OIF-Net: An Optical Flow Registration-Based PET/MR Cross-Modal Interactive Fusion Network for Low-Count Brain PET Image Denoising

The short frames of low-count positron emission tomography (PET) images generally cause high levels of statistical noise. Thus, improving the quality of low-count images by using image postprocessing algorithms to achieve better clinical diagnoses has attracted widespread attention in the medical imaging community. Most existing deep learning-based low-count PET image enhancement methods have achieved satisfying results, however, few of them focus on denoising low-count PET images with the magnetic resonance (MR) image modality as guidance. The prior context features contained in MR images can provide abundant and complementary information for single low-count PET image denoising, especially in ultralow-count (2.5%) cases. To this end, we propose a novel two-stream dual PET/MR cross-modal interactive fusion network with an optical flow pre-alignment module, namely, OIF-Net. Specifically, the learnable optical flow registration module enables the spatial manipulation of MR imaging inputs within the network without any extra training supervision. Registered MR images fundamentally solve the problem of feature misalignment in the multimodal fusion stage, which greatly benefits the subsequent denoising process. In addition, we design a spatial-channel feature enhancement module (SC-FEM) that considers the interactive impacts of multiple modalities and provides additional information flexibility in both the spatial and channel dimensions. Furthermore, instead of simply concatenating two extracted features from these two modalities as an intermediate fusion method, the proposed cross-modal feature fusion module (CM-FFM) adopts cross-attention at multiple feature levels and greatly improves the two modalities' feature fusion procedure. Extensive experimental assessments conducted on real clinical datasets, as well as an independent clinical testing dataset, demonstrate that the proposed OIF-Net outperforms the state-of-the-art methods.

Reduction of scan duration and radiation dose in cerebral CT perfusion imaging of acute stroke using a recurrent neural network

Objective. Cerebral CT perfusion (CTP) imaging is most commonly used to diagnose acute ischaemic stroke and support treatment decisions. Shortening CTP scan duration is desirable to reduce the accumulated radiation dose and the risk of patient head movement. In this study, we present a novel application of a stochastic adversarial video prediction approach to reduce CTP imaging acquisition time.Approach. A variational autoencoder and generative adversarial network (VAE-GAN) were implemented in a recurrent framework in three scenarios: to predict the last 8 (24 s), 13 (31.5 s) and 18 (39 s) image frames of the CTP acquisition from the first 25 (36 s), 20 (28.5 s) and 15 (21 s) acquired frames, respectively. The model was trained using 65 stroke cases and tested on 10 unseen cases. Predicted frames were assessed against ground-truth in terms of image quality and haemodynamic maps, bolus shape characteristics and volumetric analysis of lesions.Main results. In all three prediction scenarios, the mean percentage error between the area, full-width-at-half-maximum and maximum enhancement of the predicted and ground-truth bolus curve was less than 4 ± 4%. The best peak signal-to-noise ratio and structural similarity of predicted haemodynamic maps was obtained for cerebral blood volume followed (in order) by cerebral blood flow, mean transit time and time to peak. For the 3 prediction scenarios, average volumetric error of the lesion was overestimated by 7%-15%, 11%-28% and 7%-22% for the infarct, penumbra and hypo-perfused regions, respectively, and the corresponding spatial agreement for these regions was 67%-76%, 76%-86% and 83%-92%.Significance. This study suggests that a recurrent VAE-GAN could potentially be used to predict a portion of CTP frames from truncated acquisitions, preserving the majority of clinical content in the images, and potentially reducing the scan duration and radiation dose simultaneously by 65% and 54.5%, respectively.

STEDNet: Swin transformer-based encoder-decoder network for noise reduction in low-dose CT

BACKGROUND

Low-dose computed tomography (LDCT) can reduce the dose of X-ray radiation, making it increasingly significant for routine clinical diagnosis and treatment planning. However, the noise introduced by low-dose X-ray exposure degrades the quality of CT images, affecting the accuracy of clinical diagnosis. Purpose The noises, artifacts, and high-frequency components are similarly distributed in LDCT images. Transformer can capture global context information in an attentional manner to create distant dependencies on targets and extract more powerful features. In this paper, we reduce the impact of image errors on the ability to retain detailed information and improve the noise suppression performance by fully mining the distribution characteristics of image information.

