Dose reduction in paediatric cranial CT via iterative reconstruction: a clinical study in 78 patients

Kaul, David; Kahn, Johannes; Huizing, L.; Wiener, Edzard; Böning, Georg; Renz, Diane M.; Streitparth, Florian

doi:10.1016/j.crad.2016.06.115

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…Similar to our lower tube voltage settings in certain age groups, Kaul et al ,. incorporated decrease in tube voltage with ASIR and found that 100kV with 20% ASIR was the limit of reductions to allow for adequate image quality.…”

Section: Discussionsupporting

confidence: 89%

Retrospective review of CT brain image quality, diagnostic adequacy and radiation dose in a paediatric population imaged at a non‐paediatric tertiary hospital

et al. 2019

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Introduction: Minimising radiation exposure in paediatric imaging examinations whilst maintaining acceptable diagnostic quality continues to present a challenge. The aims of this study were to assess institutional compliance of paediatric CT brain (CTB) examinations performed in an adult hospital with ARPANSA radiation dose recommendations and to compare qualitative CTB diagnostic acceptability with objective imaging parameters and radiation dose. Methods: A retrospective review of 115 consecutive paediatric CTB examinations was undertaken at an adult tertiary referral centre in Australia over a 2year period. Dose length product (DLP) was compared with the ARPANSA standards. CTB image quality was subjectively classified by two neuroradiologists independently, with discordant results resolved by consensus. Objective assessment of image quality included measurements of signal-to-noise (SNR) and contrast-to-noise ratios (CNR) of grey and white matter. Results: All patient scans complied with ARPANSA DLP recommendations; however, 10 out of 115 scans were classified as being of diagnostically suboptimal image quality. These scans had significantly lower mean DLP values compared with diagnostically adequate examinations (105.1 vs 379.2 mGy.cm; P < 0.0001). CTB scans of adequate diagnostic quality, when compared to suboptimal scans, had significantly higher CNR (1.8 vs 1.1; P < 0.0001) and SNR in grey (7.1 vs 4.6; P < 0.0001) and white matter (5.6 vs 3.8; P < 0.0001). Conclusion: All CTB examinations in this series complied with the ARPANSA DLP recommendations; however, 9% were of suboptimal diagnostic image quality. While it is important to minimize unnecessary radiation exposure, our results suggest that excessively low DLP values can lead to suboptimal diagnostic image quality.

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Section: Discussionsupporting

confidence: 89%

Retrospective review of CT brain image quality, diagnostic adequacy and radiation dose in a paediatric population imaged at a non‐paediatric tertiary hospital

et al. 2019

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“…For iterative reconstruction of the raw data, adaptive iterative reconstruction technique (40% adaptive statistical iterative reconstruction, ASIR V, GE Healthcare, Milwaukee, WI, USA) was used in both scan series with the same iterative reconstruction settings (15,16). The Smart MAR post-processing tool (GE Healthcare, Milwaukee, WI, USA) is approved for the reconstruction of iterative primary reconstructions.…”

Section: Ct Image Reconstructionmentioning

confidence: 99%

Improvement of image quality and diagnostic confidence using Smart MAR – a projection-based CT protocol in patients with orthopedic metallic implants in hip, spine, and shoulder

et al. 2020

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Background In computed tomography (CT) scans, artifacts caused by metallic orthopedic implants still hamper the visualization of important, periprosthetic tissues. Smart MAR metal artifact reduction tool is a promising three-stage, projection-based, post-processing algorithm. Purpose To determine whether the Smart MAR tool improves subjective and objective image quality and diagnostic confidence in patients with orthopedic implants of the hip, spine, and shoulder. Material and Methods Seventy-two patients with orthopedic screws, hip/shoulder replacement, or spine spondylodesis were included. CT scans were performed on a single-source multislice CT scanner, raw data were post-processed using Smart MAR. Image quality was evaluated both quantitatively (ROI-based) and qualitatively (rater-based) and compared to iterative reconstructions (ASIR V). As comparative standard for artificial prosthetic breaks or loosening, follow-up examinations were used. Results Smart MAR reconstructions of the hip (n = 23), spine (n = 26), and shoulder (n = 23) showed a significantly reduced attenuation and noise of regions adjacent to metallic implants ( P<0.002). Subjective image quality ( P<0.005, shoulder P = 0.038/ P = 0.046) and overall diagnostic confidence were higher in Smart MAR (all regions P<0.002). Signal-to-noise ratio (SNR; P = 0.72/ P = 0.96) was not improved. Compared to standard ASIR V new, artificial metal extinctions (up to 50%) or periprosthetic hem lines (48%–73%) were introduced by Smart MAR. Conclusion Smart MAR improved image quality of the hip, spine, and shoulder CT scans resulting in higher diagnostic confidence in evaluation of periprosthetic soft tissues. As shown for spine implants, it should be used with caution and as a complementary tool for evaluation of periprosthetic loosening or integrity of metal implant, as in many cases it introduced new artifacts.

