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Okutsu M, Mitomo S, Onishi H, Nakajima A, Yabushita H, Matsuoka S, Kawamoto H, Watanabe Y, Tanaka K, Naganuma T, Tahara S, Nakamura S, Basavarajaiah S, Nakamura S. The estimation of coronary artery calcium thickness by computed tomography angiography based on optical coherence tomography measurements. Heart Vessels 2023; 38:1305-1317. [PMID: 37422802 DOI: 10.1007/s00380-023-02286-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
Optical coherence tomography (OCT) is recommended to be the most appropriate modality in assessing calcium thickness, however, it has limitations associated with infrared attenuation. Although coronary computed tomography angiography (CCTA) detects calcification, it has low resolution and hence not recommended to measure the calcium size. The aim of this study was to devise a simple algorithm to estimate calcium thickness based on the CCTA image. A total of 68 patients who had CCTA for suspected coronary artery disease and subsequently went on to have OCT were included in the study. 238 lesions of them divided into derivation and validation dataset at 2:1 ratio (47 patients with 159 lesions and 21 with 79, respectively) were analyzed. A new method was developed to estimate calcium thickness from the maximum CT density within the calcification and compared with calcium thickness measured by OCT. Maximum Calcium density and measured calcium-border CT density had a good correlation with a linear equation of y = 0.58x + 201 (r = 0.892, 95% CI 0.855-0.919, p < 0.001). The estimated calcium thickness derived from this equation showed strong agreement with measured calcium thickness in validation and derivation dataset (r2 = 0.481 and 0.527, 95% CI 0.609-0.842 and 0.497-0.782, p < 0.001 in both, respectively), more accurate than the estimation by full width at half maximum and inflection point method. In conclusion, this novel method provided the estimation of calcium thickness more accurately than conventional methods.
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Affiliation(s)
- Masaaki Okutsu
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan.
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Hirokazu Onishi
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Akihiro Nakajima
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Hiroto Yabushita
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Satoshi Matsuoka
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Hiroyoshi Kawamoto
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Yusuke Watanabe
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Kentaro Tanaka
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Toru Naganuma
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Satoko Tahara
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Shotaro Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Sandeep Basavarajaiah
- Department of Cardiology, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271, Wanagaya, Matsudo, Chiba, 270-2232, Japan
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Kozuma K, Chikamori T, Hashimoto J, Honye J, Ikeda T, Ishiwata S, Kato M, Kondo H, Matsubara K, Matsumoto K, Matsumoto N, Motoyama S, Obunai K, Sakamoto H, Soejima K, Suzuki S, Abe K, Amano H, Hioki H, Iimori T, Kawai H, Kosuge H, Nakama T, Suzuki Y, Takeda K, Ueda A, Yamashita T, Hirao K, Kimura T, Nagai R, Nakamura M, Shimizu W, Tamaki N. JCS 2021 Guideline on Radiation Safety in Cardiology. Circ J 2022; 86:1148-1203. [DOI: 10.1253/circj.cj-21-0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ken Kozuma
- Division of Cardiology, Teikyo University Hospital
| | | | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine
| | - Junko Honye
- Department of Cardiology, Kikuna Memorial Hospital
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | - Mamoru Kato
- Department of Radiology, Akita Cerebrospinal and Cardiovascular Center
| | | | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Kazuma Matsumoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | | | | | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital
| | - Shigeru Suzuki
- Department of Radiology, Totsuka Kyouritsu Daini Hospital
| | - Koichiro Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University
| | - Hideo Amano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | | | - Hideki Kawai
- Department of Cardiology, Fujita Health University
| | | | | | | | | | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | | | - Kenzo Hirao
- Division of Cardiovascular Medicine, AOI Universal Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Ryozo Nagai
- Department of Cardiovascular Medicine, Jichi Medical University
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine
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Vecsey-Nagy M, Jermendy ÁL, Suhai FI, Panajotu A, Csőre J, Borzsák S, Fontanini DM, Kolossváry M, Vattay B, Boussoussou M, Csobay-Novák C, Merkely B, Maurovich-Horvat P, Szilveszter B. Model-based adaptive filter for a dedicated cardiovascular CT scanner: Assessment of image noise, sharpness and quality. Eur J Radiol 2021; 145:110032. [PMID: 34800835 DOI: 10.1016/j.ejrad.2021.110032] [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: 07/04/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR) are ubiquitously applied in the reconstruction of coronary CT angiography (CCTA) datasets. However, currently no data is available on the impact of a model-based adaptive filter (MBAF2), recently developed for a dedicated cardiac scanner. PURPOSE Our aim was to determine the effect of MBAF2 on subjective and objective image quality parameters of coronary arteries on CCTA. METHODS Images of 102 consecutive patients referred for CCTA were evaluated. Four reconstructions of coronary images (FBP, ASIR, MBAF2, ASIR + MBAF2) were co-registered and cross-section were assessed for qualitative (graininess, sharpness, overall image quality) and quantitative [image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)] image quality parameters. Image noise and signal were measured in the aortic root and the left main coronary artery, respectively. Graininess, sharpness, and overall image quality was assessed on a 4-point Likert scale. RESULTS As compared to FBP, ASIR, and MBAF2, ASIR + MBAF2 resulted in reduced image noise [53.1 ± 12.3, 30.6 ± 8.5, 36.3 ± 4.2, 26.3 ± 4.0 Hounsfield units (HU), respectively; p < 0.001], improved SNR (8.4 ± 2.6, 14.1 ± 3.6, 11.8 ± 2.3, 16.3 ± 3.3 HU, respectively; p < 0.001) and CNR (9.4 ± 2.7, 15.9 ± 4.0, 13.3 ± 2.5, 18.3 ± 3.5 HU, respectively; p < 0.001). No difference in sharpness was observed amongst the reconstructions (p = 0.08). Although ASIR + MBAF2 was non-superior to ASIR regarding overall image quality (p = 0.99), it performed better than FBP (p < 0.001) and MBAF2 (p < 0.001) alone. CONCLUSION The combination of ASIR and MBAF2 resulted in reduced image noise and improved SNR and CNR. The implementation of MBAF2 in clinical practice may result in improved noise reduction performance and could potentiate radiation dose reduction.
