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Martini K, Moon JW, Revel MP, Dangeard S, Ruan C, Chassagnon G. Optimization of acquisition parameters for reduced-dose thoracic CT: A phantom study. Diagn Interv Imaging 2020; 101:269-279. [PMID: 32107196 DOI: 10.1016/j.diii.2020.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to analyze the impact of different options for reduced-dose computed tomography (CT) on image noise and visibility of pulmonary structures in order to define the best choice of parameters when performing ultra-low dose acquisitions of the chest in clinical routine. MATERIALS AND METHODS Using an anthropomorphic chest phantom, CT images were acquired at four defined low dose levels (computed tomography dose index [CTDIvol]=0.15, 0.20, 0.30 and 0.40mGy), by changing tube voltage, pitch factor, or rotation time and adapting tube current to reach the predefined CTDIvol-values. Images were reconstructed using two different levels of iteration (adaptive statistical iterative reconstruction [ASIR®]-v70% and ASIR®-v100%). Signal-to-noise ratio (SNR) as well as contrast-to-noise ratio (CNR) was calculated. Visibility of pulmonary structures (bronchi/vessels) were assessed by two readers on a 5-point-Likert scale. RESULTS Best visual image assessments and CNR/SNR were obtained with high tube voltage, while lowest scores were reached with lower pitch factor followed by high tube current. Protocols favoring lower pitch factor resulted in decreased visibility of bronchi/vessels, especially in the periphery. Decreasing radiation dose from 0.40 to 0.30mGy was not associated with a significant decrease in visual scores (P<0.05), however decreasing radiation dose from 0.30mGy to 0.15mGy was associated with a lower visibility of most of the evaluated structures (P<0.001). While image noise could be significantly reduced when ASIR®-v100% instead of ASIR®-v70% was used, the visibility-scores of pulmonary structures did not change significantly. CONCLUSION Favoring high tube voltage is the best option for reduced-dose protocols. A decrease of SNR and CNR does not necessarily go along with reduced visibility of pulmonary structures.
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Affiliation(s)
- K Martini
- Department of Radiology, Cochin Hospital, AP-HP Centre, 75014 Paris, France; Diagnostic and Interventional Radiology, University Hospital Zurich, 8008 Zurich, Switzerland
| | - J W Moon
- Department of Radiology, Cochin Hospital, AP-HP Centre, 75014 Paris, France
| | - M P Revel
- Department of Radiology, Cochin Hospital, AP-HP Centre, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - S Dangeard
- Department of Radiology, Cochin Hospital, AP-HP Centre, 75014 Paris, France
| | - C Ruan
- General Electric Healthcare, 78530 Buc, France
| | - G Chassagnon
- Department of Radiology, Cochin Hospital, AP-HP Centre, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France; Center for Visual Computing, École Centrale Supelec, 91190 Gif-sur-Yvette, France.
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Martini K, Barth BK, Higashigaito K, Baumueller S, Alkadhi H, Frauenfelder T. Dose-Optimized Computed Tomography for Screening and Follow-Up of Solid Pulmonary Nodules in Obesity: A Phantom Study. Curr Probl Diagn Radiol 2017; 46:204-209. [DOI: 10.1067/j.cpradiol.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/13/2016] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
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Chen EL, Ross JA, Grant C, Wilbur A, Mehta N, Hart E, Mar WA. Improved Image Quality of Low-Dose CT Pulmonary Angiograms. J Am Coll Radiol 2017; 14:648-653. [PMID: 28082157 DOI: 10.1016/j.jacr.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The use of CT pulmonary angiography (CTPA) to evaluate for pulmonary embolism has been increasing, and carries a significant radiation dose. We evaluate image quality of lower-dose images, taking into account patient size as well as the effects of image postprocessing. METHODS A total of 250 CTPAs were retrospectively reviewed. The following parameters were obtained: kVp, mA, dose length product, Hounsfield units (HU) with standard deviation in the main pulmonary artery, transverse scout measurement, and subjective image quality. RESULTS Radiation dose decreased 55% by reducing kVp from 120 to 100, and 60% from 100 to 80 kVp. Radiation dose decreased 82% from 120 to 80 kVp. Noise increased 38% from 120 kVp to 100 kVp, and increased 23% from 100 kVp to 80 kVp. Adding an overlapped reconstructed image decreased noise by 16% to 21%. Despite the increase in image noise, diagnostic quality was significantly improved at 80 and 100 kVp, compared with 120 kVp, with an average subjective quality rating of 3.8, 4.0, and 3.2, respectively, and an average pulmonary artery density of 536, 423, and 278 HU. Even in larger patients, qualitative image quality was better at 100 kVp compared with 120 kVp, with an average quality rating of 3.6 versus 2.9, respectively. CONCLUSIONS Radiation dose exposure can be easily reduced on CTPA by lowering kVp, which at the same time improves image quality. Studies using a lower kVp were of significantly higher diagnostic quality. This held true even in larger patients.