METHODS

This paper proposed an LDCT noise and artifact suppressing network based on Swin Transformer. The network includes a noise extraction sub-network and a noise removal sub-network. The noise extraction and removal capability are improved using a coarse extraction network of high-frequency features based on full convolution. The noise removal sub-network improves the network's ability to extract relevant image features by using a Swin Transformer with a shift window as an encoder-decoder and skip connections for global feature fusion. Also, the perceptual field is extended by extracting multi-scale features of the images to recover the spatial resolution of the feature maps. The network uses a loss constraint with a combination of L1 and MS-SSIM to improve and ensure the stability and denoising effect of the network.

RESULTS

The denoising ability and clinical applicability of the methods were tested using clinical datasets. Compared with DnCNN, RED-CNN, CBDNet and TSCN, the STEDNet method shows a better denoising effect on RMSE and PSNR. The STEDNet method effectively removes image noise and preserves the image structure to the maximum extent, making the reconstructed image closest to the NDCT image. The subjective and objective analysis of several sets of experiments shows that the method in this paper can effectively maintain the structure, edges, and textures of the denoised images while having good noise suppression performance. In the real data evaluation, the RMSE of this method is reduced by 18.82%, 15.15%, 2.25%, and 1.10% on average compared with DnCNN, RED-CNN, CBDNet, and TSCNN, respectively. The average improvement of PSNR is 9.53%, 7.33%, 2.65%, and 3.69%, respectively.

CONCLUSIONS

This paper proposed a LDCT image denoising algorithm based on end-to-end training. The method in this paper can effectively improve the diagnostic performance of CT images by constraining the details of the images and restoring the LDCT image structure. The problem of increased noise and artifacts in CT images can be solved while maintaining the integrity of CT image tissue structure and pathological information. Compared with other algorithms, this method has better denoising effects both quantitatively and qualitatively.

[Nonlocal low-rank and sparse matrix decomposition for low-dose cerebral perfusion CT image restoration]

OBJECTIVE

To present a nonlocal low-rank and sparse matrix decomposition (NLSMD) method for low-dose cerebral perfusion CT image restoration.

METHODS

Low-dose cerebral perfusion CT images were first partitioned into a matrix, and the low- rank and sparse matrix decomposition model was constructed to obtain high-quality low-dose cerebral perfusion CT images. The cerebral hemodynamic parameters were calculated from the restored high-quality CT images.

RESULTS

In the phantom study, the average structured similarity (SSIM) value of the sequential images obtained by filtered back-projection (FBP) algorithm was 0.9438, which was increased to 0.9765 using the proposed algorithm; the SSIM values of cerebral blood flow (CBF) and cerebral blood volume (CBV) map obtained by FBP algorithm were 0.7005 and 0.6856, respectively, which were increased using the proposed algorithm to 0.7871 and 0.7972, respectively.

CONCLUSION

The proposed method can effectively suppress noises in low-dose cerebral perfusion CT images to obtain accurate cerebral hemodynamic parameters.

Basis and current state of computed tomography perfusion imaging: a review

Computed tomography perfusion (CTP) is a functional imaging that allows for providing capillary-level hemodynamics information of the desired tissue in clinics. In this paper, we aim to offer insight into CTP imaging which covers the basics and current state of CTP imaging, then summarize the technical applications in the CTP imaging as well as the future technological potential. At first, we focus on the fundamentals of CTP imaging including systematically summarized CTP image acquisition and hemodynamic parameter map estimation techniques. A short assessment is presented to outline the clinical applications with CTP imaging, and then a review of radiation dose effect of the CTP imaging on the different applications is presented. We present a categorized methodology review on known and potential solvable challenges of radiation dose reduction in CTP imaging. To evaluate the quality of CTP images, we list various standardized performance metrics. Moreover, we present a review on the determination of infarct and penumbra. Finally, we reveal the popularity and future trend of CTP imaging.

Forward Model and Deep Learning Based Iterative Deconvolution for Robust Dynamic CT Perfusion

Perfusion maps obtained from low-dose computed tomography (CT) data suffer from poor signal to noise ratio. To enhance the quality of the perfusion maps, several works rely on denoising the low-dose CT (LD-CT) images followed by conventional regularized deconvolution. Recent works employ deep neural networks (DNN) for learning a direct mapping between the noisy and the clean perfusion maps ignoring the convolution-based forward model. DNN-based methods are not robust to practical variations in the data that are seen in real-world applications such as stroke. In this work, we propose an iterative framework that combines the perfusion forward model with a DNN-based regularizer to obtain perfusion maps directly from the LD-CT dynamic data. To improve the robustness of the DNN, we leverage the anatomical information from the contrast-enhanced LD-CT images to learn the mapping between low-dose and standard-dose perfusion maps. Through empirical experiments, we show that our model is robust both qualitatively and quantitatively to practical perturbations in the data.