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Affiliation(s)
- Milán Vecsey-Nagy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary.
| | - Ádám Levente Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Ferenc Imre Suhai
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Judit Csőre
- Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Sarolta Borzsák
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | | | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Csaba Csobay-Novák
- Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary; Medical Imaging Centre, Semmelweis University, 78.a Ulloi av., 1082 Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
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Zhang Q, Mi H, Shi X, Li W, Guo S, Wang P, Suo H, Wang Z, Jin S, Yan F, Niu Y, Xian J. Higher Iodine Concentration Enables Radiation Dose Reduction in Coronary CT Angiography. Acad Radiol 2021; 28:1072-1080. [PMID: 32553279 DOI: 10.1016/j.acra.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES To test whether higher iodine concentration together with higher noise level could lead to a further dose reduction in an already low dose coronary CT angiography (CCTA) protocol without comprising image quality. MATERIALS AND METHODS One hundred eighty patients with suspected coronary artery disease (CAD) were randomly assigned into three groups: (a) conventional dose (CD) group, 100 kV with a noise index (NI) of 25 and iohexol (350 mg I/ml); (b) low dose (LD) group, 80 kV with a NI of 25 and iohexol (350 mg I/ml); (c) further low dose (FLD) group, 80 kV with a NI of 30 and iomeprol (400 mg I/ml). The volume and injection rate of contrast medium were fixed at 60 ml and 5 ml/s. The radiation dose (volume CT dose index [CTDIvol], dose length product [DLP], and effective dose [ED]) were recorded. For image quality, both quantitative (enhancement, noise, signal-to-noise ratio [SNR], and contrast-to-noise ratio [CNR]) and qualitative indices were assessed. RESULTS Compared to the CD group, ED was reduced by 16% and 42% in the LD and FLD groups, respectively (p < 0.05). Qualitative analysis showed no significant difference among the 3 groups (p > 0.05), while quantitative analysis revealed significantly higher attenuation in the LD and FLD groups. Signal-to-noise ratios and CNRs of the LD and FLD groups were significantly higher except for the CNR at the left circumflex branch of the FLD group (p < 0.05). CONCLUSION Increasing iodine concentration and noise level may further reduce the radiation dose by 26% on top of a 16% reduction from 100 kV to 80 kV without image quality compromise.
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Affiliation(s)
- Qing Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Haifeng Mi
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Xubo Shi
- Department of Cardiology, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Wei Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Senlin Guo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Ping Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Hongna Suo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Ziyi Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Shanshan Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Fei Yan
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Yantao Niu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin lane, Dongcheng District, Beijing 100730, P.R. China.
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Yuvaraj J, Cheng K, Lin A, Psaltis PJ, Nicholls SJ, Wong DTL. The Emerging Role of CT-Based Imaging in Adipose Tissue and Coronary Inflammation. Cells 2021; 10:1196. [PMID: 34068406 PMCID: PMC8153638 DOI: 10.3390/cells10051196] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
A large body of evidence arising from recent randomized clinical trials demonstrate the association of vascular inflammatory mediators with coronary artery disease (CAD). Vascular inflammation localized in the coronary arteries leads to an increased risk of CAD-related events, and produces unique biological alterations to local cardiac adipose tissue depots. Coronary computed tomography angiography (CTA) provides a means of mapping inflammatory changes to both epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) as independent markers of coronary risk. Radiodensity or attenuation of PCAT on coronary CTA, notably, provides indirect quantification of coronary inflammation and is emerging as a promising non-invasive imaging implement. An increasing number of observational studies have shown robust associations between PCAT attenuation and major coronary events, including acute coronary syndrome, and 'vulnerable' atherosclerotic plaque phenotypes that are associated with an increased risk of the said events. This review outlines the biological characteristics of both EAT and PCAT and provides an overview of the current literature on PCAT attenuation as a surrogate marker of coronary inflammation.
