterative reconstruction in 0.4 mSv ultra-low-dose CT of the upper abdomen following transarterial chemoembolisation: comparison to low-dose and standard-dose CT and filtered back projection technique

AIM

To evaluate the advantage of sinogram-affirmed iterative reconstruction (SIR) compared to filtered back projection (FBP) in upper abdomen computed tomography (CT) after transarterial chemoembolisation (TACE) at different tube currents.

MATERIALS AND METHODS

The study was approved by the institutional review board. Written informed consent was obtained from all patients. Post-TACE CT was performed with different tube currents successively varied in four steps (180, 90, 45 and 23 mAs) with 40 patients per group (mean age: 60±12 years, range: 23-85 years, sex: 70 female, 90 male). The data were reconstructed with standard FBP and five different SIR strengths. Image quality was independently rated by two readers on a five-point scale. High (Lipiodol-to-liver) as well as low (liver-to-fat) contrast-to-noise ratios (CNRs) were intra-individually compared within one dose to determine the optimal strength (S1-S5) and inter-individually between different doses to determine the possibility of dose reduction using the Kruskal-Wallis test.

RESULTS

Subjective image quality and objective CNR analysis were concordant: intra-individually, SIR was significantly (p<0.001) superior to FBP. Inter-individually, regarding different doses (180 versus 23 ref mAs), there was no significant (p=1.00) difference when using S5 SIR at 23 mAs instead of FBP.

CONCLUSION

SIR allows for an 88% dose reduction from 3.43 to 0.4 mSv in unenhanced CT of the liver following TACE without subjective or objective loss in image quality.

Prospective evaluation of prior image constrained compressed sensing (PICCS) algorithm in abdominal CT: a comparison of reduced dose with standard dose imaging

PURPOSE

To prospectively study CT dose reduction using the "prior image constrained compressed sensing" (PICCS) reconstruction technique.

METHODS

Immediately following routine standard dose (SD) abdominal MDCT, 50 patients (mean age, 57.7 years; mean BMI, 28.8) underwent a second reduced dose (RD) scan (targeted dose reduction, 70%-90%). DLP, CTDIvol, and SSDE were compared. Several reconstruction algorithms (FBP, ASIR, and PICCS) were applied to the RD series. SD images with FBP served as reference standard. Two blinded readers evaluated each series for subjective image quality and focal lesion detection.

RESULTS

Mean DLP, CTDIvol, and SSDE for RD series were 140.3 mGy cm (median 79.4), 3.7 mGy (median 1.8), and 4.2 mGy (median 2.3) compared with 493.7 mGy cm (median 345.8), 12.9 mGy (median 7.9 mGy), and 14.6 mGy (median 10.1) for SD series, respectively. Mean effective patient diameter was 30.1 cm (median 30), which translates to a mean SSDE reduction of 72% (P < 0.001). RD-PICCS image quality score was 2.8 ± 0.5, improved over the RD-FBP (1.7 ± 0.7) and RD-ASIR (1.9 ± 0.8) (P < 0.001), but lower than SD (3.5 ± 0.5) (P < 0.001). Readers detected 81% (184/228) of focal lesions on RD-PICCS series, vs. 67% (153/228) and 65% (149/228) for RD-FBP and RD-ASIR, respectively. Mean image noise was significantly reduced on RD-PICCS series (13.9 HU) compared with RD-FBP (57.2) and RD-ASIR (44.1) (P < 0.001).

CONCLUSION

PICCS allows for marked dose reduction at abdominal CT with improved image quality and diagnostic performance over reduced dose FBP and ASIR. Further study is needed to determine indication-specific dose reduction levels that preserve acceptable diagnostic accuracy relative to higher dose protocols.

Assessment of Low-Contrast Resolution for the American College of Radiology Computed Tomographic Accreditation Program: What Is the Impact of Iterative Reconstruction?

OBJECTIVE

To compare contrast-to-noise ratio (CNR) thresholds with visual assessment of low-contrast resolution (LCR) in filtered back projection (FBP) and iteratively reconstructed (IR) computed tomographic (CT) images.

METHODS

American College of Radiology (ACR) CT accreditation phantom LCR images were acquired at CTDIvol levels of 8, 12, and 16 mGy using 2 scanner models and reconstructed using one FBP and 2 IR kernels. Acquisitions were repeated 100 times. Three board-certified medical physicists blindly reviewed the LCR section images. Pass-percentage rates (PPRs) using previous and current ACR CT accreditation criteria were compared.