[Low-dose cerebral perfusion CT image restoration using prior image constrained diffusion tensor]

OBJECTIVE

We propose an efficient method to reduce the noise in low-dose cerebral perfusion CT images using prior image constrained diffusion tensor to reduce the radiation dose in brain CT examination.

METHODS

By utilizing the redundant information in cerebral perfusion CT images, we embedded the complementary structure information in prior images into lowdose cerebral perfusion CT image restoration process to suppress the image noise and artifacts.We first calculated the diffusion tensor for the low-dose cerebral perfusion CT image and prior image separately and then constructed a prior image constrained diffusion tensor (PICDT) to incorporate the structure information from the prior image into low-dose image restoration process.

RESULTS

In experiments with the Shepp-Logan phantom, the SSIM value of CBF map obtained by the proposed algorithm was increased by 63% as compared with that of the FBP algorithm.In analysis of the clinical dataset, the SSIM value of CBF map obtained by the proposed algorithm was increased by 45% as compared with that of FBP algorithm.

CONCLUSION

The proposed method can effectively reduce noises and artifacts of low-dose cerebral perfusion CT images while maintaining the structural details to obtain accurate cerebral hemodynamic maps.

Learning non-local perfusion textures for high-quality computed tomography perfusion imaging

Background. Computed tomography perfusion (CTP) imaging plays a critical role in the acute stroke syndrome assessment due to its widespread availability, speed of image acquisition, and relatively low cost. However, due to its repeated scanning protocol, CTP imaging involves a substantial radiation dose, which might increase potential cancer risks.Methods. In this work, we present a novel deep learning model called non-local perfusion texture learning network (NPTN) for high-quality CTP imaging at low-dose cases. Specifically, considering abundant similarities in the CTP images, i.e. latent self-similarities within the non-local region in the CTP images, we firstly search the most similar pixels from the adjacent frames within a fixed search window to obtain the non-local similarities and to construct non-local textures vector. Then, both the low-dose frame and these non-local textures from adjacent frames are fed into a convolution neural network to predict high-quality CTP images, which can help better characterize the structure details and contrast variants in the targeted CTP image rather than simply utilizing the targeted frame itself. The residual learning strategy and batch normalization are utilized to boost the performance of the convolution neural network. In the experiment, the CTP images of 31 patients with suspected stroke disease are collected to demonstrate the performance of the presented NPTN method.Results. The results show the presented NPTN method obtains superior performance compared with the competing methods. From numerical value, at all dose levels, the presented NPTN method has achieved around 3.0 dB improvement of average PSNR, an increase of around 1.4% of average SSIM, and a decrease of around 4.8% of average RMSE in the low-dose CTP reconstruction task, and also has achieved an increase of around 3.4% of average SSIM and a decrease of around 61.1% of average RMSE in the cerebral blood flow (CBF) estimation task.Conclusions. The presented NPTN method can obtain high-quality CTP images and estimate high-accuracy CBF map by characterizing more structure details and contrast variants in the CTP image and outperform the competing methods at low-dose cases.

Position paper of the EACVI and EANM on artificial intelligence applications in multimodality cardiovascular imaging using SPECT/CT, PET/CT, and cardiac CT

In daily clinical practice, clinicians integrate available data to ascertain the diagnostic and prognostic probability of a disease or clinical outcome for their patients. For patients with suspected or known cardiovascular disease, several anatomical and functional imaging techniques are commonly performed to aid this endeavor, including coronary computed tomography angiography (CCTA) and nuclear cardiology imaging. Continuous improvement in positron emission tomography (PET), single-photon emission computed tomography (SPECT), and CT hardware and software has resulted in improved diagnostic performance and wide implementation of these imaging techniques in daily clinical practice. However, the human ability to interpret, quantify, and integrate these data sets is limited. The identification of novel markers and application of machine learning (ML) algorithms, including deep learning (DL) to cardiovascular imaging techniques will further improve diagnosis and prognostication for patients with cardiovascular diseases. The goal of this position paper of the European Association of Nuclear Medicine (EANM) and the European Association of Cardiovascular Imaging (EACVI) is to provide an overview of the general concepts behind modern machine learning-based artificial intelligence, highlights currently prefered methods, practices, and computational models, and proposes new strategies to support the clinical application of ML in the field of cardiovascular imaging using nuclear cardiology (hybrid) and CT techniques.