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Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Andrew Lin
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA 90048, USA;
| | - Peter J. Psaltis
- Department of Medicine, University of Adelaide, Adelaide, SA 5005, Australia;
- South Australian Health Medical Research Institute, Adelaide, SA 5000, Australia
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Dennis T. L. Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
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Bernard A, Comby PO, Lemogne B, Haioun K, Ricolfi F, Chevallier O, Loffroy R. Deep learning reconstruction versus iterative reconstruction for cardiac CT angiography in a stroke imaging protocol: reduced radiation dose and improved image quality. Quant Imaging Med Surg 2021; 11:392-401. [PMID: 33392038 DOI: 10.21037/qims-20-626] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background To assess the radiation dose and image quality of cardiac computed tomography angiography (CCTA) in an acute stroke imaging protocol using a deep learning reconstruction (DLR) method compared to a hybrid iterative reconstruction algorithm. Methods Retrospective analysis of 296 consecutive patients admitted to the emergency department for stroke suspicion. All patients underwent a stroke CT imaging protocol including a non-enhanced brain CT, a brain perfusion CT imaging if necessary, a CT angiography (CTA) of the supra-aortic vessels, a CCTA and a post-contrast brain CT. The CCTA was performed with a prospectively ECG-gated volume acquisition. Among all CT scans performed, 143 were reconstructed with an iterative reconstruction algorithm (AIDR 3D, adaptive iterative dose reduction three dimensional) and 146 with a DLR algorithm (AiCE, advanced intelligent clear-IQ engine). Image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective image quality (IQ) scored from 1 to 4 were assessed. Dose-length product (DLP), volume CT dose index (CTDIvol) and effective dose (ED) were obtained. Results The radiation dose was significantly lower with AiCE than with AIDR 3D (DLP =106.4±50.0 vs. 176.1±37.1 mGy·cm, CTDIvol =6.9±3.2 vs. 11.5±2.2 mGy, and ED =1.5±0.7 vs. 2.5±0.5 mSv) (P<0.001). The median SNR and CNR were higher [9.9 (IQR, 8.1-12.3); and 12.6 (IQR, 10.5-15.5), respectively], with AiCE than with AIDR 3D [6.5 (IQR, 5.2-8.5); and 8.4 (IQR, 6.7-11.0), respectively] (P<0.001). SNR and CNR were increased by 51% and 49%, respectively, with AiCE compared to AIDR 3D. The image quality was significantly better with AiCE (mean IQ score =3.4±0.7) than with AIDR 3D (mean IQ score =3±0.9) (P<0.001). Conclusions The use of a DLR algorithm for cardiac CTA in an acute stroke imaging protocol reduced the radiation dose by about 40% and improved the image quality by about 50% compared to an iterative reconstruction algorithm.
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Affiliation(s)
- Angélique Bernard
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Pierre-Olivier Comby
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Brivaël Lemogne
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Karim Haioun
- Computed Tomography Division, Canon Medical Systems France, Suresnes, France
| | - Frédéric Ricolfi
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Cardiovascular and Interventional Radiology, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Romaric Loffroy
- Department of Cardiovascular and Interventional Radiology, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
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Abdullah KA, McEntee MF, Reed W, Kench PL. Evaluation of an integrated 3D-printed phantom for coronary CT angiography using iterative reconstruction algorithm. J Med Radiat Sci 2020; 67:170-176. [PMID: 32219989 PMCID: PMC7476188 DOI: 10.1002/jmrs.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION 3D-printed imaging phantoms are now increasingly available and used for computed tomography (CT) dose optimisation study and image quality analysis. The aim of this study was to evaluate the integrated 3D-printed cardiac insert phantom when evaluating iterative reconstruction (IR) algorithm in coronary CT angiography (CCTA) protocols. METHODS The 3D-printed cardiac insert phantom was positioned into a chest phantom and scanned with a 16-slice CT scanner. Acquisitions were performed with CCTA protocols using 120 kVp at four different tube currents, 300, 200, 100 and 50 mA (protocols A, B, C and D, respectively). The image data sets were reconstructed with a filtered back projection (FBP) and three different IR algorithm strengths. The image quality metrics of image noise, signal-noise ratio (SNR) and contrast-noise ratio (CNR) were calculated for each protocol. RESULTS Decrease in dose levels has significantly increased the image noise, compared to FBP of protocol A (P < 0.001). As a result, the SNR and CNR were significantly decreased (P < 0.001). For FBP, the highest noise with poor SNR and CNR was protocol D with 19.0 ± 1.6 HU, 18.9 ± 2.5 and 25.1 ± 3.6, respectively. For IR algorithm, the highest strength (AIDR3Dstrong ) yielded the lowest noise with excellent SNR and CNR. CONCLUSIONS The use of IR algorithm and increasing its strengths have reduced noise significantly and thus increased the SNR and CNR when compared to FBP. Therefore, this integrated 3D-printed phantom approach could be used for dose optimisation study and image quality analysis in CCTA protocols.
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Affiliation(s)
| | - Mark F. McEntee
- Discipline of Medical Radiation SciencesFaculty of Health SciencesThe University of SydneyLidcombeNew South WalesAustralia
| | - Warren Reed
- Discipline of Medical Radiation SciencesFaculty of Health SciencesThe University of SydneyLidcombeNew South WalesAustralia
| | - Peter L. Kench
- Discipline of Medical Radiation SciencesFaculty of Health SciencesThe University of SydneyLidcombeNew South WalesAustralia
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Funama Y, Takahashi H, Goto T, Aoki Y, Yoshida R, Kumagai Y, Awai K. Improving Low-contrast Detectability and Noise Texture Pattern for Computed Tomography Using Iterative Reconstruction Accelerated with Machine Learning Method: A Phantom Study. Acad Radiol 2020; 27:929-936. [PMID: 31918961 DOI: 10.1016/j.acra.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/01/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of iterative reconstruction (IR) and filtered back projection (FBP) images in terms of low-contrast detectability at different radiation doses, IR levels, and slice thickness using the mathematical model observer with a focus on low-contrast detectability. MATERIALS AND METHODS The CCT189 MITA CT IQ Low-Contrast Phantom was used and helical scans were performed using a 64-detector CT scanner. Tube voltage was set at 120 kVp and tube current was adjusted from 45 to 600 mA. Images were reconstructed at slice thicknesses of 0.625 and 5.0 mm with FBP and five types of iterative progressive reconstruction with visual modeling (IPV) algorithms. The noise power spectrum (NPS) and normalized NPS were calculated. To evaluate low-contrast detectability, the model observer with the channelized Hotelling observer model was applied using low-contrast modules in the phantom. RESULTS The NPS and normalized NPS for IPV images had similar curves as that for FBP images. At a slice thickness of 0.625 mm and equivalent radiation dose level, the mean improvement of low-contrast detectability for IPV images was 1.19-2.15-fold greater than FBP images with corresponding noise reduction levels. At equivalent noise levels of 5.0-8.0 HU, low-contrast detectability of the IPVstd2 to IPVstr2 images as almost the same or better than that of the FBP images. However, the detectability of the IPVstr4 image was lower than that of the FBP image (p = 0.02). CONCLUSION Low-contrast detectability of the IPV images was improved with a similar normalized NPS as with FBP images. Furthermore, a radiation reduction of >50% was achieved for the IPV images, while maintaining similar low-contrast detectability.
