Ultra‐low dose <scp>CT</scp> colonography with automatic tube current modulation and sinogram‐affirmed iterative reconstruction: Effects on radiation exposure and image quality

Cianci, Roberta; Pizzi, Andrea Delli; Esposito, Gianluigi; Timpani, Mauro; Tavoletta, Alessandra; Pulsone, Pierluigi; Basilico, Raffaella; Cotroneo, Antonio Raffaele; Filippone, Antonella

doi:10.1002/acm2.12510

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…We used the terms ULD and SD patient radiation dose, and the estimated mean effective dose levels were 0.9 and 3.6 mSv for ULD and SD, respectively. The terms SD and ULD have no universal definition, but our radiation dose levels are in approximate agreement with those of others in CTC ( 20 ) and urinary low-dose CT examinations ( 21 ) . In a study by Lambert et al .…”

Section: Discussionsupporting

confidence: 85%

Extracolonic Findings—identification at Low-Dose CTC

Thorén

Johnsson

Hellström

et al. 2021

Radiation Protection Dosimetry

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In contrast to optical colonoscopy, computed tomography colonography (CTC) has the ability to reveal pathology outside of the colon. While identification of colorectal lesions at CTC requires only limited radiation dose, the detection of abnormalities in extracolonic soft tissue requires more radiation. The purpose of this study was to investigate the influence of ultra-low-dose (ULD) CTC on the detection and characterisation of extracolonic findings. In a prospective study 49 patients with colorectal symptoms were examined with CTC adding a ULD series (mean effective dose 0.9 ± 0.4 mSv) to the normal unenhanced standard dose (SD) series (mean effective dose 3.6 ± 1.2 mSv). Five radiologists individually and blindly evaluated the ULD, followed by evaluation of the SD after ≥9 weeks (median 35 weeks). A ViewDEX-based examination protocol was used, including a confidence scale and a graded assessment of need for follow-up according to the CTC Reporting and Data System (C-RADS E0–E4). The reference findings comprised the combined information from CTC (ULD, SD and contrast-enhanced CTC series) and a 4-year radiological and clinical follow-up. For the overall detection of reference findings (E2–E4) we found a statistically significant difference in favour of SD. This, however, was not the case when looking at classification of possibly important/important reference findings (E3–E4). Our results suggest that CTC with ULD (0.9 mSv) is comparable to SD (3.6 mSv) for identification of clinically relevant extracolonic pathology, but there is a large inter-observer variability.

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Section: Discussionsupporting

confidence: 85%

Extracolonic Findings—identification at Low-Dose CTC

Thorén

Johnsson

Hellström

et al. 2021

Radiation Protection Dosimetry

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“…The ultra-low-dose technique employed in this study reduced the tube voltage by 33% and halved the tube current when compared to the standard-dose protocol. Furthermore, the algorithm of adaptive iterative dose reduction used in this study effectively worked on noise reduction and improvement of image quality [ 9 , 25 , 26 ]. These technical means reduced the effective radiation by 99.29%.…”

Section: Discussionmentioning

confidence: 99%

The clinical performance of ultra-low-dose shoulder CT scans: The assessment on image and physical 3D printing models

et al. 2022

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Objectives Evaluation of the clinical performance of ultra-low-dose computed tomography (CT) images of the shoulder joint on image-based diagnosis and three-dimensional (3D) printing surgical planning. Materials and methods A total of 93 patients with displaced shoulder fractures were randomly divided into standard-dose, low-dose, and ultra-low-dose groups. Three-dimensional printing models of all patients’ shoulder joints were fabricated. The subjective image quality and 3D-printing model were evaluated by two senior orthopedic surgeons who were blinded to any scanning setting. A 3-point scale system was used to quantitatively assess the image quality and 3D printing model, where more than 2 points meant adequate level for clinical application. Results Compared with the standard dose protocol, ultra-low-dose technique reduced the radiation dose by 99.29% without loss of key image quality of fracture pattern. Regarding the subjective image quality, the assessment scores for groups of standard, low, and ultra-low doses were 3.00, 2.76, 2.00 points on scapula and humerus, and 3.00, 2.73, 2.44 points on clavicle. Scores of the three groups for the assessment of 3D printing models were 3.00, 2.80, 1.34 on scapula and humerus, and 3.00, 2.90, 2.06 on clavicle. In the ultra-low-dose group, 24 out of 33 (72.7%) 3D printing models of scapula and humerus received lower than 2 points of the evaluation score, while nearly 94% of the clavicle models reached the adequate level. Conclusion An ultra-low-dose protocol is adequate for the diagnosis of either displaced or non-displaced fractures of the shoulder joint even though minor flaws of images are present. Three-dimensional printing models of shoulder joints created from ultra-low-dose CT scans can be used for surgical planning at specific bone like the clavicle but perform insufficiently in the overall surgical planning for shoulder injuries due to the significant geometric flaws.

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“…These software reconstructions techniques are Sinogram-Affirmed Iterative Reconstruction (SAFIRE) and a conventional filtered back projection. These techniques allowed the use of even lower doses of radiation than the conventional low dose (LD) protocol named ultra-low dose (ULD) with maintained image quality[ 5 , 24 , 30 ]. In 2018, a study evaluating the ULD protocol's diagnostic value in detecting polyps[ 31 ] showed that the ULD protocol lowers the effective dose up to 63.2% compared to LD protocol (0.98 mSv for ULD and 2.69 mSv for LD).…”

Section: Radiation Induced Risksmentioning

confidence: 99%

“…In contrast, the 2D option is the routine CT examination technique. Polyp detection was also comparable, with no significant difference in detection rate and polyp measurement for LD and ULD protocols[ 30 ]. Therefore if iterative reconstruction methods (the software option in almost all modern CT scanners) were included during the scanning, there was no significant image quality degradation with ULD-CTC compared with LD-CTC.…”

Section: Radiation Induced Risksmentioning

confidence: 99%

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Computed tomography colonography and radiation risk: How low can we go?

Popić

Tipuric²,

Balen

et al. 2021

WJGE

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Computed tomography colonography (CTC) has become a key examination in detecting colonic polyps and colorectal carcinoma (CRC). It is particularly useful after incomplete optical colonoscopy (OC) for patients with sedation risks and patients anxious about the risks or potential discomfort associated with OC. CTC's main advantages compared with OC are its non-invasive nature, better patient compliance, and the ability to assess the extracolonic disease. Despite these advantages, ionizing radiation remains the most significant burden of CTC. This opinion review comprehensively addresses the radiation risk of CTC, incorporating imaging technology refinements such as automatic tube current modulation, filtered back projections, lowering the tube voltage, and iterative reconstructions as tools for optimizing low and ultra-low dose protocols of CTC. Future perspectives arise from integrating artificial intelligence in computed tomography machines for the screening of CRC.

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Ultra‐low dose CT colonography with automatic tube current modulation and sinogram‐affirmed iterative reconstruction: Effects on radiation exposure and image quality

Cited by 13 publications

References 30 publications

Extracolonic Findings—identification at Low-Dose CTC

Extracolonic Findings—identification at Low-Dose CTC

The clinical performance of ultra-low-dose shoulder CT scans: The assessment on image and physical 3D printing models

Computed tomography colonography and radiation risk: How low can we go?

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