SpiNet: A deep neural network for Schatten p-norm regularized medical image reconstruction

PURPOSE

To propose a generic deep learning based medical image reconstruction model (named as SpiNet) that can enforce any Schatten p-norm regularization with 0 < p ≤ 2, where the p can be learnt (or fixed) based on the problem at hand.

METHODS

Model-based deep learning architecture for solving inverse problems consists of two parts, a deep learning based denoiser and an iterative data consistency solver. The former has either L2 norm or L1 norm enforced on it, which are convex and can be easily minimized. This work proposes a method to enforce any p norm on the noise prior where 0 < p ≤ 2. This is achieved by using Majorization-Minimization algorithm, which upper bounds the cost function with a convex function, thus can be easily minimized. The proposed SpiNet has the capability to work for a fixed p or it can learn p based on the data. The network was tested for solving the inverse problem of reconstructing magnetic resonance (MR) images from undersampled k space data and the results were compared with a popular model-based deep learning architecture MoDL which enforces L2 norm along with other compressive sensing-based algorithms. This comparison between MoDL and proposed SpiNet was performed for undersampling rates (R) of 2×, 4×, 6×, 8×, 12×, 16×, and 20×. Multiple figures of merit such as PSNR, SSIM, and NRMSE were utilized in this comparison. A two-tailed t test was performed for all undersampling rates and for all metrices for proving the superior performance of proposed SpiNet compared to MoDL. For training and testing, the same dataset that was utilized in MoDL implementation was deployed.

RESULTS

The results indicate that for all undersampling rates, the proposed SpiNet shows higher PSNR and SSIM and lower NRMSE than MoDL. However, for low undersampling rates of 2× and 4×, there is no significant difference in performance of proposed SpiNet and MoDL in terms of PSNR and NRMSE. This can be expected as the learnt p value is close to 2 (norm enforced by MoDL). For higher undersampling rates ≥6×, SpiNet significantly outperforms MoDL in all metrices with improvement as high as 4 dB in PSNR and 0.5 points in SSIM.

CONCLUSION

As deep learning based medical image reconstruction methods are gaining popularity, the proposed SpiNet provides a generic framework to incorporate Schatten p-norm regularization with 0 <p ≤ 2 with an added advantage of providing superior performance compared to its counterparts. The proposed SpiNet also has useful addition of Schatten p-norm value in regularization term being automatically chosen based on the available training data.

Parameter-Transferred Wasserstein Generative Adversarial Network (PT-WGAN) for Low-Dose PET Image Denoising

Due to the widespread use of positron emission tomography (PET) in clinical practice, the potential risk of PET-associated radiation dose to patients needs to be minimized. However, with the reduction in the radiation dose, the resultant images may suffer from noise and artifacts that compromise diagnostic performance. In this paper, we propose a parameter-transferred Wasserstein generative adversarial network (PT-WGAN) for low-dose PET image denoising. The contributions of this paper are twofold: i) a PT-WGAN framework is designed to denoise low-dose PET images without compromising structural details, and ii) a task-specific initialization based on transfer learning is developed to train PT-WGAN using trainable parameters transferred from a pretrained model, which significantly improves the training efficiency of PT-WGAN. The experimental results on clinical data show that the proposed network can suppress image noise more effectively while preserving better image fidelity than recently published state-of-the-art methods. We make our code available at https://github.com/90n9-yu/PT-WGAN.

Application and Construction of Deep Learning Networks in Medical Imaging

Deep learning (DL) approaches are part of the machine learning (ML) subfield concerned with the development of computational models to train artificial intelligence systems. DL models are characterized by automatically extracting high-level features from the input data to learn the relationship between matching datasets. Thus, its implementation offers an advantage over common ML methods that often require the practitioner to have some domain knowledge of the input data to select the best latent representation. As a result of this advantage, DL has been successfully applied within the medical imaging field to address problems, such as disease classification and tumor segmentation for which it is difficult or impossible to determine which image features are relevant. Therefore, taking into consideration the positive impact of DL on the medical imaging field, this article reviews the key concepts associated with its evolution and implementation. The sections of this review summarize the milestones related to the development of the DL field, followed by a description of the elements of deep neural network and an overview of its application within the medical imaging field. Subsequently, the key steps necessary to implement a supervised DL application are defined, and associated limitations are discussed.