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Affiliation(s)
- Yoshinori Funama
- Department of Medical Radiation Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto 862-0976, Japan.
| | | | - Taiga Goto
- Hitachi Ltd. Healthcare Business Unit, Kashiwa, Chiba, Japan
| | - Yuko Aoki
- Hitachi Ltd. Healthcare Business Unit, Kashiwa, Chiba, Japan
| | - Ryo Yoshida
- Hitachi Ltd. Healthcare Business Unit, Kashiwa, Chiba, Japan
| | - Yukio Kumagai
- Hitachi Ltd. Healthcare Business Unit, Kashiwa, Chiba, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Tanabe Y, Kido T, Kimura F, Kobayashi Y, Matsunaga N, Yoshioka K, Yoshimura N, Mochizuki T. Japanese Survey of Radiation Dose Associated With Coronary Computed Tomography Angiography - 2013 Data From a Multicenter Registry in Daily Practice. Circ J 2020; 84:601-608. [PMID: 32074543 DOI: 10.1253/circj.cj-19-0843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although coronary computed tomography angiography (CTA) is frequently used for identifying coronary artery disease, no studies have investigated the radiation dose in detail in Japan. The aim of this study was to estimate the radiation dose of coronary CTA in Japanese clinical practice and to identify the independent predictors associated with radiation dose. METHODS AND RESULTS A multicenter, retrospective, observational study (54 institutions) was conducted for estimating the radiation dose of coronary CTA in 2,469 patients between January and December 2013. Independent predictors associated with radiation dose were investigated on linear regression analysis. Median dose-length product (DLP) was 809.0 mGy·cm (IQR, 350.0-1,368.8 mGy·cm), corresponding to an estimated radiation dose of 11 mSv. The DLP per site significantly differed between institutions (median DLP per site, 92-2,131 mGy·cm; P<0.05). Independent predictors associated with radiation dose on multivariable linear regression were body weight, heart rate, non-stable sinus rhythm, scan length, tube voltage setting, electrocardiogram (ECG)-gated scanning protocol, and the image reconstruction technique (P<0.05 each). CONCLUSIONS The coronary CTA radiation dose was relatively high in 2013, and it varied significantly between institutions. Effective strategies for radiation dose reduction were low tube voltage ≤100 kVp, retrospective ECG-gated scanning with dose modulation technique, prospective ECG-gated scanning, and the iterative reconstruction technique.
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Affiliation(s)
- Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Fumiko Kimura
- Department of Radiology, PsI clinic
- Department of Radiology, Dia Medical Net
| | - Yasuyuki Kobayashi
- Department of Medical Information and Communication Technology Research, Graduate School of Medicine, St. Marianna University School of Medicine
| | - Naofumi Matsunaga
- Department of Radiology, Yamaguchi University Graduate School of Medicine
| | | | - Norihiko Yoshimura
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine
- Department of Radiology, I.M. Sechenov First Moscow State Medical University
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Lin CT, Chu LCH, Zimmerman SL, Fishman EK. High-pitch non-gated scans on the second and third generation dual-source CT scanners: comparison of coronary image quality. Clin Imaging 2020; 59:45-49. [DOI: 10.1016/j.clinimag.2019.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/29/2019] [Accepted: 09/23/2019] [Indexed: 11/24/2022]
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11
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Choi AD, Leifer ES, Yu JH, Datta T, Bronson KC, Rollison SF, Schuzer JL, Steveson C, Shanbhag SM, Chen MY. Reduced radiation dose with model based iterative reconstruction coronary artery calcium scoring. Eur J Radiol 2019; 111:1-5. [DOI: 10.1016/j.ejrad.2018.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023]
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12
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Benz DC, Fuchs TA, Gräni C, Studer Bruengger AA, Clerc OF, Mikulicic F, Messerli M, Stehli J, Possner M, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Head-to-head comparison of adaptive statistical and model-based iterative reconstruction algorithms for submillisievert coronary CT angiography. Eur Heart J Cardiovasc Imaging 2019; 19:193-198. [PMID: 28200212 DOI: 10.1093/ehjci/jex008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/16/2017] [Indexed: 01/04/2023] Open
Abstract
Aims Iterative reconstruction (IR) algorithms allow for a significant reduction in radiation dose of coronary computed tomography angiography (CCTA). We performed a head-to-head comparison of adaptive statistical IR (ASiR) and model-based IR (MBIR) algorithms to assess their impact on quantitative image parameters and diagnostic accuracy for submillisievert CCTA. Methods and results CCTA datasets of 91 patients were reconstructed using filtered back projection (FBP), increasing contributions of ASiR (20, 40, 60, 80, and 100%), and MBIR. Signal and noise were measured in the aortic root to calculate signal-to-noise ratio (SNR). In a subgroup of 36 patients, diagnostic accuracy of ASiR 40%, ASiR 100%, and MBIR for diagnosis of coronary artery disease (CAD) was compared with invasive coronary angiography. Median radiation dose was 0.21 mSv for CCTA. While increasing levels of ASiR gradually reduced image noise compared with FBP (up to - 48%, P < 0.001), MBIR provided largest noise reduction (-79% compared with FBP) outperforming ASiR (-59% compared with ASiR 100%; P < 0.001). Increased noise and lower SNR with ASiR 40% and ASiR 100% resulted in substantially lower diagnostic accuracy to detect CAD as diagnosed by invasive coronary angiography compared with MBIR: sensitivity and specificity were 100 and 37%, 100 and 57%, and 100 and 74% for ASiR 40%, ASiR 100%, and MBIR, respectively. Conclusion MBIR offers substantial noise reduction with increased SNR, paving the way for implementation of submillisievert CCTA protocols in clinical routine. In contrast, inferior noise reduction by ASiR negatively affects diagnostic accuracy of submillisievert CCTA for CAD detection.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Annina A Studer Bruengger