RESULTS

Observer PPRs for FBP images were less than 32%. For IR images, 5 of 18 settings/dose/model configurations had PPRs greater than 32% (maximum 76.3%). For CNR evaluation of FBP images, PPRs for 15 configurations were greater than 70%. For IR images, all PPRs were at least 96%.

CONCLUSIONS

The CNR threshold used by the ACR CT accreditation program yields higher PPRs than visual assessment of LCR, potentially resulting in lower-quality images passing the ACR CNR criteria.

Ultralow-Dose Abdominal Computed Tomography: Comparison of 2 Iterative Reconstruction Techniques in a Prospective Clinical Study

PURPOSE

To assess lesion detection and image quality of ultralow-dose (ULD) abdominal computed tomography (CT) reconstructed with filtered back projection (FBP) and 2 iterative reconstruction techniques: hybrid-based iDose, and image-based SafeCT.

MATERIALS AND METHODS

In this institutional review board-approved ongoing prospective clinical study, 41 adult patients provided written informed consent for an additional ULD abdominal CT examination immediately after standard dose (SD) CT exam on a 256-slice multidetector computed tomography (iCT, Philips-Healthcare). The SD examination (size-specific dose estimate, 10 ± 3 mGy) was performed at 120 kV with automatic exposure control, and reconstructed with FBP. The ULD examination (1.5 ± 0.4 mGy) was performed at 120 kV and fixed tube current of 17 to 20 mAs/slice to achieve ULD radiation dose, with the rest of the scan parameters same as SD examination. The ULD data were reconstructed with (a) FBP, (b) iDose, and (c) SafeCT. Lesions were detected on ULD FBP series and compared to SD FBP "reference-standard" series. True lesions, pseudolesions, and missed lesions were recorded. Four abdominal radiologists independently blindly performed subjective image quality. Objective image quality included image noise calculation and noise spectral density plots.

RESULTS

All true lesions (n, 52: liver metastases, renal cysts, diverticulosis) in SD FBP images were detected in ULD images. Although there were no missed or pseudolesions on ULD iDose and ULD SafeCT images, appearance of small low-contrast hepatic lesions was suboptimal. The ULD FBP images were unacceptable across all patients for both lesion detection and image quality. In patients with a body mass index (BMI) of 25 kg/m or less, ULD iDose and ULD SafeCT images were acceptable for image quality that was close to SD FBP for both normal and abnormal abdominal and pelvic structures. With increasing BMI, the image quality of ULD images was deemed unacceptable due to photo starvation. Evaluation of kidney stones with ULD iDose/SafeCT images was found acceptable regardless of patient size. Image noise levels were significantly lower in ULD iDose and ULD SafeCT images compared to ULD FBP (P < 0.01).

CONCLUSIONS

Preliminary results show that ULD abdominal CT reconstructed with iterative reconstruction techniques is achievable in smaller patients (BMI ≤ 25 kg/m) but remains a challenge for overweight to obese patients. Lesion detection is similar in full-dose SD FBP and ULD iDose/SafeCT images, with suboptimal visibility of low-contrast lesions in ULD images.

Correlation of clinical and physical-technical image quality in chest CT: a human cadaver study applied on iterative reconstruction

Background

The first aim of this study was to evaluate the correlation between clinical and physical-technical image quality applied to different strengths of iterative reconstruction in chest CT images using Thiel cadaver acquisitions and Catphan images. The second aim was to determine the potential dose reduction of iterative reconstruction compared to conventional filtered back projection based on different clinical and physical-technical image quality parameters.

Methods

Clinical image quality was assessed using three Thiel embalmed human cadavers. A Catphan phantom was used to assess physical-technical image quality parameters such as noise, contrast-detail and contrast-to-noise ratio (CNR).

Both Catphan and chest Thiel CT images were acquired on a multislice CT scanner at 120 kVp and 0.9 pitch. Six different refmAs settings were applied (12, 30, 60, 90, 120 and 150refmAs) and each scan was reconstructed using filtered back projection (FBP) and iterative reconstruction (SAFIRE) algorithms (1,3 and 5 strengths) using a sharp kernel, resulting in 24 image series. Four radiologists assessed the clinical image quality, using a visual grading analysis (VGA) technique based on the European Quality Criteria for Chest CT.

