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D'hondt L, Kellens PJ, Torfs K, Bosmans H, Bacher K, Snoeckx A. Absolute ground truth-based validation of computer-aided nodule detection and volumetry in low-dose CT imaging. Phys Med 2024; 121:103344. [PMID: 38593627 DOI: 10.1016/j.ejmp.2024.103344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/20/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE To validate the performance of computer-aided detection (CAD) and volumetry software using an anthropomorphic phantom with a ground truth (GT) set of 3D-printed nodules. METHODS The Kyoto Kaguku Lungman phantom, containing 3D-printed solid nodules including six diameters (4 to 9 mm) and three morphologies (smooth, lobulated, spiculated), was scanned at varying CTDIvol levels (6.04, 1.54 and 0.20 mGy). Combinations of reconstruction algorithms (iterative and deep learning image reconstruction) and kernels (soft and hard) were applied. Detection, volumetry and density results recorded by a commercially available AI-based algorithm (AVIEW LCS + ) were compared to the absolute GT, which was determined through µCT scanning at 50 µm resolution. The associations between image acquisition parameters or nodule characteristics and accuracy of nodule detection and characterization were analyzed with chi square tests and multiple linear regression. RESULTS High levels of detection sensitivity and precision (minimal 83 % and 91 % respectively) were observed across all acquisitions. Neither reconstruction algorithm nor radiation dose showed significant associations with detection. Nodule diameter however showed a highly significant association with detection (p < 0.0001). Volumetric measurements for nodules > 6 mm were accurate within 10 % absolute range from volumeGT, regardless of dose and reconstruction. Nodule diameter and morphology are major determinants of volumetric accuracy (p < 0.001). Density assignment was not significantly influenced by any parameters. CONCLUSIONS Our study confirms the software's accurate performance in nodule volumetry, detection and density characterization with robustness for variations in CT imaging protocols. This study suggests the incorporation of similar phantom setups in quality assurance of CAD tools.
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Affiliation(s)
- Louise D'hondt
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Proeftuinstraat 86, Ghent, Belgium; Faculty of Medicine, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium.
| | - Pieter-Jan Kellens
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Proeftuinstraat 86, Ghent, Belgium
| | - Kwinten Torfs
- Leuven University Center of Medical Physics in Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Hilde Bosmans
- Leuven University Center of Medical Physics in Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Klaus Bacher
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Proeftuinstraat 86, Ghent, Belgium
| | - Annemiek Snoeckx
- Faculty of Medicine, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem, Belgium
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Xiao H, Wang X, Yang P, Wang L, Xu J. Coronary artery calcium scoring assessment in ultra-low-dose chest computed tomography. Clin Imaging 2024; 106:110045. [PMID: 38056107 DOI: 10.1016/j.clinimag.2023.110045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To investigate the effect of non-electrocardiogram (ECG) -triggered ultra-low-dose CT (ULD-CT) with different reconstruction protocols on coronary artery calcium (CAC) scoring assessment, compared with ECG-triggered CAC CT (CAC-CT). METHODS This prospective study included 115 patients who underwent CAC-CT and ULD-CT scans under the same topogram images. CAC-CT adopted a prospective ECG-triggered sequential acquisition with a tube potential of 120 kV, and the reconstruction protocol was standard Qr36 + slice 3 mm (CACQr-3mm group). ULD-CT adopted a non-ECG-triggered high-pitch acquisition with a tube potential of Sn100 kV, and four groups of images (named ULDQr-3mm, ULDSa-3mm, ULDQr-1.5mm, and ULDSa-1.5mm) were reconstructed using different reconstruction algorithms (standard Qr36, kV-independent Sa36) and slice thicknesses (3 mm, 1.5 mm). The accuracy of CAC detection by ULD-CT was calculated. The agreement of the CAC score between ULD-CT and CAC-CT scans was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plot, and the agreement of risk categorization was assessed using weighted kappa. RESULTS The sensitivity and specificity of the ULDSa-1.5mm group for detecting positive CAC were 100% and 97.4%, respectively (k = 0.980). The CAC score for the ULDSa-3mm and ULDSa-1.5mm groups demonstrated excellent agreement with the CACQr-3mm group (ICC = 0.992, 0.990, respectively), with a mean difference of -12.3 and - 12.4. The agreement of risk categorization based on absolute and percentile CAC score between the ULDSa-1.5mm and CACQr-3mm groups was excellent (weighted k = 0.954, 0.983, respectively), and risk reclassification rates were low (3.5%, 2.8%, respectively). The effective dose was reduced by approximately 77.2% for the ULD-CT compared to the CAC-CT (0.18 mSv vs. 0.79 mSv, p < 0.001). CONCLUSION Reconstruction with a 1.5-mm slice thickness and kV-independent iterative algorithmic protocol in ULD-CT yielded excellent agreement in CAC score quantification and risk categorization compared with ECG-triggered CAC-CT.