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
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Luhur R, Schuijf JD, Mews J, Blobel J, Hamm B, Lembcke A. Accuracy of coronary artery calcium scoring with tube current reduction by 75%, using an adaptive iterative reconstruction algorithm. Br J Radiol 2018; 91:20170678. [PMID: 29260893 DOI: 10.1259/bjr.20170678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the accuracy of an iterative reconstruction (IR) technique for coronary artery calcium scoring with reduced radiation dose. METHODS 163 consecutive patients underwent twofold scanning by 320-row detector CT at 120 kVp. A low-dose scan at 25% tube current but with standard scan length (14 cm) was followed by a standard dose scan with routine tube current but reduced scan length (10 cm). Reduced dose images were constructed using filtered back-projection (FBP) and IR (adaptive iterative dose reduction in three dimensions). The standard dose scan reconstructed with FBP served as the gold standard for comparisons. Image noise and Agatston coronary calcium scores were determined and compared between the groups. RESULTS Compared with FBP at standard dose, noise at reduced dose increased markedly with FBP but remained low with IR. Mean Agatston score with FBP at reduced dose showed a significant increase as compared with FBP at standard dose. No significant difference was observed when applying IR at reduced dose. At reduced dose, 38 (23.3%) patients were reassigned to a different cardiovascular risk category with FBP but only 8 (4.9%) with IR. Out of 47 patients with a zero Agatston score, 15 patients (31.9%) were false-positive with FBP at reduced dose, but no false positives were found with IR. CONCLUSION IR allows accurate coronary artery calcium scoring with a radiation dose reduced by 75%. Advances in knowledge: The application of adaptive iterative dose reduction in three dimensions allows the maintenance of accurate Agatston scores and risk stratification at significantly reduced tube current, thus reducing the patient's exposure to ionizing radiation.
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Affiliation(s)
- Reny Luhur
- 1 Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Berlin , Germany
| | - Joanne D Schuijf
- 2 Center for Medical Research & Development Europe,Toshiba Medical Systems Europe BV , Toshiba Medical Systems Europe BV , Zoetermeer , Netherlands
| | - Jürgen Mews
- 2 Center for Medical Research & Development Europe,Toshiba Medical Systems Europe BV , Toshiba Medical Systems Europe BV , Zoetermeer , Netherlands
| | - Jörg Blobel
- 2 Center for Medical Research & Development Europe,Toshiba Medical Systems Europe BV , Toshiba Medical Systems Europe BV , Zoetermeer , Netherlands
| | - Bernd Hamm
- 1 Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Berlin , Germany
| | - Alexander Lembcke
- 1 Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Berlin , Germany
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Ri K, Kumamaru KK, Fujimoto S, Kawaguchi Y, Dohi T, Yamada S, Takamura K, Kogure Y, Yamada N, Kato E, Irie R, Takamura T, Suzuki M, Hori M, Aoki S, Daida H. Noninvasive Computed Tomography–Derived Fractional Flow Reserve Based on Structural and Fluid Analysis. J Comput Assist Tomogr 2018; 42:256-262. [DOI: 10.1097/rct.0000000000000679] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Fareed A, Vavere AL, Zimmermann E, Tanami Y, Steveson C, Matheson M, Paul N, Clouse M, Cox C, Lima JA, Arbab-Zadeh A. Impact of iterative reconstruction vs. filtered back projection on image quality in 320-slice CT coronary angiography: Insights from the CORE320 multicenter study. Medicine (Baltimore) 2017; 96:e8452. [PMID: 29310329 PMCID: PMC5728730 DOI: 10.1097/md.0000000000008452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Iterative reconstruction has been shown to reduce image noise compared with traditional filtered back projection with quantum denoising software (FBP/QDS+) in CT imaging but few comparisons have been made in the same patients without the influence of interindividual factors. The objective of this study was to investigate the impact of adaptive iterative dose reduction in 3-dimensional (AIDR 3D) and FBP/QDS+-based image reconstruction on image quality in the same patients.We randomly selected 100 patients enrolled in the coronary evaluation using 320-slice CT study who underwent CT coronary angiography using prospectively electrocardiogram triggered image acquisition with a 320-detector scanner. Both FBP/QDS+ and AIDR 3D reconstructions were performed using original data. Studies were blindly analyzed for image quality by measuring the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Image quality was assessed qualitatively using a 4-point scale.Median age was 63 years (interquartile range [IQR]: 56-71) and 72% were men, median body mass index 27 (IQR: 24-30) and median calcium score 222 (IQR: 11-644). For all regions of interest, mean image noise was lower for AIDR 3D vs. FBP/QDS+ (31.69 vs. 34.37, P ≤ .001). SNR and CNR were significantly higher for AIDR 3D vs. FBP/QDS+ (16.28 vs. 14.64, P < .001 and 19.21 vs. 17.06, P < .001, respectively). Subjective (qualitative) image quality scores were better using AIDR 3D vs. FBP/QDS+ with means of 1.6 and 1.74, respectively (P ≤ .001).Assessed in the same individuals, iterative reconstruction decreased image noise and raised SNR/CNR as well as subjective image quality scores compared with traditional FBP/QDS+ in 320-slice CT coronary angiography at standard radiation doses.
