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Han D, Cai J, Heus A, Heuvelmans M, Imkamp K, Dorrius M, Pelgrim GJ, de Jonge G, Oudkerk M, van den Berge M, Vliegenthart R. Detection and size quantification of pulmonary nodules in ultralow-dose versus regular-dose CT: a comparative study in COPD patients. Br J Radiol 2023; 96:20220709. [PMID: 36728829 PMCID: PMC10078877 DOI: 10.1259/bjr.20220709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To evaluate detectability and semi-automatic diameter and volume measurements of pulmonary nodules in ultralow-dose CT (ULDCT) vs regular-dose CT (RDCT). METHODS Fifty patients with chronic obstructive pulmonary disease (COPD) underwent RDCT on 64-multidetector CT (120 kV, filtered back projection), and ULDCT on third-generation dual source CT (100 kV with tin filter, advanced modeled iterative reconstruction). One radiologist evaluated the presence of nodules on both scans in random order, with discrepancies judged by two independent radiologists and consensus reading. Sensitivity of nodule detection on RDCT and ULDCT was compared to reader consensus. Systematic error in semi-automatically derived diameter and volume, and 95% limits of agreement (LoA) were evaluated. Nodule classification was compared by κ statistics. RESULTS ULDCT resulted in 83.1% (95% CI: 81.0-85.2) dose reduction compared to RDCT (p < 0.001). 45 nodules were present, with diameter range 4.0-25.3 mm and volume range 16.0-4483.0 mm3. Detection sensitivity was non-significant (p = 0.503) between RDCT 88.8% (95% CI: 76.0-96.3) and ULDCT 95.5% (95% CI: 84.9-99.5). No systematic bias in diameter measurements (median difference: -0.2 mm) or volumetry (median difference: -6 mm3) was found for ULDCT compared to RDCT. The 95% LoA for diameter and volume measurements were ±3.0 mm and ±33.5%, respectively. κ value for nodule classification was 0.852 for diameter measurements and 0.930 for volumetry. CONCLUSION ULDCT based on Sn100 kV enables comparable detectability of solid pulmonary nodules in COPD patients, at 83% reduced radiation dose compared to RDCT, without relevant difference in nodule measurement and size classification. ADVANCES IN KNOWLEDGE Pulmonary nodule detectability and measurements in ULDCT are comparable to RDCT.
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Affiliation(s)
- Daiwei Han
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jiali Cai
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne Heus
- Department of Radiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marjolein Heuvelmans
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Kai Imkamp
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - Monique Dorrius
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gert-Jan Pelgrim
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gonda de Jonge
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy Research B.V., Groningen, The Netherlands
- University of Groningen, Groningen, The Netherlands
| | - Maarten van den Berge
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tækker M, Kristjánsdóttir B, Graumann O, Laursen CB, Pietersen PI. Diagnostic accuracy of low-dose and ultra-low-dose CT in detection of chest pathology: a systematic review. Clin Imaging 2021; 74:139-148. [PMID: 33517021 DOI: 10.1016/j.clinimag.2020.12.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/12/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Studies have evaluated imaging modalities with a lower radiation dose than standard-dose CT (SD-CT) for chest examination. This systematic review aimed to summarize evidence on diagnostic accuracy of these modalities - low-dose and ultra-low-dose CT (LD- and ULD-CT) - for chest pathology. METHOD Ovid-MEDLINE, Ovid-EMBASE and the Cochrane Library were systematically searched April 29th-30th, 2019 and screened by two reviewers. Studies on diagnostic accuracy were included if they defined their index tests as 'LD-CT', 'Reduced-dose CT' or 'ULD-CT' and had SD-CT as reference standard. Risk of bias was evaluated on study level using the Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted to compare the diagnostic accuracy measurements. RESULTS Of the 4257 studies identified, 18 were eligible for inclusion. SD-CT (3.17 ± 1.47 mSv) was used as reference standard in all studies to evaluate diagnostic accuracy of LD- (1.22 ± 0.34 mSv) and ULD-CT (0.22 ± 0.05 mSv), respectively. LD-CT had high sensitivities for detection of bronchiectasis (82-96%), honeycomb (75-100%), and varying sensitivities for nodules (63-99%) and ground glass opacities (GGO) (77-91%). ULD-CT had high sensitivities for GGO (93-100%), pneumothorax (100%), consolidations (90-100%), and varying sensitivities for nodules (60-100%) and emphysema (65-90%). CONCLUSION The included studies found LD-CT to have high diagnostic accuracy in detection of honeycombing and bronchiectasis and ULD-CT to have high diagnostic accuracy for pneumothorax, consolidations and GGO. Summarizing evidence on diagnostic accuracy of LD- and ULD-CT for other chest pathology was not possible due to varying outcome measures, lack of precision estimates and heterogeneous study design and methodology.