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Affiliation(s)
- Huawei Xiao
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Xiangquan Wang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Panfeng Yang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Ling Wang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Jian Xu
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
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Hop JF, Walstra ANH, Pelgrim GJ, Xie X, Panneman NA, Schurink NW, Faby S, van Straten M, de Bock GH, Vliegenthart R, Greuter MJW. Detectability and Volumetric Accuracy of Pulmonary Nodules in Low-Dose Photon-Counting Detector Computed Tomography: An Anthropomorphic Phantom Study. Diagnostics (Basel) 2023; 13:3448. [PMID: 37998584 PMCID: PMC10669978 DOI: 10.3390/diagnostics13223448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/05/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this phantom study was to assess the detectability and volumetric accuracy of pulmonary nodules on photon-counting detector CT (PCD-CT) at different low-dose levels compared to conventional energy-integrating detector CT (EID-CT). In-house fabricated artificial nodules of different shapes (spherical, lobulated, spiculated), sizes (2.5-10 mm and 5-1222 mm3), and densities (-330 HU and 100 HU) were randomly inserted into an anthropomorphic thorax phantom. The phantom was scanned with a low-dose chest protocol with PCD-CT and EID-CT, in which the dose with PCD-CT was lowered from 100% to 10% with respect to the EID-CT reference dose. Two blinded observers independently assessed the CT examinations of the nodules. A third observer measured the nodule volumes using commercial software. The influence of the scanner type, dose, observer, physical nodule volume, shape, and density on the detectability and volumetric accuracy was assessed by a multivariable regression analysis. In 120 CT examinations, 642 nodules were present. Observer 1 and 2 detected 367 (57%) and 289 nodules (45%), respectively. With PCD-CT and EID-CT, the nodule detectability was similar. The physical nodule volumes were underestimated by 20% (range 8-52%) with PCD-CT and 24% (range 9-52%) with EID-CT. With PCD-CT, no significant decrease in the detectability and volumetric accuracy was found at dose reductions down to 10% of the reference dose (p > 0.05). The detectability and volumetric accuracy were significantly influenced by the observer, nodule volume, and a spiculated nodule shape (p < 0.05), but not by dose, CT scanner type, and nodule density (p > 0.05). Low-dose PCD-CT demonstrates potential to detect and assess the volumes of pulmonary nodules, even with a radiation dose reduction of up to 90%.
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Affiliation(s)
- Joost F. Hop
- Department of Radiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (A.N.H.W.); (G.-J.P.); (N.A.P.); (R.V.); (M.J.W.G.)
| | - Anna N. H. Walstra
- Department of Radiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (A.N.H.W.); (G.-J.P.); (N.A.P.); (R.V.); (M.J.W.G.)
| | - Gert-Jan Pelgrim
- Department of Radiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (A.N.H.W.); (G.-J.P.); (N.A.P.); (R.V.); (M.J.W.G.)
| | - Xueqian Xie
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China;
| | - Noor A. Panneman
- Department of Radiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (A.N.H.W.); (G.-J.P.); (N.A.P.); (R.V.); (M.J.W.G.)
| | - Niels W. Schurink
- Siemens Healthineers Nederland B.V., 2595 BN Den Haag, The Netherlands
| | - Sebastian Faby
- Computed Tomography, Siemens Healthcare GmbH, 91301 Forchheim, Germany;
| | - Marcel van Straten
- Department of Radiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (A.N.H.W.); (G.-J.P.); (N.A.P.); (R.V.); (M.J.W.G.)
| | - Marcel J. W. Greuter
- Department of Radiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (A.N.H.W.); (G.-J.P.); (N.A.P.); (R.V.); (M.J.W.G.)