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Affiliation(s)
- Ahmed Fareed
- Department of Medicine/Cardiology Division, Johns Hopkins University, Baltimore, MD
- Department of Medicine/Cardiology Division, Suez Canal University, Ismailia, Egypt
| | - Andrea L. Vavere
- Department of Medicine/Cardiology Division, Johns Hopkins University, Baltimore, MD
| | - Elke Zimmermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Yutaka Tanami
- Department of Medicine/Cardiology Division, Johns Hopkins University, Baltimore, MD
| | - Chloe Steveson
- Toshiba Medical Systems, Otawara, Minato-Ku, Tokyo, Japan
| | - Matthew Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Narinder Paul
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - Melvin Clouse
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Christopher Cox
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - João A.C. Lima
- Department of Medicine/Cardiology Division, Johns Hopkins University, Baltimore, MD
| | - Armin Arbab-Zadeh
- Department of Medicine/Cardiology Division, Johns Hopkins University, Baltimore, MD
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Funama Y, Utsunomiya D, Hirata K, Taguchi K, Nakaura T, Oda S, Kidoh M, Yuki H, Yamashita Y. Improved Estimation of Coronary Plaque and Luminal Attenuation Using a Vendor-specific Model-based Iterative Reconstruction Algorithm in Contrast-enhanced CT Coronary Angiography. Acad Radiol 2017; 24:1070-1078. [PMID: 28396126 DOI: 10.1016/j.acra.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 01/16/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the stabilities of plaque attenuation and coronary lumen for different plaque types, stenotic degrees, lumen densities, and reconstruction methods using coronary vessel phantoms and the visualization of coronary plaques in clinical patients through coronary computed tomography (CT) angiography. MATERIALS AND METHODS We performed 320-detector volume scanning of vessel tubes with stenosis and a tube without stenosis using three types of plaque CT numbers. The stenotic degrees were 50% and 75%. Images were reconstructed with filtered back projection (FBP) and two types of iterative reconstructions (AIDR3D and FIRST [forward-projected model-based iterative reconstruction solution]), with stenotic CT number of approximately 40, 80, and 150 HU (Hounsfield unit), respectively. In each case, the tubing of the coronary vessel was filled with diluted contrast material and distilled water to reach the target lumen CT numbers of approximately 350 HU and 450 HU, and 0 HU, respectively. Peak lumen and plaque CT numbers were measured to calculate the lumen-plaque contrast. In addition, we retrospectively evaluated the image quality with regard to coronary arterial lumen and the plaque in 10 clinical patients on a 4-point scale. RESULTS At 50% stenosis, the plaque CT number with contrast enhancement increased for FBP and AIDR3D, and the difference in the plaque CT number with and without contrast enhancement was 15-44 HU for FBP and 10-31 HU for AIDR3D. However, the plaque CT number for FIRST had a smaller variation and the difference with and without contrast enhancement was -12 to 8 HU. The visual evaluation score for the vessel lumen was 2.8 ± 0.6, 3.5 ± 0.5, and 3.7 ± 0.5 for FBP, AIDR3D, and FIRST, respectively. CONCLUSIONS The FIRST method controls the increase in plaque density and the lumen-plaque contrast. Consequently, it improves the visualization of coronary plaques in coronary CT angiography.
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Affiliation(s)
- Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto 862-0976, Japan.
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichiro Hirata
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsuyuki Taguchi
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideaki Yuki
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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André F, Fortner P, Vembar M, Mueller D, Stiller W, Buss SJ, Kauczor HU, Katus HA, Korosoglou G. Improved image quality with simultaneously reduced radiation exposure: Knowledge-based iterative model reconstruction algorithms for coronary CT angiography in a clinical setting. J Cardiovasc Comput Tomogr 2017; 11:213-220. [DOI: 10.1016/j.jcct.2017.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/16/2017] [Accepted: 02/19/2017] [Indexed: 12/01/2022]
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Precht H, Thygesen J, Gerke O, Egstrup K, Waaler D, Lambrechtsen J. Influence of adaptive statistical iterative reconstruction algorithm on image quality in coronary computed tomography angiography. Acta Radiol Open 2017; 5:2058460116684884. [PMID: 28405477 PMCID: PMC5384491 DOI: 10.1177/2058460116684884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/24/2016] [Indexed: 12/02/2022] Open
Abstract
Background Coronary computed tomography angiography (CCTA) requires high spatial and temporal resolution, increased low contrast resolution for the assessment of coronary artery stenosis, plaque detection, and/or non-coronary pathology. Therefore, new reconstruction algorithms, particularly iterative reconstruction (IR) techniques, have been developed in an attempt to improve image quality with no cost in radiation exposure. Purpose To evaluate whether adaptive statistical iterative reconstruction (ASIR) enhances perceived image quality in CCTA compared to filtered back projection (FBP). Material and Methods Thirty patients underwent CCTA due to suspected coronary artery disease. Images were reconstructed using FBP, 30% ASIR, and 60% ASIR. Ninety image sets were evaluated by five observers using the subjective visual grading analysis (VGA) and assessed by proportional odds modeling. Objective quality assessment (contrast, noise, and the contrast-to-noise ratio [CNR]) was analyzed with linear mixed effects modeling on log-transformed data. The need for ethical approval was waived by the local ethics committee as the study only involved anonymously collected clinical data. Results VGA showed significant improvements in sharpness by comparing FBP with ASIR, resulting in odds ratios of 1.54 for 30% ASIR and 1.89 for 60% ASIR (P = 0.004). The objective measures showed significant differences between FBP and 60% ASIR (P < 0.0001) for noise, with an estimated ratio of 0.82, and for CNR, with an estimated ratio of 1.26. Conclusion ASIR improved the subjective image quality of parameter sharpness and, objectively, reduced noise and increased CNR.