Results

Correlation coefficients between clinical and physical-technical image quality varied from 0.88 to 0.92, depending on the selected physical-technical parameter. Depending on the strength of SAFIRE, the potential dose reduction based on noise, CNR and the inverse image quality figure (IQF_inv) varied from 14.0 to 67.8 %, 16.0 to 71.5 % and 22.7 to 50.6 % respectively. Potential dose reduction based on clinical image quality varied from 27 to 37.4 %, depending on the strength of SAFIRE.

Conclusion

Our results demonstrate that noise assessments in a uniform phantom overestimate the potential dose reduction for the SAFIRE IR algorithm. Since the IQF_inv based dose reduction is quite consistent with the clinical based dose reduction, an optimised contrast-detail phantom could improve the use of contrast-detail analysis for image quality assessment in chest CT imaging. In conclusion, one should be cautious to evaluate the performance of CT equipment taking into account only physical-technical parameters as noise and CNR, as this might give an incomplete representation of the actual clinical image quality performance.

Low-dose CT for patients with clinically suspected acute appendicitis: optimal strength of sinogram affirmed iterative reconstruction for image quality and diagnostic performance

BACKGROUND

As there is increased concern over the radiation exposure particularly in adolescents and young adults, computed tomography (CT) dose reduction is needed in the diagnosis of acute appendicitis.

PURPOSE

To evaluate the optimal strength of sinogram affirmed iterative reconstruction (SAFIRE) to obtain the best image quality on a 30-mAs applied low-dose CT (LDCT 30mAs) and to compare the diagnostic performances of the LDCT 30mAs with different SAFIRE strengths with that of the 100-mAs applied LDCT (LDCT 100mAs) for the diagnosis of acute appendicitis.

MATERIAL AND METHODS

A total of 102 consecutive patients (47 men, 55 women; mean age, 41.2 years; range, 15-82 years) with right lower quadrant pain underwent abdominal-pelvic CT, consisting of arterial phase LDCT 100mAs and portal venous phase LDCT30mAs under a fixed 120 kV. LDCT 30mAs images were reconstructed separately with five strength levels (S1-S5). Two blinded radiologists recorded scores for the subjective image quality of the LDCT 30mAs dataset (S0-S5) and confidence scores for the diagnosis of acute appendicitis on each dataset and LDCT 100mAs. CT image noise was measured for each set.

RESULTS

The study population consisted of 58 patients with confirmed appendicitis and 44 without appendicitis. There was no significant difference in diagnostic performance between LDCT 100mAs and LDCT 30mAs with any strength for both readers (AUC for reader 1, LDCT 30mAs with S0-S5 = 0.97, LDCT 100mAs = 0.93, P = 0.0936; for reader 2, LDCT 30mAs with S0-S5 = 0.96, LDCT 100mAs = 0.97, P = 0.128). The measured noise decreased as the strength increased from S0 to S5 (mean, 20.8 > 17.7 > 15.6 > 13.5 > 11.5 > 9.5, P < 0.0001). However, overall subjective image quality on S3 was better than the other strengths for both readers (S0 < S1 < S2 < S3 > S4 > S5, P < 0.0001).

CONCLUSION

Although measured noise declined as SAFIRE strength increased, S3 seems optimal for the best subjective image quality on LDCT 30mAs. The diagnostic performance of LDCT 30mAs with any strength is comparable to that of LDCT 100mAs for the diagnosis of acute appendicitis.

Quantum noise properties of CT images with anatomical textured backgrounds across reconstruction algorithms: FBP and SAFIRE

PURPOSE

Quantum noise properties of CT images are generally assessed using simple geometric phantoms with uniform backgrounds. Such phantoms may be inadequate when assessing nonlinear reconstruction or postprocessing algorithms. The purpose of this study was to design anatomically informed textured phantoms and use the phantoms to assess quantum noise properties across two clinically available reconstruction algorithms, filtered back projection (FBP) and sinogram affirmed iterative reconstruction (SAFIRE).

METHODS

Two phantoms were designed to represent lung and soft-tissue textures. The lung phantom included intricate vessel-like structures along with embedded nodules (spherical, lobulated, and spiculated). The soft tissue phantom was designed based on a three-dimensional clustered lumpy background with included low-contrast lesions (spherical and anthropomorphic). The phantoms were built using rapid prototyping (3D printing) technology and, along with a uniform phantom of similar size, were imaged on a Siemens SOMATOM Definition Flash CT scanner and reconstructed with FBP and SAFIRE. Fifty repeated acquisitions were acquired for each background type and noise was assessed by estimating pixel-value statistics, such as standard deviation (i.e., noise magnitude), autocorrelation, and noise power spectrum. Noise stationarity was also assessed by examining the spatial distribution of noise magnitude. The noise properties were compared across background types and between the two reconstruction algorithms.