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Affiliation(s)
- Eric L Chen
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jeremy A Ross
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Andrew Wilbur
- University of Illinois at Chicago, Chicago, Illinois
| | | | - Eric Hart
- Northwestern Memorial Hospital, Chicago, Illinois
| | - Winnie A Mar
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois.
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Li X, Chen GZ, Zhao YE, Schoepf UJ, Albrecht MH, Bickford MW, Gu HF, Zhang LJ, Lu GM. Radiation Optimized Dual-source Dual-energy Computed Tomography Pulmonary Angiography: Intra-individual and Inter-individual Comparison. Acad Radiol 2017; 24:13-21. [PMID: 27789203 DOI: 10.1016/j.acra.2016.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/11/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to intra-individually and inter-individually compare image quality, radiation dose, and diagnostic accuracy of dual-source dual-energy computed tomography pulmonary angiography (CTPA) protocols in patients with suspected pulmonary embolism (PE). METHODS Thirty-three patients with suspected PE underwent initial and follow-up dual-energy CTPA at 80/Sn140 kVp (group A) or 100/Sn140 kVp (group B), which were assigned based on tube voltages. Subjective and objective CTPA image quality and lung perfusion map image quality were evaluated. Diagnostic accuracies of CTPA and perfusion maps were assessed by two radiologists independently. Effective dose (ED) was calculated and compared. RESULTS Mean computed tomography (CT) values of pulmonary arteries were higher in group A than group B (P = .006). There was no difference in signal-to-noise ratio and contrast-to-noise ratio between the two groups (both P > .05). Interobserver agreement for evaluating subjective image quality of CTPA and color-coded perfusion images was either good (κ = 0.784) or excellent (κ = 0.887). Perfusion defect scores and diagnostic accuracy of CTPA showed no difference between both groups (both P > .05). Effective dose of group A was reduced by 45.8% compared to group B (P < .001). CONCLUSIONS Second-generation dual-source dual-energy CTPA with 80/Sn140 kVp allows for sufficient image quality and diagnostic accuracy for detecting PE while substantially reducing radiation dose.
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Affiliation(s)
- Xie Li
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Guo Zhong Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Yan E Zhao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - U Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Matthew W Bickford
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Hai Feng Gu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China.