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Affiliation(s)
- Helle Precht
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark; Conrad Research Programme, University College Lillebelt, Odense, Denmark
| | - Jesper Thygesen
- Department of Clinical Engineering, Central Denmark Region, Århus, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Center of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Kenneth Egstrup
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Dag Waaler
- Gjøvik University College, Gjøvik, Norway
| | - Jess Lambrechtsen
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
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Diagnostic accuracy of CT for the detection of left ventricular myocardial fibrosis in various myocardial diseases. Int J Cardiol 2017; 228:375-379. [DOI: 10.1016/j.ijcard.2016.11.140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/06/2016] [Indexed: 11/21/2022]
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Volumetric Single-Beat Coronary Computed Tomography Angiography: Relationship of Image Quality, Heart Rate, and Body Mass Index. Initial Patient Experience With a New Computed Tomography Scanner. J Comput Assist Tomogr 2017; 40:763-72. [PMID: 27331931 DOI: 10.1097/rct.0000000000000428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) image quality (IQ) is very important for accurate diagnosis. We propose to evaluate IQ expressed as Likert scale, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) from coronary CT angiography images acquired with a new volumetric single-beat CT scanner on consecutive patients and assess the IQ dependence on heart rate (HR) and body mass index (BMI). METHODS We retrospectively analyzed the data of the first 439 consecutive patients (mean age, 55.13 [SD, 12.1] years; 51.47% male), who underwent noninvasive coronary CT angiography in a new single-beat volumetric CT scanner (Revolution CT) to evaluate chest pain at West Kendall Baptist Hospital. Based on patient BMI (mean, 29.43 [SD, 5.81] kg/m), the kVp (kilovolt potential) value and tube current were adjusted within a range of 80 to 140 kVp and 122 to 720 mA, respectively. Each scan was performed in a single-beat acquisition within 1 cardiac cycle, regardless of the HR. Motion correction software (SnapShot Freeze) was used for correcting motion artifacts in patients with higher HRs. Autogating was used to automatically acquire systolic and diastolic phases for higher HRs with electrocardiographic milliampere dose modulation. Image quality was assessed qualitatively by Likert scale and quantitatively by SNR and CNR for the 4 major vessels right coronary, left main, left anterior descending, and left circumflex arteries on axial and multiplanar reformatted images. Values for Likert scale were as follows: 1, nondiagnostic; 2, poor; 3, good; 4, very good; and 5, excellent. Signal-to-noise ratio and CNR were calculated from the average 2 CT attenuation values within regions of interest placed in the proximal left main and proximal right coronary artery. For contrast comparison, a region of interest was selected from left ventricular wall at midcavity level using a dedicated workstation. We divided patients in 2 groups related to the HR: less than or equal to 70 beats/min (bpm) and greater than 70 bpm and also analyzed them in 2 BMI groupings: BMI less than or equal to 30 kg/m and BMI greater than 30 kg/m. RESULTS Mean SNR was 8.7 (SD, 3.1) (n = 349) for group with HR 70 bpm or less and 7.7 (SD, 2.4) (n = 78) for group with HR greater than 70 bpm (P = 0.008). Mean CNR was 6.9 (SD, 2.7) (n = 349) for group with HR 70 bpm or less and 5.9 (SD, 2.2) (n = 78) for group with HR 70 bpm or greater (P = 0.002). Mean SNR was 8.8 (SD, 3.2) (n = 249) for group with BMI 30 kg/m or less and 8.1 (SD, 2.6) (n = 176) for group with BMI greater than 30 kg/m (P = 0.008). Mean CNR was 7.0 (SD, 2.8) (n = 249) for group with BMI 30 kg/m or less and 6.4 (SD, 2.4) (n = 176) for group with BMI greater than 30 kg/m (P = 0.002). The results for mean Likert scale values were statistically different, reflecting difference in IQ between people with HR 70 bpm or less and greater than 70 bpm, BMI 30 kg/m or less, and BMI greater than 30 kg/m.