RESULTS

In FBP and SAFIRE images, noise was globally nonstationary for all phantoms. In FBP images of all phantoms, and in SAFIRE images of the uniform phantom, noise appeared to be locally stationary (within a reasonably small region of interest). Noise was locally nonstationary in SAFIRE images of the textured phantoms with edge pixels showing higher noise magnitude compared to pixels in more homogenous regions. For pixels in uniform regions, noise magnitude was reduced by an average of 60% in SAFIRE images compared to FBP. However, for edge pixels, noise magnitude ranged from 20% higher to 40% lower in SAFIRE images compared to FBP. SAFIRE images of the lung phantom exhibited distinct regions with varying noise texture (i.e., noise autocorrelation/power spectra).

CONCLUSIONS

Quantum noise properties observed in uniform phantoms may not be representative of those in actual patients for nonlinear reconstruction algorithms. Anatomical texture should be considered when evaluating the performance of CT systems that use such nonlinear algorithms.

Sinogram Affirmed Iterative Reconstruction (SAFIRE) versus weighted filtered back projection (WFBP) effects on quantitative measure in the COPDGene 2 test object

PURPOSE

Assessing pulmonary emphysema using Quantitative CT of the lung depends on accurate measures of CT density. Sinogram-Affirmed-Iterative-Reconstruction (SAFIRE) is a new approach for reconstructing CT data acquired at significantly lower doses. However, quantitative effects of this method remain unexplored. The authors investigated the effects on the median values of materials in the COPDGene2 test-object as a function of the reconstruction method [weighted filtered back projection (WFBP) versus SAFIRE], test-object size, dose, and material composition using a Siemens SOMATOM Definition FLASH CT scanner.

METHODS

The COPDGene2 test-object contains eight materials; acrylic, water, four foams (20 lb, 12 lb, lung-equivalent, and 4 lb emphysema-equivalent), internal and external-air. The test-object was scanned with three different outer ring sizes, simulating three different body habitus. There is an average size (36 cm) Ring A, large size (40 cm) Ring B, and small size Ring C (30 cm). The CT protocol used 120 kVp, 0.5 s rotation, 1.0 pitch, and a 0.6 slice collimation with progressively decreasing x-ray exposure values, 11.94-0.74 mGy. With a thorax length of 30 cm, the corresponding effective doses would be 5.01-0.31 mSv. The effects of using SAFIRE versus WFBP were assessed using a two tailed t-test for each ring size, material, and dose. Multivariable linear regression was used to evaluate the relative effects of ring size, material composition, dose, and reconstruction method on the measured median value in HU.

RESULTS

SAFIRE versus WFBP, at the largest ring size and two lowest doses there was a significant difference in median values of 4 lb-foam, p<0.01. Using the smallest ring size at the lowest dose level there was a significant difference in the median value of 4 lb-foam, but the effect size was small, 1 HU. There is a significant difference in median values of both internal and external air using both the small and medium size rings at the three lowest dose levels, p<0.05. There are significant differences noted at both high and low dose levels when using the large ring size in the median values of internal and external air when, p<0.05. These effects on 4 lb-foam, inside and outside air are shown to be in part due to truncation effects on the median value since the lowest HU value in the CT scale used is -1024 HU. Multivariable linear regression results demonstrated significant effects on the measured material median value and standard deviation due to ring size, material composition, dose level, and reconstruction method, p<0.05.

CONCLUSIONS

The authors have shown that there is no significant effect on the median values obtained when using WFBP versus SAFIRE in materials with CT density between 120 and -856 HU using three different test-object sizes and CT doses that vary from 11.94 to 0.74 mGy. The authors have demonstrated there are significant effects on median values obtained when using WFBP versus SAFIRE in materials with CT density values between -937 and -1000 HU depending on the ring size and dose used. As expected, there is considerable reduction in image noise (lower standard deviation) using SAFIRE versus WFBP with all ring sizes, doses, and materials in the COPDGene2 test-object.

Observer Performance in the Detection and Classification of Malignant Hepatic Nodules and Masses with CT Image-Space Denoising and Iterative Reconstruction

PURPOSE

To determine if lower-dose computed tomographic (CT) scans obtained with adaptive image-based noise reduction (adaptive nonlocal means [ANLM]) or iterative reconstruction (sinogram-affirmed iterative reconstruction [SAFIRE]) result in reduced observer performance in the detection of malignant hepatic nodules and masses compared with routine-dose scans obtained with filtered back projection (FBP).

