Effects of radiation dose reduction on diagnostic performance of 3rd generation Dual Source CT pulmonary angiography

Winkelmann, Moritz T.; Walter, Sven; Stock, Eva; Brendlin, Andreas; Kolb, Manuel; Othman, Ahmed E.; Afat, Saif

doi:10.1016/j.ejrad.2020.109426

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…In contrast to filtered back projection (FBP), the widespread adoption of iterative reconstruction (IR) algorithms has opened up a multitude of approaches for low dose CT image acquisition due to their superior noise and artifact reduction [13]. Other studies with a similar methodological approach to our study in patients with suspected cervical abscesses, and pulmonary angiography for suspected pulmonary embolisms respectively, have shown a large potential for image quality improvements at low tube acquisition in combination with iterative reconstruction techniques on 3rd generation CT scanners [14,15].…”

Section: Introductionmentioning

confidence: 79%

“…For reconstruction, we used the software solution ReconCT ver. 14.2.0.40998 (Siemens Healthineers, Forchheim, Germany), that additionally allows for seamless low dose simulation by adding overall image noise relative to a percentual radiation dose reduction [15]. To facilitate reading and intraindividual comparison, we chose to generate datasets with the visual impression of image noise at 100, 80, 60, 40, and 20% radiation dose.…”

Section: Image Reconstruction Parametersmentioning

confidence: 99%

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Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison

Brendlin¹,

Winkelmann²,

Linh

et al. 2021

Diagnostics

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To evaluate the effect of radiation dose reduction on image quality and diagnostic confidence in contrast-enhanced whole-body computed tomography (WBCT) staging. We randomly selected March 2016 for retrospective inclusion of 18 consecutive patients (14 female, 60 ± 15 years) with clinically indicated WBCT staging on the same 3rd generation dual-source CT. Using low-dose simulations, we created data sets with 100, 80, 60, 40, and 20% of the original radiation dose. Each set was reconstructed using filtered back projection (FBP) and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 1–5, resulting in 540 datasets total. ADMIRE 2 was the reference standard for intraindividual comparison. The effective radiation dose was calculated using commercially available software. For comparison of objective image quality, noise assessments of subcutaneous adipose tissue regions were performed automatically using the software. Three radiologists blinded to the study evaluated image quality and diagnostic confidence independently on an equidistant 5-point Likert scale (1 = poor to 5 = excellent). At 100%, the effective radiation dose in our population was 13.3 ± 9.1 mSv. At 20% radiation dose, it was possible to obtain comparably low noise levels when using ADMIRE 5 (p = 1.000, r = 0.29). We identified ADMIRE 3 at 40% radiation dose (5.3 ± 3.6 mSv) as the lowest achievable radiation dose with image quality and diagnostic confidence equal to our reference standard (p = 1.000, r > 0.4). The inter-rater agreement for this result was almost perfect (ICC ≥ 0.958, 95% CI 0.909–0.983). On a 3rd generation scanner, it is feasible to maintain good subjective image quality, diagnostic confidence, and image noise in single-energy WBCT staging at dose levels as low as 40% of the original dose (5.3 ± 3.6 mSv), when using ADMIRE 3.

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Section: Introductionmentioning

confidence: 79%

Section: Image Reconstruction Parametersmentioning

confidence: 99%

Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison

Brendlin¹,

Winkelmann²,

Linh

et al. 2021

Diagnostics

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“…Radiation dose can also be reduced through various reconstruction algorithms such as iterative reconstruction as mentioned previously (30)(31)(32)(33). At the same time reduction of tube current using low kV protocols is another way to reduce radiation dose but metallic implants cause artefacts and the BMI of the patient also affects results (24,27).…”

Section: Discussionmentioning

confidence: 99%

Ultra-low dose CT for scaphoid fracture detection—a simulational approach to quantify the capability of radiation exposure reduction without diagnostic limitation

Keller¹,

Hagen²,

Neubauer³

et al. 2022

Quant Imaging Med Surg

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Background: Modern CT might deliver higher image quality than necessary for fracture imaging, which would mean non-essential effective radiation exposure for patients. We simulated ultra-low dose (ULD)-CT at different dose levels and analyzed their diagnostic performance for scaphoid fracture detection.Methods: 30 consecutive high quality CT with clinically suspected scaphoid fractures were assessed. ULDsimulations were made at 20%, 10% and 5% of original dose. Three readers at different levels of experience (expert, moderate, inexperienced) expressed their diagnostic confidence (DC; 5-point-Likert-scale) and analyzed the presence and classification of scaphoid fractures within Krimmer's and Herbert's classifications.Effective radiation exposure of the original data sets and ULD-CT were calculated.Results: At 20% and 10% dose the more experienced readers reached perfect sensitivity (100%) and specificity (100%), showing perfect agreement regarding fracture classification (1.00). Diagnostic performance decreased at 5% dose (92.86% sensitivity, 100% specificity; expert reader). The inexperienced reader showed reduced sensitivity and specificity at all dose levels. At 10% dose minimal DC of all readers was 3/5 and mean calculated effective radiation exposure was 1.11 [±0.36] µSv. Conclusions:The results suggest that ULD-CT at 10% dose compared to high quality CT might offer sufficient image quality to precisely detect and classify scaphoid fractures, if moderate experience of the radiologist is granted.