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Omotayo A, Elbakri I. Objective performance assessment of five computed tomography iterative reconstruction algorithms. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:913-930. [PMID: 27612054 DOI: 10.3233/xst-160601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Iterative algorithms are gaining clinical acceptance in CT. We performed objective phantom-based image quality evaluation of five commercial iterative reconstruction algorithms available on four different multi-detector CT (MDCT) scanners at different dose levels as well as the conventional filtered back-projection (FBP) reconstruction. METHODS Using the Catphan500 phantom, we evaluated image noise, contrast-to-noise ratio (CNR), modulation transfer function (MTF) and noise-power spectrum (NPS). The algorithms were evaluated over a CTDIvol range of 0.75-18.7 mGy on four major MDCT scanners: GE DiscoveryCT750HD (algorithms: ASIR™ and VEO™); Siemens Somatom Definition AS+ (algorithm: SAFIRE™); Toshiba Aquilion64 (algorithm: AIDR3D™); and Philips Ingenuity iCT256 (algorithm: iDose4™). Images were reconstructed using FBP and the respective iterative algorithms on the four scanners. RESULTS Use of iterative algorithms decreased image noise and increased CNR, relative to FBP. In the dose range of 1.3-1.5 mGy, noise reduction using iterative algorithms was in the range of 11%-51% on GE DiscoveryCT750HD, 10%-52% on Siemens Somatom Definition AS+, 49%-62% on Toshiba Aquilion64, and 13%-44% on Philips Ingenuity iCT256. The corresponding CNR increase was in the range 11%-105% on GE, 11%-106% on Siemens, 85%-145% on Toshiba and 13%-77% on Philips respectively. Most algorithms did not affect the MTF, except for VEO™ which produced an increase in the limiting resolution of up to 30%. A shift in the peak of the NPS curve towards lower frequencies and a decrease in NPS amplitude were obtained with all iterative algorithms. VEO™ required long reconstruction times, while all other algorithms produced reconstructions in real time. Compared to FBP, iterative algorithms reduced image noise and increased CNR. CONCLUSIONS The iterative algorithms available on different scanners achieved different levels of noise reduction and CNR increase while spatial resolution improvements were obtained only with VEO™. This study is useful in that it provides performance assessment of the iterative algorithms available from several mainstream CT manufacturers.
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Affiliation(s)
- Azeez Omotayo
- Division of Medical Physics, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Idris Elbakri
- Division of Medical Physics, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, MB, Canada
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Submillisievert Computed Tomography of the Chest Using Model-Based Iterative Algorithm: Optimization of Tube Voltage With Regard to Patient Size. J Comput Assist Tomogr 2016; 41:254-262. [PMID: 27636247 DOI: 10.1097/rct.0000000000000505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to define optimal tube potential for soft tissue and vessel visualization in dose-reduced chest CT protocols using model-based iterative algorithm in average and overweight patients. METHODS Thirty-six patients receiving chest CT according to 3 protocols (120 kVp/noise index [NI], 60; 100 kVp/NI, 65; 80 kVp/NI, 70) were included in this prospective study, approved by the ethics committee. Patients' physical parameters and dose descriptors were recorded. Images were reconstructed with model-based algorithm. Two radiologists evaluated image quality and lesion conspicuity; the protocols were intraindividually compared with preceding control CT reconstructed with statistical algorithm (120 kVp/NI, 20). Mean and standard deviation of attenuation of the muscle and fat tissues and signal-to-noise ratio of the aorta were measured. RESULTS Diagnostic images (lesion conspicuity, 95%-100%) were acquired in average and overweight patients at 1.34, 1.02, and 1.08 mGy and at 3.41, 3.20, and 2.88 mGy at 120, 100, and 80 kVp, respectively. Data are given as CT dose index volume values. CONCLUSIONS Model-based algorithm allows for submillisievert chest CT in average patients; the use of 100 kVp is recommended.
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A Practice Quality Improvement Project: Reducing Dose of Routine Chest CT Imaging in a Busy Clinical Practice. J Digit Imaging 2016; 29:622-6. [PMID: 26992381 DOI: 10.1007/s10278-016-9877-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The purpose of this report is to describe our experience with the implementation of a practice quality improvement (PQI) project in thoracic imaging as part of the American Board of Radiology Maintenance of Certification process. The goal of this PQI project was to reduce the effective radiation dose of routine chest CT imaging in a busy clinical practice by employing the iDose(4) (Philips Healthcare) iterative reconstruction technique. The dose reduction strategy was implemented in a stepwise process on a single 64-slice CT scanner with a volume of 1141 chest CT scans during the year. In the first annual quarter, a baseline effective dose was established using the standard filtered back projection (FBP) algorithm protocol and standard parameters such as kVp and mAs. The iDose(4) technique was then applied in the second and third annual quarters while keeping all other parameters unchanged. In the fourth quarter, a reduction in kVp was also implemented. Throughout the process, the images were continually evaluated to assure that the image quality was comparable to the standard protocol from multiple other scanners. Utilizing a stepwise approach, the effective radiation dose was reduced by 23.62 and 43.63 % in quarters two and four, respectively, compared to our initial standard protocol with no perceived difference in diagnostic quality. This practice quality improvement project demonstrated a significant reduction in the effective radiation dose of thoracic CT scans in a busy clinical practice.