Efficient radiation dose reduction in whole-brain CT perfusion imaging using a 3D GAN: Performance and clinical feasibility

Dose reduction in cerebral CT perfusion (CTP) imaging is desirable but is accompanied by an increase in noise that can compromise the image quality and the accuracy of image-based haemodynamic modelling used for clinical decision support in acute ischaemic stroke. The few reported methods aimed at denoising low-dose CTP images lack practicality by considering only small sections of the brain or being computationally expensive. Moreover, the prediction of infarct and penumbra size and location - the chief means of decision support for treatment options - from denoised data has not been explored using these approaches. In this work, we present the first application of a 3D generative adversarial network (3D GAN) for predicting normal-dose CTP data from low-dose CTP data. Feasibility of the approach was tested using real data from 30 acute ischaemic stroke patients in conjunction with low dose simulation. The 3D GAN model was applied to 64^3 voxel patches extracted from two different configurations of the CTP data- frame-based and stacked. The method led to whole-brain denoised data being generated for haemodynamic modelling within 90 seconds. Accuracy of the method was evaluated using standard image quality metrics and the extent to which the clinical content and lesion characteristics of the denoised CTP data were preserved. Results showed an average improvement of 5.15-5.32 dB PSNR and 0.025-0.033 SSIM for CTP images and 2.66-3.95 dB PSNR and 0.036-0.067 SSIM for functional maps at 50% and 25% of normal dose using GAN model in conjunction with a stacked data regime for image synthesis. Consequently, the average lesion volumetric error reduced significantly (p-value < 0.05) by 18-29% and dice coefficient improved significantly by 15-22%. We conclude that GAN-based denoising is a promising practical approach for reducing radiation dose in CTP studies and improving lesion characterisation.

SiameseGAN: A Generative Model for Denoising of Spectral Domain Optical Coherence Tomography Images

Optical coherence tomography (OCT) is a standard diagnostic imaging method for assessment of ophthalmic diseases. The speckle noise present in the high-speed OCT images hampers its clinical utility, especially in Spectral-Domain Optical Coherence Tomography (SDOCT). In this work, a new deep generative model, called as SiameseGAN, for denoising Low signal-to-noise ratio (LSNR) B-scans of SDOCT has been developed. SiameseGAN is a Generative Adversarial Network (GAN) equipped with a siamese twin network. The siamese network module of the proposed SiameseGAN model helps the generator to generate denoised images that are closer to groundtruth images in the feature space, while the discriminator helps in making sure they are realistic images. This approach, unlike baseline dictionary learning technique (MSBTD), does not require an apriori high-quality image from the target imaging subject for denoising and takes less time for denoising. Moreover, various deep learning models that have been shown to be effective in performing denoising task in the SDOCT imaging were also deployed in this work. A qualitative and quantitative comparison on the performance of proposed method with these state-of-the-art denoising algorithms has been performed. The experimental results show that the speckle noise can be effectively mitigated using the proposed SiameseGAN along with faster denoising unlike existing approaches.

Noise2Atom: unsupervised denoising for scanning transmission electron microscopy images

We propose an effective deep learning model to denoise scanning transmission electron microscopy (STEM) image series, named Noise2Atom, to map images from a source domain [Formula: see text] to a target domain [Formula: see text], where [Formula: see text] is for our noisy experimental dataset, and [Formula: see text] is for the desired clear atomic images. Noise2Atom uses two external networks to apply additional constraints from the domain knowledge. This model requires no signal prior, no noise model estimation, and no paired training images. The only assumption is that the inputs are acquired with identical experimental configurations. To evaluate the restoration performance of our model, as it is impossible to obtain ground truth for our experimental dataset, we propose consecutive structural similarity (CSS) for image quality assessment, based on the fact that the structures remain much the same as the previous frame(s) within small scan intervals. We demonstrate the superiority of our model by providing evaluation in terms of CSS and visual quality on different experimental datasets.