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Peng L, Liao Y, Zhou R, Zhong Y, Jiang H, Wang J, Fu Y, Xue L, Zhang X, Sun M, Feng G, Meng Z, Peng S, He X, Teng G, Gao X, Zhang H, Tian M. [ 18F]FDG PET/MRI combined with chest HRCT in early cancer detection: a retrospective study of 3020 asymptomatic subjects. Eur J Nucl Med Mol Imaging 2023; 50:3723-3734. [PMID: 37401938 PMCID: PMC10547651 DOI: 10.1007/s00259-023-06273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/18/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE PET/MRI has become an important medical imaging approach in clinical practice. In this study, we retrospectively investigated the detectability of fluorine-18 (18F)-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]FDG PET/MRI) combined with chest computerized tomography (CT) for early cancer in a large cohort of asymptomatic subjects. METHODS This study included a total of 3020 asymptomatic subjects who underwent whole-body [18F]FDG PET/MRI and chest HRCT examinations. All subjects received a 2-4-year follow-up for cancer development. Cancer detection rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the [18F]FDG PET/MRI with or without chest HRCT were calculated and analyzed. RESULTS Sixty-one subjects were pathologically diagnosed with cancers, among which 59 were correctly detected by [18F]FDG PET/MRI combined with chest HRCT. Of the 59 patients (32 with lung cancer, 9 with breast cancer, 6 with thyroid cancer, 5 with colon cancer, 3 with renal cancer, 1 with prostate cancer, 1 with gastric cancer, 1 with endometrial cancer, and 1 with lymphoma), 54 (91.5%) were at stage 0 or stage I (according to the 8th edition of the tumor-node-metastasis [TNM] staging system), 33 (55.9%) were detected by PET/MRI alone (27 with non-lung cancers and 6 with lung cancer). Cancer detection rate, sensitivity, specificity, PPV, and NPV for PET/MRI combined with chest CT were 2.0%, 96.7%, 99.6%, 83.1%, and 99.9%, respectively. For PET/MRI alone, the metrics were 1.1%, 54.1%, 99.6%, 73.3%, and 99.1%, respectively, and for PET/MRI in non-lung cancers, the metrics were 0.9%, 93.1%, 99.6%, 69.2%, and 99.9%, respectively. CONCLUSIONS [18F]FDG PET/MRI holds great promise for the early detection of non-lung cancers, while it seems insufficient for detecting early-stage lung cancers. Chest HRCT can be complementary to whole-body PET/MRI for early cancer detection. TRIAL REGISTRATION ChiCTR2200060041. Registered 16 May 2022. Public site: https://www.chictr.org.cn/index.html.
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Affiliation(s)
- Liling Peng
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Yi Liao
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Yan Zhong
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Han Jiang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Jing Wang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Yu Fu
- College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, China
| | - Le Xue
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Xiaohui Zhang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Mingxiang Sun
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Gang Feng
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Zhaoting Meng
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Sisi Peng
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Xuexin He
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Gaojun Teng
- Radiology Department, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
| | - Xin Gao
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China.
| | - Hong Zhang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Zhejiang, Hangzhou, China.
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhejiang, Hangzhou, China.
| | - Mei Tian
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Human Phenome Institute, Fudan University, Shanghai, China.
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Martini K, Jungblut L, Sartoretti T, Langhart S, Yalynska T, Nemeth B, Frauenfelder T, Euler A. Impact of radiation dose on the detection of interstitial lung changes and image quality in low-dose chest CT - Assessment in multiple dose levels from a single patient scan. Eur J Radiol 2023; 166:110981. [PMID: 37478655 DOI: 10.1016/j.ejrad.2023.110981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To assess image quality and detectability of interstitial lung changes using multiple radiation doses from the same chest CT scan of patients with suspected interstitial lung disease (ILD). METHOD Retrospective study of consecutive adult patients with suspected ILD receiving unenhanced chest CT as single-energy dual-source acquisition at 100 kVp (Dual-split mode). 67% and 33% of the overall tube current time product were assigned to tube A and B, respectively. 100%-dose was 2.34 ± 0.97 mGy. Five different radiation doses (100%, 67%, 45%, 39%, 33%) were reconstructed from this single acquisition using linear-blending technique. Two blinded radiologists assessed reticulations, ground-glass opacities (GGO) and honeycombing as well as subjective image noise. Percentage agreement (PA) as compared to 100%-dose were calculated. Non-parametric statistical tests were used. RESULTS A total of 228 patients were included (61.2 ± 14.6 years,146 female). PA was highest for honeycombing (>96%) and independent of dose reduction (P > 0.8). PA for reticulations and GGO decreased when reducing the radiation dose from 100% to 67% for both readers (reticulations: 83.3% and 93.9%; GGO: 87.7% and 79.8% for reader 1 and 2, respectively). Additional dose reduction did not significantly change PA for both readers (all P > 0.05). Subjective image noise increased with decreasing radiation dose (Spearman Rho of ρ = 0.34 and ρ = 0.53 for reader 1 and 2, respectively, P < 0.001). CONCLUSIONS Radiation dose reduction had a stronger impact on subtle interstitial lung changes. Detectability decreased with initial dose reduction indicating that a minimum dose is needed to maintain diagnostic accuracy in chest CT for suspected ILD.