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Evaluation of pulmonary nodules and infection on chest CT with radiation dose equivalent to chest radiography: Prospective intra-individual comparison study to standard dose CT. Eur J Radiol 2015; 85:360-5. [PMID: 26781141 DOI: 10.1016/j.ejrad.2015.11.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare prospectively, in patients undergoing chest computed tomography (CT) for pulmonary-nodules or infection, image-quality and accuracy of standard dose (SD) and reduced dose (RD) CT with tin-filtration. MATERIAL AND METHODS This IRB-approved study included 100 consecutive patients (36 female;median age 56 years) referred for follow-up of pulmonary-nodules (n=43) or suspicion of infection (n=57) undergoing single-energy CT with SD and RD using tin-filtration at 100 kVp (CTDIvol 2.47 mGy and 0.07 mGy, respectively). Images were reconstructed with advanced modeled iterative reconstruction (ADMIRE) at strength 3 and 5. Image-noise was measured. Two independent readers evaluated nodules and pulmonary-infection. SD CT served as reference standard. RESULTS No significant difference was found in noise between RD with ADMIRE5 and SD with ADMIRE3 (118HU ± 14 vs. 120HU ± 17; p=0.08). Sensitivity for detection of atelectasis and interstitial lung changes was higher in images reconstructed with ADMIRE5 (93% and 88%; respectively) than in those reconstructed with ADIMRE3 (77% and 78%; respectively). Sensitivity for detection of consolidations was 90% for ADMIRE3 and 89% for ADMIRE5. Sensitivity for nodule detection was 71% for ADMIRE3 and 81% for ADMIRE5. Specificity for detection of atelectasis and interstitial lung changes was 99% and 96% with ADMIRE5 and 99% and 96% with ADMIRE3. Specificity for detection of consolidations was 99% for ADMIRE3 and 5. Specificity for detection of nodules was 87% for both ADMIRE3 and 5. CONCLUSION Chest CT with a radiation dose equivalent to conventional radiography is feasible and allows for detection of pulmonary infection with high sensitivity, whereas the accuracy for detecting nodules is only moderate.
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70-kVp High-pitch Computed Tomography Pulmonary Angiography with 40 mL Contrast Agent: Initial Experience. Acad Radiol 2015; 22:1562-70. [PMID: 26432073 DOI: 10.1016/j.acra.2015.08.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/25/2015] [Accepted: 08/23/2015] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To assess image quality, radiation dose, and diagnostic accuracy of 70-kVp high-pitch computed tomography pulmonary angiography (CTPA) using 40 mL contrast agent and sinogram affirmed iterative reconstruction (SAFIRE) compared to 100-kVp CTPA using 60 mL contrast agent and filtered back projection. MATERIALS AND METHODS Eighty patients underwent CTPA at either 70 kVp (group A, n = 40; 3.2 pitch, 40 mL contrast medium, and SAFIRE) or 100 kVp (group B, n = 40; 1.2 pitch, 60 mL contrast medium, and filtered back projection). Signal-to-noise ratio and contrast-to-noise ratio were calculated. Subjective image quality was evaluated using a five-grade scale, and diagnostic accuracy was assessed. Radiation doses were compared. RESULTS Computed tomography values, signal-to-noise ratio, and contrast-to-noise ratio of pulmonary arteries were higher in group A compared to group B (all P < 0.001). Subjective image quality showed no difference between the two groups (P = 0.559) with good interobserver agreement (κ = 0.647). No difference was found regarding diagnostic accuracy between the two groups (P > 0.05). The effective dose for group A was lower by 80% compared to group B (P < 0.001). CONCLUSIONS 70-kVp high-pitch CTPA with reduced contrast media and SAFIRE provides comparable image quality and substantial radiation dose savings compared to a routine CTPA protocol.
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Guariglia S, Meliadò G, Zivelonghi E, Pinali L, Montemezzi S, Cavedon C. Dose reduction and image quality in CT examinations using an iterative reconstruction algorithm: a phantom study. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/4/045203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Tang CX, Schoepf UJ, Chowdhury SM, Fox MA, Zhang LJ, Lu GM. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism. Pediatr Radiol 2015; 45:1431-9. [PMID: 25846076 PMCID: PMC4553120 DOI: 10.1007/s00247-015-3336-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 02/03/2015] [Accepted: 03/02/2015] [Indexed: 12/29/2022]
Abstract
Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations.