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“…mAs SD 120 kV, 25–200 eff. mAs LD FBP HIR (SAFIRE 2) 20–90 38.1 SD 3.8–30.5 LD NA NA Scholtz [ 55 ] 2017 123 36 SD, SECT 30 SD, DECT 32 LD, SECT 25 LD, DECT SD SECT vs SD DECT vs. LD SECT vs. LD DECT 192-MDCT (Siemens, Siemens Healthineers, Erlangen, Germany) 120 kV, 270 mAs SECT 80/150 kV, 410/273 mAs DECT 120 kV, 270 mAs am, SECT 80/150 kV, 410/273 mAs am, DECT MBIR (ADMIRE) 18 CTDI, SECT 27 CTDI, DECT 25 DLP, SECT 24 DLP, DECT 39.5 SD, SECT 41.0 SD, DECT 32.2 LD, SECT 30.0 LD, DECT 771.5 SD, SECT 770.6 SD, DECT 575.0 LD, SECT 587.0 LD, DECT NA Kaul [ 37 ] 2016 78 18 SD 22 LD1 20 LD2 18 LD3 SD FBP vs. LD1 FBP vs. LD2 ASIR20 vs. LD3 ASIR30/40 64-MDCT (GE Lightspeed VCT, GE Healthcare, Milwaukee, WI, USA) 120 kV, 100–300 mA am, SD 100 kV, 100–300 mA am, LD1–3 FBP HIR (ASIR 20–40%) 20/43/66 CTDI 23/34/64 DLP 31.9 SD 25.4 LD1 18.3 LD2 10.8 LD3 396.0 SD 304.0 LD1 260.0 LD2 141.0 LD3 NA Bodelle [ 56 ] 2014 94 54 SD 40 LD SD vs. LD 128-MDCT (Siemens SOMATOM Definition Flash/AS, Siemens Healthineers, Erlangen, Germany) 120 kV, 340 mAs SD 120 kV, 260 mAs LD FBP HIR (SAFIRE 1–5) 29 DLP NA 1045.0 SD 744.0 LD …”

Section: Resultsmentioning

confidence: 99%

“…Four NCCT studies focused on or included patients for ICH evaluation, using heterogeneous study designs and methodologies. Not taking into account simulated LD protocols, dose reductions ranged from 18 to 66% while maintaining sufficient quantitative and qualitative IQ [ 37 , 48 , 55 , 56 ].…”

Section: Resultsmentioning

confidence: 99%

Computed Tomography of the Head

et al. 2023

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In 1971, the first computed tomography (CT) scan was performed on a patient’s brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New technological developments, broader availability, and the clinical success of CT led to a steady growth in examination numbers. Most frequent indications for non-contrast CT (NCCT) of the head include the assessment of ischemia and stroke, intracranial hemorrhage and trauma, while CT angiography (CTA) has become the standard for first-line cerebrovascular evaluation; however, resulting improvements in patient management and clinical outcomes come at the cost of radiation exposure, increasing the risk for secondary morbidity. Therefore, radiation dose optimization should always be part of technical advancements in CT imaging but how can the dose be optimized? What dose reduction can be achieved without compromising diagnostic value, and what is the potential of the upcoming technologies artificial intelligence and photon counting CT? In this article, we look for answers to these questions by reviewing dose reduction techniques with respect to the major clinical indications of NCCT and CTA of the head, including a brief perspective on what to expect from current and future developments in CT technology with respect to radiation dose optimization.

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Dose reduction in paediatric cranial CT via iterative reconstruction: a clinical study in 78 patients

Cited by 9 publications

References 19 publications

Retrospective review of CT brain image quality, diagnostic adequacy and radiation dose in a paediatric population imaged at a non‐paediatric tertiary hospital

Retrospective review of CT brain image quality, diagnostic adequacy and radiation dose in a paediatric population imaged at a non‐paediatric tertiary hospital

Improvement of image quality and diagnostic confidence using Smart MAR – a projection-based CT protocol in patients with orthopedic metallic implants in hip, spine, and shoulder

Computed Tomography of the Head

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