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Affiliation(s)
- Katharina Martini
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Lisa Jungblut
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Sabinne Langhart
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Tetyana Yalynska
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Bence Nemeth
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - André Euler
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Department of Radiology, Kantonsspital Baden, University of Zurich, Im Ergel 1, 5404 Baden, Switzerland.
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Milanese G, Ledda RE, Sabia F, Ruggirello M, Sestini S, Silva M, Sverzellati N, Marchianò AV, Pastorino U. Ultra-low dose computed tomography protocols using spectral shaping for lung cancer screening: Comparison with low-dose for volumetric LungRADS classification. Eur J Radiol 2023; 161:110760. [PMID: 36878153 DOI: 10.1016/j.ejrad.2023.110760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE To compare Low-Dose Computed Tomography (LDCT) with four different Ultra-Low-Dose Computed Tomography (ULDCT) protocols for PN classification according to the Lung Reporting and Data System (LungRADS). METHODS Three hundred sixty-one participants of an ongoing lung cancer screening (LCS) underwent single-breath-hold double chest Computed Tomography (CT), including LDCT (120kVp, 25mAs; CTDIvol 1,62 mGy) and one ULDCT among: fully automated exposure control ("ULDCT1"); fixed tube-voltage and current according to patient size ("ULDCT2"); hybrid approach with fixed tube-voltage ("ULDCT3") and tube current automated exposure control ("ULDCT4"). Two radiologists (R1, R2) assessed LungRADS 2022 categories on LDCT, and then after 2 weeks on ULDCT using two different kernels (R1: Qr49ADMIRE 4; R2: Br49ADMIRE 3). Intra-subject agreement for LungRADS categories between LDCT and ULDCT was measured by the k-Cohen Index with Fleiss-Cohen weights. RESULTS LDCT-dominant PNs were detected in ULDCT in 87 % of cases on Qr49ADMIRE 4 and 88 % on Br49ADMIRE 3. The intra-subject agreement was: κULDCT1 = 0.89 [95 %CI 0.82-0.96]; κULDCT2 = 0.90 [0.81-0.98]; κULDCT3 = 0.91 [0.84-0.99]; κULDCT4 = 0.88 [0.78-0.97] on Qr49ADMIRE 4, and κULDCT1 = 0.88 [0.80-0.95]; κULDCT2 = 0.91 [0.86-0.96]; κULDCT3 = 0.87 [0.78-0.95]; and κULDCT4 = 0.88 [0.82-0.94] on Br49ADMIRE 3. LDCT classified as LungRADS 4B were correctly identified as LungRADS 4B at ULDCT3, with the lowest radiation exposure among the tested protocols (median effective doses were 0.31, 0.36, 0.27 and 0.37 mSv for ULDCT1, ULDCT2, ULDCT3, and ULDCT4, respectively). CONCLUSIONS ULDCT by spectral shaping allows the detection and characterization of PNs with an excellent agreement with LDCT and can be proposed as a feasible approach in LCS.