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Affiliation(s)
- Chun Xiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - U. Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | | | - Mary A. Fox
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
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den Harder AM, Willemink MJ, de Ruiter QMB, Schilham AMR, Krestin GP, Leiner T, de Jong PA, Budde RPJ. Achievable dose reduction using iterative reconstruction for chest computed tomography: A systematic review. Eur J Radiol 2015. [PMID: 26212557 DOI: 10.1016/j.ejrad.2015.07.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Iterative reconstruction (IR) allows for dose reduction with maintained image quality in CT imaging. In this systematic review the reported effective dose reductions for chest CT and the effects on image quality are investigated. METHODS A systematic search in PubMed and EMBASE was performed. Primary outcome was the reported local reference and reduced effective dose and secondary outcome was the image quality with IR. Both non contrast-enhanced and enhanced studies comparing reference dose with reduced dose were included. RESULTS 24 studies were included. The median number of patients per study was 66 (range 23-200) with in total 1806 patients. The median reported local reference dose of contrast-enhanced chest CT with FBP was 2.6 (range 1.5-21.8) mSv. This decreased to 1.4 (range 0.4-7.3) mSv at reduced dose levels using IR. With non contrast-enhanced chest CT the dose decreased from 3.4 (range 0.7-7.8) mSv to 0.9 (range 0.1-4.5) mSv. Objective mage quality and diagnostic confidence and acceptability remained the same or improved with IR compared to FBP in most studies while data on diagnostic accuracy was limited. CONCLUSION Radiation dose can be reduced to less than 2 mSv for contrast-enhanced chest CT and non contrast-enhanced chest CT is possible at a submillisievert dose using IR algorithms.
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Affiliation(s)
- Annemarie M den Harder
- Department of Radiology, University Medical Center, PO Box 85500, 3508GA Utrecht, The Netherlands.
| | - Martin J Willemink
- Department of Radiology, University Medical Center, PO Box 85500, 3508GA Utrecht, The Netherlands
| | - Quirina M B de Ruiter
- Department of Vascular Surgery, University Medical Center, PO Box 85500, 3508GA Utrecht, The Netherlands
| | - Arnold M R Schilham
- Department of Radiology, University Medical Center, PO Box 85500, 3508GA Utrecht, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center, PO Box 85500, 3508GA Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center, PO Box 85500, 3508GA Utrecht, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The Netherlands
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CT pulmonary angiogram with 60% dose reduction: Influence of iterative reconstructions on image quality. Diagn Interv Imaging 2015; 96:487-93. [DOI: 10.1016/j.diii.2014.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/18/2022]
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Burckel LA, Defez D, Chaillot P, Douek P, Boussel L. Use of an automatic recording system for CT doses: Evaluation of the impact of iterative reconstruction on radiation exposure in clinical practice. Diagn Interv Imaging 2015; 96:265-72. [DOI: 10.1016/j.diii.2014.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Clarke R, Lewis EF. Feasibility of Using Iterative Reconstruction to Reduce Radiation Dose for Computed Tomography Pulmonary Angiograms. J Med Imaging Radiat Sci 2015; 46:50-56. [DOI: 10.1016/j.jmir.2014.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
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Pontana F, Henry S, Duhamel A, Faivre JB, Tacelli N, Pagniez J, Remy J, Remy-Jardin M. Impact of iterative reconstruction on the diagnosis of acute pulmonary embolism (PE) on reduced-dose chest CT angiograms. Eur Radiol 2015; 25:1182-9. [PMID: 25636413 DOI: 10.1007/s00330-014-3393-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/21/2014] [Accepted: 08/08/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the impact of iterative reconstruction on the detectability of clots. METHODS AND MATERIALS Fifty-three patients were enrolled in a study comparing reduced-dose and full-dose images, available from the same dual-source data set. From each acquisition, three series of images were generated: (1) full-dose images (from both tubes), reconstructed with filtered back projection (FBP) (group 1; standard of reference), (2) reduced-dose images (from tube A only; 60 % dose reduction) reconstructed with FBP (group 2) and iterative reconstruction (SAFIRE) (group 3). RESULTS In group 1 (mean DLP: 264.6 mGy.cm), (1) PE