MATERIALS AND METHODS

This study was approved by the institutional review board and was compliant with HIPAA. Informed consent was obtained from patients for the retrospective use of medical records for research purposes. CT projection data from 33 abdominal and 27 liver or pancreas CT examinations were collected (median volume CT dose index, 13.8 and 24.0 mGy, respectively). Hepatic malignancy was defined by progression or regression or with histopathologic findings. Lower-dose data were created by using a validated noise insertion method (10.4 mGy for abdominal CT and 14.6 mGy for liver or pancreas CT) and images reconstructed with FBP, ANLM, and SAFIRE. Four readers evaluated routine-dose FBP images and all lower-dose images, circumscribing liver lesions and selecting diagnosis. The jackknife free-response receiver operating characteristic figure of merit (FOM) was calculated on a per-malignant nodule or per-mass basis. Noninferiority was defined by the lower limit of the 95% confidence interval (CI) of the difference between lower-dose and routine-dose FOMs being less than -0.10.

RESULTS

Twenty-nine patients had 62 malignant hepatic nodules and masses. Estimated FOM differences between lower-dose FBP and lower-dose ANLM versus routine-dose FBP were noninferior (difference: -0.041 [95% CI: -0.090, 0.009] and -0.003 [95% CI: -0.052, 0.047], respectively). In patients with dedicated liver scans, lower-dose ANLM images were noninferior (difference: +0.015 [95% CI: -0.077, 0.106]), whereas lower-dose FBP images were not (difference -0.049 [95% CI: -0.140, 0.043]). In 37 patients with SAFIRE reconstructions, the three lower-dose alternatives were found to be noninferior to the routine-dose FBP.

CONCLUSION

At moderate levels of dose reduction, lower-dose FBP images without ANLM or SAFIRE were noninferior to routine-dose images for abdominal CT but not for liver or pancreas CT.

Dose and image quality of cone-beam computed tomography as compared with conventional multislice computed tomography in abdominal imaging

OBJECTIVES

Recent technical developments have facilitated the application of cone-beam computed tomography (CBCT) for interventional and intraoperative imaging. The aim of this study was to compare the radiation doses and image quality in CBCT with those of conventional multislice spiral computed tomography (MSCT) for abdominal and genitourinary imaging.

METHODS

Different CBCT and MSCT protocols for imaging soft tissues and hard-contrast objects at different dose levels were investigated in this study. Local skin and organ doses were measured with thermoluminescent dosimeters placed in an anthropomorphic phantom. Moreover, the contrast-to-noise ratio, the noise-power spectrum, and the high-contrast resolution derived from the modulation transfer function were determined in a phantom with the same absorption properties as those of anthropomorphic phantom.

RESULTS

The effective dose of the examined abdominal/genitourinary CBCT protocols ranged between 0.35 mSv and 18.1 mSv. As compared with MSCT, the local skin dose of CBCT examinations could locally reach much higher doses up to 190 mGy. The effective dose necessary to realize the same contrast-to-noise ratio with CBCT and MSCT depended on the MSCT convolution kernel: the MSCT dose was smaller than the corresponding CBCT dose for a soft kernel but higher than that for a hard kernel. The noise-power spectrum of the CBCT images at tube voltages of 85/90 kV(p) is at least half of that of images measured at 103/115 kV(p) at any arbitrarily chosen spatial frequency. Although the pixel size and slice thickness of CBCT were half of those of the MSCT images, high-contrast resolution was inferior to the MSCT images reconstructed with a hard convolution kernel.

CONCLUSIONS

As compared with MSCT using a medium-hard convolution kernel, CBCT produces images at medium noise levels and, simultaneously, medium spatial resolution at approximately the same dose. It is well suited for visualizing hard-contrast objects in the abdomen with relatively low image noise and patient dose. For the detection of low-contrast objects at standard tube voltages of approximately 120 kV(p), however, MSCT should be preferred.

Combined Use of Automatic Tube Voltage Selection and Current Modulation with Iterative Reconstruction for CT Evaluation of Small Hypervascular Hepatocellular Carcinomas: Effect on Lesion Conspicuity and Image Quality

Objective

To assess the lesion conspicuity and image quality in CT evaluation of small (≤ 3 cm) hepatocellular carcinomas (HCCs) using automatic tube voltage selection (ATVS) and automatic tube current modulation (ATCM) with or without iterative reconstruction.