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Affiliation(s)
- Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Roberta Eufrasia Ledda
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Federica Sabia
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Margherita Ruggirello
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Diagnostic Imaging and Radiotherapy, Milan, Italy.
| | - Stefano Sestini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Alfonso Vittorio Marchianò
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Diagnostic Imaging and Radiotherapy, Milan, Italy.
| | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
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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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8
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Pozzessere C, von Garnier C, Beigelman-Aubry C. Radiation Exposure to Low-Dose Computed Tomography for Lung Cancer Screening: Should We Be Concerned? Tomography 2023; 9:166-177. [PMID: 36828367 PMCID: PMC9964027 DOI: 10.3390/tomography9010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Lung cancer screening (LCS) programs through low-dose Computed Tomography (LDCT) are being implemented in several countries worldwide. Radiation exposure of healthy individuals due to prolonged CT screening rounds and, eventually, the additional examinations required in case of suspicious findings may represent a concern, thus eventually reducing the participation in an LCS program. Therefore, the present review aims to assess the potential radiation risk from LDCT in this setting, providing estimates of cumulative dose and radiation-related risk in LCS in order to improve awareness for an informed and complete attendance to the program. After summarizing the results of the international trials on LCS to introduce the benefits coming from the implementation of a dedicated program, the screening-related and participant-related factors determining the radiation risk will be introduced and their burden assessed. Finally, future directions for a personalized screening program as well as technical improvements to reduce the delivered dose will be presented.
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Affiliation(s)
- Chiara Pozzessere
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Correspondence:
| | - Christophe von Garnier
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
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9
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Ottilinger T, Martini K, Baessler B, Sartoretti T, Bauer RW, Leschka S, Sartoretti E, Walter JE, Frauenfelder T, Wildermuth S, Alkadhi H, Messerli M. Semi-automated volumetry of pulmonary nodules: Intra-individual comparison of standard dose and chest X-ray equivalent ultralow dose chest CT scans. Eur J Radiol 2022; 156:110549. [PMID: 36272226 DOI: 10.1016/j.ejrad.2022.110549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the performance of semi-automated volumetry of solid pulmonary nodules on single-energy tin-filtered ultralow dose (ULD) chest CT scans at a radiation dose equivalent to chest X-ray relative to standard dose (SD) chest CT scans and assess the impact of kernel and iterative reconstruction selection. METHODS Ninety-four consecutive patients from a prospective single-center study were included and underwent clinically indicated SD chest CT (1.9 ± 0.8 mSv) and additional ULD chest CT (0.13 ± 0.01 mSv) in the same session. All scans were reconstructed with a soft tissue (Br40) and lung (Bl64) kernel as well as with Filtered Back Projection (FBP) and Iterative Reconstruction (ADMIRE-3 and ADMIRE-5). One hundred and forty-eight solid pulmonary nodules were identified and analysed by semi-automated volumetry on all reconstructions. Nodule volumes were compared amongst all reconstructions thereby focusing on the agreement between SD and ULD scans. RESULTS Nodule volumes ranged from 58.5 (28.8-126) mm3 for ADMIRE-5 Br40 ULD reconstructions to 72.5 (39-134) mm3 for FBP Bl64 SD reconstructions with significant differences between reconstructions (p < 0.001). Interscan agreement of volumes between two given reconstructions ranged from ICC = 0.605 to ICC = 0.999. Between SD and ULD scans, agreement of nodule volumes was highest for FBP Br40 (ICC = 0.995), FBP Bl64 (ICC = 0.939) and ADMIRE-5 Bl64 (ICC = 0.994) reconstructions. ADMIRE-3 reconstructions exhibited reduced interscan agreement of nodule volumes (ICCs from 0.788 - 0.882). CONCLUSIONS The interscan agreement of node volumes between SD and ULD is high depending on the choice of kernel and reconstruction algorithm. However, caution should be exercised when comparing two image series that were not identically reconstructed.
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Affiliation(s)
- Thorsten Ottilinger
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland; University Zurich, Zurich, Switzerland
| | - Katharina Martini
- University Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Bettina Baessler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Thomas Sartoretti
- University Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Switzerland
| | - Ralf W Bauer
- RNS, Private Radiology and Radiation Therapy Group, Wiesbaden, Germany
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
| | - Elisabeth Sartoretti
- University Zurich, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Switzerland
| | - Joan E Walter
- Department of Nuclear Medicine, University Hospital Zurich, Switzerland
| | - Thomas Frauenfelder
- University Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
| | - Hatem Alkadhi
- University Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Michael Messerli
- University Zurich, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Switzerland.
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