was diagnosed in 8 patients (15 %) with 82 clots in the central (n = 5), segmental (n = 39) and subsegmental (n = 38) arteries and (2) mean level of noise was 30.56 ± 5.07. In group 2 (mean DLP: 105.8 mGy.cm), a significant increase in noise (44.56 ± 6.24; p < 0.0001) (1) hampered detection of PE in one patient and (2) altered detection of peripheral clots (12 false-negative and 2 false-positive results). In group 3, image noise was not significantly different from that in group 1 (p = 0.1525; effect size: 0.2683), with a similar detection of PE compared to group 1 (p = 1). CONCLUSION Reconstruction of reduced-dose images (60 % dose reduction) with SAFIRE provided image quality and diagnostic value comparable to those of full-dose FBP images. KEY POINTS • Iterative reconstruction does not alter the detection of endoluminal clots. • Iterative reconstruction allows dose reduction in the context of acute PE. • Iterative reconstruction allows radiologists to approach the prospects of submilliSievert CT.
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Affiliation(s)
- François Pontana
- Department of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Université de Lille 2 Nord de France, 59000, Lille, France
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Montet X, Hachulla AL, Neroladaki A, Lador F, Rochat T, Botsikas D, Becker CD. Image quality of low mA CT pulmonary angiography reconstructed with model based iterative reconstruction versus standard CT pulmonary angiography reconstructed with filtered back projection: an equivalency trial. Eur Radiol 2014; 25:1665-71. [DOI: 10.1007/s00330-014-3563-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/03/2014] [Accepted: 12/09/2014] [Indexed: 01/01/2023]
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Yamashiro T, Miyara T, Honda O, Kamiya H, Murata K, Ohno Y, Tomiyama N, Moriya H, Koyama M, Noma S, Kamiya A, Tanaka Y, Murayama S. Adaptive Iterative Dose Reduction Using Three Dimensional Processing (AIDR3D) improves chest CT image quality and reduces radiation exposure. PLoS One 2014; 9:e105735. [PMID: 25153797 PMCID: PMC4143266 DOI: 10.1371/journal.pone.0105735] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the advantages of Adaptive Iterative Dose Reduction using Three Dimensional Processing (AIDR3D) for image quality improvement and dose reduction for chest computed tomography (CT). Methods Institutional Review Boards approved this study and informed consent was obtained. Eighty-eight subjects underwent chest CT at five institutions using identical scanners and protocols. During a single visit, each subject was scanned using different tube currents: 240, 120, and 60 mA. Scan data were converted to images using AIDR3D and a conventional reconstruction mode (without AIDR3D). Using a 5-point scale from 1 (non-diagnostic) to 5 (excellent), three blinded observers independently evaluated image quality for three lung zones, four patterns of lung disease (nodule/mass, emphysema, bronchiolitis, and diffuse lung disease), and three mediastinal measurements (small structure visibility, streak artifacts, and shoulder artifacts). Differences in these scores were assessed by Scheffe's test. Results At each tube current, scans using AIDR3D had higher scores than those without AIDR3D, which were significant for lung zones (p<0.0001) and all mediastinal measurements (p<0.01). For lung diseases, significant improvements with AIDR3D were frequently observed at 120 and 60 mA. Scans with AIDR3D at 120 mA had significantly higher scores than those without AIDR3D at 240 mA for lung zones and mediastinal streak artifacts (p<0.0001), and slightly higher or equal scores for all other measurements. Scans with AIDR3D at 60 mA were also judged superior or equivalent to those without AIDR3D at 120 mA. Conclusion For chest CT, AIDR3D provides better image quality and can reduce radiation exposure by 50%.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
- * E-mail:
| | - Tetsuhiro Miyara
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Osamu Honda
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hisashi Kamiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima-shi, Fukushima, Japan
| | - Mitsuhiro Koyama
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Satoshi Noma
- Department of Radiology, Tenri Hospital, Tenri, Nara, Japan
| | - Ayano Kamiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Yuko Tanaka
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