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“…In accordance with our hospital’s standard CTPA protocol, we employed Advanced Modeled Iterative Reconstruction (ADMIRE ® , Siemens Healthineers, Forchheim, Germany) strength3 for standard protocol reconstructions. For ULD protocol reconstructions, we performed a tube current simulation by reducing the mAs to 25% and employed a high level of iterative reconstruction (ADMIRE strength 5), as this combination showed promising results in other studies [ 11 ]. In the same step, we additionally simulated a limited scan range from the top of the aortic arch to the basal pericardium.…”

Section: Methodsmentioning

confidence: 99%

“…In light of this background, there have been numerous approaches to reducing radiation doses in CT, particularly in CTPA. Apart from modulation of tube current (mAs) and reducing peak tube voltage (kVp), the introduction of the latest generation CT scanners and the resurgence of iterative reconstruction (IR) techniques have significantly contributed towards radiation exposure reductions in CTPA, enabling mean radiation doses below 2 mSv [ 11 ]. In addition, approaches using the reduction of the scan range in the z-axis have shown promising results in abdominopelvic CT and CTPA [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of a Contrast-Enhanced Ultra-Low-Dose High-Pitch CT Protocol with Reduced Scan Range for Detection of Pulmonary Embolisms

et al. 2021

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(1) Background: To evaluate the diagnostic performance of a simulated ultra-low-dose (ULD), high-pitch computed tomography pulmonary angiography (CTPA) protocol with low tube current (mAs) and reduced scan range for detection of pulmonary embolisms (PE). (2) Methods: We retrospectively included 130 consecutive patients (64 ± 16 years, 69 female) who underwent clinically indicated high-pitch CTPA examination for suspected acute PE on a 3rd generation dual-source CT scanner (SOMATOM FORCE, Siemens Healthineers, Forchheim, Germany). ULD datasets with a realistic simulation of 25% mAs, reduced scan range (aortic arch—basal pericardium), and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 5 were created. The effective radiation dose (ED) of both datasets (standard and ULD) was estimated using a dedicated dosimetry software solution. Subjective image quality and diagnostic confidence were evaluated independently by three reviewers using a 5-point Likert scale. Objective image quality was compared using noise measurements. For assessment of diagnostic accuracy, patients and pulmonary vessels were reviewed binarily for affection by PE, using standard CTPA protocol datasets as the reference standard. Percentual affection of pulmonary vessels by PE was computed for disease severity (modified Qanadli score). (3) Results: Mean ED in ULD protocol was 0.7 ± 0.3 mSv (16% of standard protocol: 4.3 ± 1.7 mSv, p < 0.001, r > 0.5). Comparing ULD to standard protocol, subjective image quality and diagnostic confidence were comparably good (p = 0.486, r > 0.5) and image noise was significantly lower in ULD (p < 0.001, r > 0.5). A total of 42 patients (32.2%) were affected by PE. ULD protocol had a segment-based false-negative rate of only 0.1%. Sensitivity for detection of any PE was 98.9% (95% CI, 97.2–99.7%), specificity was 100% (95% CI, 99.8–100%), and overall accuracy was 99.9% (95% CI, 98.6–100%). Diagnoses correlated strongly between ULD and standard protocol (Chi-square (1) = 42, p < 0.001) with a decrease in disease severity of only 0.48% (T = 1.667, p = 0.103). (4) Conclusions: Compared to a standard CTPA protocol, the proposed ULD protocol proved reliable in detecting and ruling out acute PE with good levels of image quality and diagnostic confidence, as well as significantly lower image noise, at 0.7 ± 0.3 mSv (84% dose reduction).

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Effects of radiation dose reduction on diagnostic performance of 3rd generation Dual Source CT pulmonary angiography

Cited by 13 publications

References 32 publications

Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison

Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison

Ultra-low dose CT for scaphoid fracture detection—a simulational approach to quantify the capability of radiation exposure reduction without diagnostic limitation

Diagnostic Performance of a Contrast-Enhanced Ultra-Low-Dose High-Pitch CT Protocol with Reduced Scan Range for Detection of Pulmonary Embolisms

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