Materials and Methods

One hundred and five patients with 123 HCC lesions were included. Fifty-seven patients were scanned using both ATVS and ATCM and images were reconstructed using either filtered back-projection (FBP) (group A1) or sinogram-affirmed iterative reconstruction (SAFIRE) (group A2). Forty-eight patients were imaged using only ATCM, with a fixed tube potential of 120 kVp and FBP reconstruction (group B). Quantitative parameters (image noise in Hounsfield unit and contrast-to-noise ratio of the aorta, the liver, and the hepatic tumors) and qualitative visual parameters (image noise, overall image quality, and lesion conspicuity as graded on a 5-point scale) were compared among the groups.

Results

Group A2 scanned with the automatically chosen 80 kVp and 100 kVp tube voltages ranked the best in lesion conspicuity and subjective and objective image quality (p values ranging from < 0.001 to 0.004) among the three groups, except for overall image quality between group A2 and group B (p = 0.022). Group A1 showed higher image noise (p = 0.005) but similar lesion conspicuity and overall image quality as compared with group B. The radiation dose in group A was 19% lower than that in group B (p = 0.022).

Conclusion

CT scanning with combined use of ATVS and ATCM and image reconstruction with SAFIRE algorithm provides higher lesion conspicuity and better image quality for evaluating small hepatic HCCs with radiation dose reduction.

Degradation of CT Low-Contrast Spatial Resolution Due to the Use of Iterative Reconstruction and Reduced Dose Levels

PURPOSE

To determine the dose reduction that could be achieved without degrading low-contrast spatial resolution (LCR) performance for two commercial iterative reconstruction (IR) techniques, each evaluated at two strengths with many repeated scans.

MATERIALS AND METHODS

Two scanner models were used to image the American College of Radiology (ACR) CT accreditation phantom LCR section at volume CT dose indexes of 8, 12, and 16 mGy. Images were reconstructed by using filtered back projection (FBP) and two manufacturers' IR techniques, each at two strengths (moderate and strong). Data acquisition and reconstruction were repeated 100 times for each, yielding 1800 images. Three diagnostic medical physicists reviewed the LCR images in a blinded fashion and graded the visibility of four 6-mm rods with a six-point scale. Noninferiority and inferiority-superiority analyses were used to interpret the differences in LCR relative to FBP images acquired at 16 mGy.

RESULTS

LCR decreased with decreasing dose for all reconstructions. Relative to FBP and full dose, 25%-50% dose reductions resulted in inferior LCR for vendors 1 and 2 for FBP and 25% dose reductions resulted in inferior and equivalent performance for vendor 1 and equivalent and superior performance for vendor 2 at moderate and strong IR settings, respectively. When dose was reduced by 50%, both IR techniques resulted in inferior LCR at both strength settings.

CONCLUSION

For radiation dose reductions of 25% or more, the ability to resolve the four 6-mm rods in the ACR CT accreditation phantom can be lost.

Dose reduction with iterative reconstruction: Optimization of CT protocols in clinical practice

OBJECTIVES

To create an adaptable and global approach for optimizing MDCT protocols by evaluating the influence of acquisition parameters and Iterative Reconstruction (IR) on dose reduction and image quality.

MATERIALS AND METHODS

MDCT acquisitions were performed on quality image phantom by varying kVp, mAs, and pitch for the same collimation. The raw data were reconstructed by FBP and Sinogram Affirmed Iterative Reconstruction (SAFIRE) with different reconstruction kernel and thickness. A total of 4032 combinations of parameters were obtained. Indices of quality image (image noise, NCT, CNR, SNR, NPS and MTF) were analyzed. We developed a software in order to facilitate the optimization between dose reduction and image quality. Its outcomes were verified on an adult anthropomorphic phantom.

RESULTS

Dose reduction resulted in the increase of image noise and the decrease of SNR and CNR. The use of IR improved these indices for the same dose without affecting NCT and MTF. The image validation was performed by the anthropomorphic phantom. The software proposed combinations of parameters to reduce doses while keeping indices of the image quality adequate. We observed a CTDIvol reduction between -44% and -83% as compared to the French diagnostic reference levels (DRL) for different anatomical localization.

CONCLUSION

The software developed in this study may help radiologists in selecting adequate combinations of parameters that allows to obtain an appropriate image with dose reduction.