- Center for Clinical Training, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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Lu GM, Luo S, Meinel FG, McQuiston AD, Zhou CS, Kong X, Zhao YE, Zheng L, Schoepf UJ, Zhang LJ. High-pitch computed tomography pulmonary angiography with iterative reconstruction at 80 kVp and 20 mL contrast agent volume. Eur Radiol 2014; 24:3260-8. [PMID: 25100336 DOI: 10.1007/s00330-014-3365-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/12/2014] [Accepted: 07/21/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the image quality, radiation dose and diagnostic accuracy of 80kVp, high-pitch CT pulmonary angiography (CTPA) with iterative reconstruction using 20 ml of contrast agent. METHODS One hundred patients with suspected pulmonary embolism (PE) were randomly divided into two groups (n = 50 each; group A, 100 kVp, 1.2 pitch, 60 ml of contrast medium and filtered back projection algorithm; group B, 80 kVp, 2.2 pitch, 20 ml of contrast medium and sinogram affirmed iterative reconstruction). Image quality, diagnostic accuracy and radiation dose were evaluated and compared. RESULTS Mean CT numbers of pulmonary arteries in group B were higher than those in group A (all P < 0.001). Contrast-to-noise ratio and signal-to-noise ratio of group B were higher than those of group A (both P < 0.001). There was no significant difference in subjective image quality scores between two groups (P = 0.807). The interobserver agreement was excellent (k = 0.836). There was no significant difference in diagnostic accuracy between the two groups (P > 0.05). Compared with group A, radiation dose of group B was reduced by 50.3% (P < 0.001). CONCLUSIONS High-pitch CTPA at 80 kVp can obtain sufficient image quality in normal-weight individuals with 20 ml of contrast agent and half the radiation dose of a conventional CTPA protocol. KEY POINTS CTPA is feasible at 80 kVp using only 20 ml of contrast agent. High-pitch CTPA at 80 kVp has an effective dose under 1 mSv. This CTPA protocol can obtain sufficient image quality in normal-weight individuals.
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Affiliation(s)
- Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China,
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Duong PA, Little BP. Dose Tracking and Dose Auditing in a Comprehensive Computed Tomography Dose-Reduction Program. Semin Ultrasound CT MR 2014; 35:322-30. [DOI: 10.1053/j.sult.2014.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ultra low-dose chest CT using filtered back projection: comparison of 80-, 100- and 120 kVp protocols in a prospective randomized study. Eur J Radiol 2014; 83:1934-44. [PMID: 25063211 DOI: 10.1016/j.ejrad.2014.06.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/10/2014] [Accepted: 06/23/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess lesion detection and diagnostic image quality of filtered back projection (FBP) reconstruction technique in ultra low-dose chest CT examinations. METHODS AND MATERIALS In this IRB-approved ongoing prospective clinical study, 116 CT-image-series at four different radiation-doses were performed for 29 patients (age, 57-87 years; F:M - 15:12; BMI 16-32 kg/m(2)). All patients provided written-informed-consent for the acquisitions of additional ultra low-dose (ULD) series on a 256-slice MDCT (iCT, Philips Healthcare). In-addition to their clinical standard-dose chest CT (SD, 120 kV mean CTDIvol, 6 ± 1 mGy), ULD-CT was subsequently performed at three-dose-levels (0.9 mGy [120 kV]; 0.5 mGy [100 kV] and 0.2 mGy [80 kV]). Images were reconstructed with FBP (2.5mm 1.25 mm) resulting into four-stacks: SD-FBP (reference-standard), FBP0.9, FBP0.5, and FBP0.2. Four thoracic-radiologists from two-teaching-hospitals independently-evaluated data for lesion-detection and visibility-of-small-structures. Friedman's-non-parametric-test with post hoc Dunn's-test was used for data-analysis. RESULTS Interobserver-agreement was substantial between radiologists (k=0.6-0.8). With pooled analysis, 146-pulmonary (27-groundglass-opacities, 64-solid-lung-nodules, 7-consolidations, 27-emphysema) and 347-mediastinal/soft tissue lesions (87-mediastinal, 46-hilar, 62-axillary-lymph-nodes, and 11-mediastinal-masses) were evaluated. Compared to the SD-FBP, 100% pulmonary-lesions were seen with FBP0.9, up to 81% with FBP0.5 (missed: 4), and up to 30% with FBP0.2 images (missed:16). Compared to SD-FBP, all enlarged mediastinal-lymph-nodes were seen with FBP0.9 images. All mediastinal-masses (>2 cm, 11/11) were seen equivalent to SD-FBP images at 0.9 mGy. Across all sizes of patients, FBP0.9 images had optimal visualization for lung findings. They were optimal for mediastinal soft tissues for only non-obese patients. CONCLUSION Filtered-back-projection technique allows optimal lesion detection and acceptable image quality for chest-CT examinations at CDTIvol of 0.9 mGy for lung and mediastinal findings in selected sizes of patients.