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Affiliation(s)
- Maria Tækker
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Björg Kristjánsdóttir
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Kloevervaenget 2, entrance 87-88, 5000 Odense C, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Pia I Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Kloevervaenget 2, entrance 87-88, 5000 Odense C, Denmark; Regional Center for Technical Simulation, Odense University Hospital, Region of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
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Zhang L, Pelgrim GJ, Yan J, Zhang H, Vliegenthart R, Xie X. Feasibility of bronchial wall quantification in low- and ultralow-dose third-generation dual-source CT: An ex vivo lung study. J Appl Clin Med Phys 2020; 21:218-226. [PMID: 32991062 PMCID: PMC7592972 DOI: 10.1002/acm2.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 07/21/2020] [Accepted: 08/27/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate image quality and bronchial wall quantification in low- and ultralow-dose third-generation dual-source computed tomography (CT). METHODS A lung specimen from a formerly healthy male was scanned using third-generation dual-source CT at standard-dose (51 mAs/120 kV, CTDIvol 3.41 mGy), low-dose (1/4th and 1/10th of standard dose), and ultralow-dose setting (1/20th). Low kV (70, 80, 90, and Sn100 kV) scanning was applied in each low/ultralow-dose setting, combined with adaptive mAs to keep a constant dose. Images were reconstructed at advanced modeled iterative reconstruction (ADMIRE) levels 1, 3, and 5 for each scan. Bronchial wall were semi-automatically measured from the lobar level to subsegmental level. Spearman correlation analysis was performed between bronchial wall quantification (wall thickness and wall area percentage) and protocol settings (dose, kV, and ADMIRE). ANOVA with a post hoc pairwise test was used to compare signal-to-noise ratio (SNR), noise and bronchial wall quantification values among standard- and low/ultralow-dose settings, and among ADMIRE levels. RESULTS Bronchial wall quantification had no correlation with dose level, kV, or ADMIRE level (|correlation coefficients| < 0.3). SNR and noise showed no statistically significant differences at different kV in the same ADMIRE level (1, 3, or 5) and in the same dose group (P > 0.05). Generally, there were no significant differences in bronchial wall quantification among the standard- and low/ultralow-dose settings, and among different ADMIRE levels (P > 0.05). CONCLUSION The combined use of low/ultralow-dose scanning and ADMIRE does not influence bronchial wall quantification compared to standard-dose CT. This specimen study suggests the potential that an ultralow-dose scan can be used for bronchial wall quantification.
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Affiliation(s)
- Lin Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Radiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Gert Jan Pelgrim
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jing Yan
- Siemens Healthcare Ltd, Shanghai, China
| | - Hao Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Xueqian Xie
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Schreuder AN, Bridges DS, Rigsby L, Blakey M, Janson M, Hedrick SG, Wilkinson JB. Validation of the RayStation Monte Carlo dose calculation algorithm using a realistic lung phantom. J Appl Clin Med Phys 2019; 20:127-137. [PMID: 31763759 PMCID: PMC6909115 DOI: 10.1002/acm2.12777] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Our purposes are to compare the accuracy of RaySearch's analytical pencil beam (APB) and Monte Carlo (MC) algorithms for clinical proton therapy and to present clinical validation data using a novel animal tissue lung phantom. METHODS We constructed a realistic lung phantom composed of a rack of lamb resting on a stack of rectangular natural cork slabs simulating lung tissue. The tumor was simulated using 70% lean ground lamb meat inserted in a spherical hole with diameter 40 ± 5 mm carved into the cork slabs. A single-field plan using an anterior beam and a two-field plan using two anterior-oblique beams were delivered to the phantom. Ion chamber array measurements were taken medial and distal to the tumor. Measured doses were compared with calculated RayStation APB and MC calculated doses. RESULTS Our lung phantom enabled measurements with the MatriXX PT at multiple depths in the phantom. Using the MC calculations, the 3%/3 mm gamma index pass rates, comparing measured with calculated doses, for the distal planes were 74.5% and 85.3% for the APB and 99.1% and 92% for the MC algorithms. The measured data revealed up to 46% and 30% underdosing within the distal regions of the target volume for the single and the two field plans when APB calculations are used. These discrepancies reduced to less than 18% and 7% respectively using the MC calculations. CONCLUSIONS RaySearch Laboratories' Monte Carlo dose calculation algorithm is superior to the pencil-beam algorithm for lung targets. Clinicians relying on the analytical pencil-beam algorithm should be aware of its pitfalls for this site and verify dose prior to delivery. We conclude that the RayStation MC algorithm is reliable and more accurate than the APB algorithm for lung targets and therefore should be used to plan proton therapy for patients with lung cancer.