End-to-end Res-Unet based reconstruction algorithm for photoacoustic imaging

Recently, deep neural networks have attracted great attention in photoacoustic imaging (PAI). In PAI, reconstructing the initial pressure distribution from acquired photoacoustic (PA) signals is a typically inverse problem. In this paper, an end-to-end Unet with residual blocks (Res-Unet) is designed and trained to solve the inverse problem in PAI. The performance of the proposed algorithm is explored and analyzed by comparing a recent model-resolution-based regularization algorithm (MRR) with numerical and physical phantom experiments. The improvement obtained in the reconstructed images was more than 95% in pearson correlation and 39% in peak signal-to-noise ratio in comparison to the MRR. The Res-Unet also achieved superior performance over the state-of-the-art Unet++ architecture by more than 18% in PSNR in simulation experiments.

Deep learning on image denoising: An overview

Deep learning techniques have received much attention in the area of image denoising. However, there are substantial differences in the various types of deep learning methods dealing with image denoising. Specifically, discriminative learning based on deep learning can ably address the issue of Gaussian noise. Optimization models based on deep learning are effective in estimating the real noise. However, there has thus far been little related research to summarize the different deep learning techniques for image denoising. In this paper, we offer a comparative study of deep techniques in image denoising. We first classify the deep convolutional neural networks (CNNs) for additive white noisy images; the deep CNNs for real noisy images; the deep CNNs for blind denoising and the deep CNNs for hybrid noisy images, which represents the combination of noisy, blurred and low-resolution images. Then, we analyze the motivations and principles of the different types of deep learning methods. Next, we compare the state-of-the-art methods on public denoising datasets in terms of quantitative and qualitative analyses. Finally, we point out some potential challenges and directions of future research.

Investigation of Low-Dose CT Image Denoising Using Unpaired Deep Learning Methods

Low-dose computed tomography (LDCT) is desired due to prevalence and ionizing radiation of CT, but suffers elevated noise. To improve LDCT image quality, an image-domain denoising method based on cycle-consistent generative adversarial network ("CycleGAN") is developed and compared with two other variants, IdentityGAN and GAN-CIRCLE. Different from supervised deep learning methods, these unpaired methods can effectively learn image translation from the low-dose domain to the full-dose (FD) domain without the need of aligning FDCT and LDCT images. The results on real and synthetic patient CT data show that these methods can achieve peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM) comparable to, if not better than, the other state-of-the-art denoising methods. Among CycleGAN, IdentityGAN, and GAN-CIRCLE, the later achieves the best denoising performance with the shortest computation time. Subsequently, GAN-CIRCLE is used to demonstrate that the increasing number of training patches and of training patients can improve denoising performance. Finally, two non-overlapping experiments, i.e. no counterparts of FDCT and LDCT images in the training data, further demonstrate the effectiveness of unpaired learning methods. This work paves the way for applying unpaired deep learning methods to enhance LDCT images without requiring aligned full-dose and low-dose images from the same patient.

A Task-dependent Investigation on Dose and Texture in CT Image Reconstruction

Localizing and characterizing clinically-significant lung nodules, a potential precursor to lung cancer, at the lowest achievable radiation dose is demanded to minimize the stochastic radiation effects from x-ray computed tomography (CT). A minimal dose level is heavily dependent on the image reconstruction algorithms and clinical task, in which the tissue texture always plays an important role. This study aims to investigate the dependence through a task-based evaluation at multiple dose levels and variable textures in reconstructions with prospective patient studies. 133 patients with a suspicious pulmonary nodule scheduled for biopsy were recruited and the data was acquired at120kVp with three different dose levels of 100, 40 and 20mAs. Three reconstruction algorithms were implemented: analytical filtered back-projection (FBP) with optimal noise filtering; statistical Markov random field (MRF) model with optimal Huber weighting (MRF-H) for piecewise smooth reconstruction; and tissue-specific texture model (MRF-T) for texture preserved statistical reconstruction. Experienced thoracic radiologists reviewed and scored all images at random, blind to the CT dose and reconstruction algorithms. The radiologists identified the nodules in each image including the 133 biopsy target nodules and 66 other non-target nodules. For target nodule characterization, only MRF-T at 40mAs showed no statistically significant difference from FBP at 100mAs. For localizing both the target nodules and the non-target nodules, some as small as 3mm, MRF-T at 40 and 20mAs levels showed no statistically significant difference from FBP at 100mAs, respectively. MRF-H and FBP at 40 and 20mAs levels performed statistically differently from FBP at 100mAs. This investigation concluded that (1) the textures in the MRF-T reconstructions improves both the tasks of localizing and characterizing nodules at low dose CT and (2) the task of characterizing nodules is more challenging than the task of localizing nodules and needs more dose or enhanced textures from reconstruction.