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What is the minimal radiation dose that can be used for detecting pleural effusion? AJR Am J Roentgenol 2014; 203:118-22. [PMID: 24951204 DOI: 10.2214/ajr.13.11842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to assess the effect of radiation dose reduction on the detection of pleural effusions, thickening, and calcifications. MATERIALS AND METHODS Forty-five human cadavers (mean age at death, 60 ± 17 [SD] years; male-female ratio, 29:16; mean body mass index, 29 ± 5.7 [SD] kg/m(2)) were scanned at seven different dose levels (CT Dose Index volume [CTDIvol] = 20, 12, 10, 6, 4, 2, and 0.8 mGy) on a 128-MDCT unit (Definition FLASH). Images were reconstructed at a 3-mm slice thickness and 2-mm increment with filtered back projection (FBP) technique. Two chest radiologists independently reviewed all image series for the detection of pleural effusion, pleural calcification, and adjacent parenchymal opacification from atelectasis or consolidation. Objective image noise was measured at each dose level on the pleural effusion using ImageJ software. Data analysis was performed with the Student t test and kappa test. RESULTS Pleural effusions were seen in 39 of 45 cadavers on image series acquired at 2-20 mGy. Only 14 of 39 pleural effusions were identified at 0.8 mGy. Pleural effusions were not detected in 25 of 39 cadavers at 0.8 mGy because of photon starvation and increased image noise. Patient size was significantly larger in subjects with undetected pleural effusion than in those with detectable pleural effusion at 0.8 mGy (p < 0.01). Pleural calcifications and thickening (seen at 2-10 mGy images in three of three cadavers) were not identified on 0.8-mGy FBP images. On the other hand, adjacent parenchymal opacification could be assessed at all dose levels. The mean CT numbers of the pleural effusion were significantly lower on 0.8-mGy images than on images obtained at all other dose levels (-21 ± 55 [SD] vs 17.6 ± 19 HU, respectively) (p < 0.001). CONCLUSION Pleural effusions, thickening, and calcifications can be seen on FBP images reconstructed at a CTDIvol as low as 2 mGy (32-cm body phantom). CT at 0.8 mGy may provide suboptimal information on very small pleural effusions, pleural thickening, and calcifications.
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Hashemi S, Mehrez H, Cobbold RSC, Paul NS. Optimal image reconstruction for detection and characterization of small pulmonary nodules during low-dose CT. Eur Radiol 2014; 24:1239-50. [PMID: 24658869 DOI: 10.1007/s00330-014-3142-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 02/18/2014] [Accepted: 03/04/2014] [Indexed: 12/21/2022]
Affiliation(s)
- SayedMasoud Hashemi
- Institute of Biomaterial and Biomedical Engineering, University of Toronto, Room RS-420A, 164 College Street, Toronto, ON, Canada, M5S 3G9
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Mortensen J, Gutte H. SPECT/CT and pulmonary embolism. Eur J Nucl Med Mol Imaging 2013; 41 Suppl 1:S81-90. [PMID: 24213621 PMCID: PMC4003400 DOI: 10.1007/s00259-013-2614-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 11/04/2022]
Abstract
Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE.
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Affiliation(s)
- Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, 2100, Copenhagen, Denmark,
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