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Affiliation(s)
- Andries N. Schreuder
- Provision Center for Proton Therapy – Knoxville6450 Provision Cares WayKnoxvilleTN37909USA
| | - Daniel S. Bridges
- Provision Center for Proton Therapy – Knoxville6450 Provision Cares WayKnoxvilleTN37909USA
| | - Lauren Rigsby
- Provision Center for Proton Therapy – Knoxville6450 Provision Cares WayKnoxvilleTN37909USA
| | - Marc Blakey
- Provision Center for Proton Therapy – Knoxville6450 Provision Cares WayKnoxvilleTN37909USA
| | - Martin Janson
- RaySearch LaboratoriesSveavägen 44SE‐103 65StockholmSweden
| | - Samantha G. Hedrick
- Provision Center for Proton Therapy – Knoxville6450 Provision Cares WayKnoxvilleTN37909USA
| | - John B. Wilkinson
- Provision Center for Proton Therapy – Knoxville6450 Provision Cares WayKnoxvilleTN37909USA
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Milanese G, Silva M, Frauenfelder T, Eberhard M, Sabia F, Martini C, Marchianò A, Prokop M, Sverzellati N, Pastorino U. Comparison of ultra-low dose chest CT scanning protocols for the detection of pulmonary nodules: a phantom study. TUMORI JOURNAL 2019; 105:394-403. [PMID: 31041885 DOI: 10.1177/0300891619847271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To test ultra-low-dose computed tomography (ULDCT) scanning protocols for the detection of pulmonary nodules (PN). METHODS A chest phantom containing 19 solid and 11 subsolid PNs was scanned on a third-generation dual-source computed tomography (CT) scanner. Five ULDCT scans (Sn100kVp and 120, 70, 50, 30, and 20 reference mAs, using tube current modulation), reconstructed with iterative reconstruction (IR) algorithm at strength levels 2, 3, 4, and 5, were compared with standard CT (120kVp, 150 reference mAs, using tube current modulation). PNs were subjectively assessed according to a 4-point scale: 0, nondetectable nodule; 1, detectable nodule, very unlikely to be correctly measured; 2, detectable nodule, likely to be correctly measured; 3, PN quality equal to standard of reference. PN scores were analysed according to the Lung Imaging Reporting and Data System (Lung-RADS), simulating detection of nodules at baseline and incidence screening round. RESULTS For the baseline round, there were 17 Lung-RADS 2, 4 Lung-RADS 3, 8 Lung-RADS 4A, and 1 Lung-RADS 4B PNs. They were detectable in any ULDCT protocol, with the exception of 1 nondetectable part-solid nodule in 1 scanning protocol (120 reference mAs; IR strength: 3). For the incidence round, there were 4 Lung-RADS 2, 14 Lung-RADS 3, 2 Lung-RADS 4A, and 10 Lung-RADS 4B PNs. Ten were nondetectable in at least one ULDCT dataset; however, they were at least detectable in ULDCT with 70 reference mAs (IR strength: 4 and 5). CONCLUSIONS ULDCT scanning protocols allowing the detection of PNs can be proposed for the purpose of lung cancer screening.
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Affiliation(s)
- Gianluca Milanese
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mario Silva
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Thomas Frauenfelder
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Federica Sabia
- Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alfonso Marchianò
- Department of Radiology, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mathias Prokop
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola Sverzellati
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
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Accuracy of Pulmonary Nodule Volumetry at Different Exposure Parameters in Low-Dose Computed Tomography. J Comput Assist Tomogr 2019; 43:926-930. [DOI: 10.1097/rct.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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