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The Effect of Heart Rate on Exposure Window and Best Phase for Stress Perfusion Computed Tomography. J Comput Assist Tomogr 2017; 41:242-248. [DOI: 10.1097/rct.0000000000000514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Omotayo A, Elbakri I. Objective performance assessment of five computed tomography iterative reconstruction algorithms. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:913-930. [PMID: 27612054 DOI: 10.3233/xst-160601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Iterative algorithms are gaining clinical acceptance in CT. We performed objective phantom-based image quality evaluation of five commercial iterative reconstruction algorithms available on four different multi-detector CT (MDCT) scanners at different dose levels as well as the conventional filtered back-projection (FBP) reconstruction. METHODS Using the Catphan500 phantom, we evaluated image noise, contrast-to-noise ratio (CNR), modulation transfer function (MTF) and noise-power spectrum (NPS). The algorithms were evaluated over a CTDIvol range of 0.75-18.7 mGy on four major MDCT scanners: GE DiscoveryCT750HD (algorithms: ASIR™ and VEO™); Siemens Somatom Definition AS+ (algorithm: SAFIRE™); Toshiba Aquilion64 (algorithm: AIDR3D™); and Philips Ingenuity iCT256 (algorithm: iDose4™). Images were reconstructed using FBP and the respective iterative algorithms on the four scanners. RESULTS Use of iterative algorithms decreased image noise and increased CNR, relative to FBP. In the dose range of 1.3-1.5 mGy, noise reduction using iterative algorithms was in the range of 11%-51% on GE DiscoveryCT750HD, 10%-52% on Siemens Somatom Definition AS+, 49%-62% on Toshiba Aquilion64, and 13%-44% on Philips Ingenuity iCT256. The corresponding CNR increase was in the range 11%-105% on GE, 11%-106% on Siemens, 85%-145% on Toshiba and 13%-77% on Philips respectively. Most algorithms did not affect the MTF, except for VEO™ which produced an increase in the limiting resolution of up to 30%. A shift in the peak of the NPS curve towards lower frequencies and a decrease in NPS amplitude were obtained with all iterative algorithms. VEO™ required long reconstruction times, while all other algorithms produced reconstructions in real time. Compared to FBP, iterative algorithms reduced image noise and increased CNR. CONCLUSIONS The iterative algorithms available on different scanners achieved different levels of noise reduction and CNR increase while spatial resolution improvements were obtained only with VEO™. This study is useful in that it provides performance assessment of the iterative algorithms available from several mainstream CT manufacturers.
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Affiliation(s)
- Azeez Omotayo
- Division of Medical Physics, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Idris Elbakri
- Division of Medical Physics, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, MB, Canada
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Effect of the forward-projected model-based iterative reconstruction solution algorithm on image quality and radiation dose in pediatric cardiac computed tomography. Pediatr Radiol 2016; 46:1663-1670. [PMID: 27531216 DOI: 10.1007/s00247-016-3676-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/22/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Some iterative reconstruction algorithms are useful for reducing the radiation dose in pediatric cardiac CT. A new iterative reconstruction algorithm (forward-projected model-based iterative reconstruction solution) has been developed, but its usefulness for radiation dose reduction in pediatric cardiac CT is unknown. OBJECTIVE To investigate the effect of the new algorithm on CT image quality and on radiation dose in pediatric cardiac CT. MATERIALS AND METHODS We obtained phantom data at six dose levels, as well as pediatric cardiac CT data, and reconstructed CT images using filtered back projection, adaptive iterative dose reduction 3-D (AIDR 3-D) and the new algorithm. We evaluated phantom image quality using physical assessment. Four radiologists performed visual evaluation of cardiac CT image quality. RESULTS In the phantom study, the new algorithm effectively suppressed noise in the low-dose range and moderately generated modulation transfer function, yielding a higher signal-to-noise ratio compared with filtered back projection or AIDR 3-D. When clinical cardiac CT was performed, images obtained by the new method had less perceived image noise and better tissue contrast at similar resolution compared with AIDR 3-D images. CONCLUSION The new algorithm reduced image noise at moderate resolution in low-dose CT scans and improved the perceived quality of cardiac CT images to some extent. This new algorithm might be superior to AIDR 3-D for radiation dose reduction in pediatric cardiac CT.
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Murphy DJ, Keraliya AR, Agrawal MD, Aghayev A, Steigner ML. Cross-sectional imaging of aortic infections. Insights Imaging 2016; 7:801-818. [PMID: 27761883 PMCID: PMC5110479 DOI: 10.1007/s13244-016-0522-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/15/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022] Open
Abstract
Aortic infections are uncommon clinical entities, but are associated with high rates of morbidity and mortality. In this review, we focus on the cross-sectional imaging appearance of aortic infections, including aortic valve endocarditis, pyogenic aortitis, mycotic aneurysm and aortic graft infections, with an emphasis on CT, MRI and PET/CT appearance. Teaching Points • Aortic infections are associated with high morbidity and mortality. • CT, MRI and FDG PET/CT play complementary roles in aortic infection imaging. • Radiologists should be vigilant for aortic infection manifestations to ensure timely diagnosis.
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Affiliation(s)
- D J Murphy
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - A R Keraliya
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - M D Agrawal
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - A Aghayev
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - M L Steigner
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Yun SJ, Jin W, Yoon SH, Chun YS, Cha JG, Koo HS, Park SY, Park JS, Ryu KN, Lee SH, Shin JS. Diagnostic performance of abdominal CT for diagnosis of pelvic fractures: comparison with pelvic CT. Acta Radiol 2016; 57:1244-50. [PMID: 26787672 DOI: 10.1177/0284185115626473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/23/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the emergency department, patients with abdominopelvic trauma inadvertently undergo both abdominal computed tomography (CT) (for intra-abdominal and intra-pelvic organs) and pelvic CT (CT with multiplanar reformation in three orthogonal planes of the bony pelvis). However, the systemic use of CT is concerning given the cumulative radiation dose. PURPOSE To evaluate the diagnostic value of abdominal CT in comparison to pelvic CT in patients with suspected pelvic fractures. MATERIAL AND METHODS Seventy-two patients who underwent abdominal CT and pelvic CT within a 2-week period to evaluate pelvic fractures were included. Two reviewers retrospectively analyzed eight anatomical regions of the pelvic bones on both abdominal CT and pelvic CT over a 1-week interval. The interpretation of pelvic CT scans by two senior musculoskeletal radiologists was considered as the reference standard. Diagnostic performance and inter-observer agreement of both CT scans were evaluated. RESULTS For reviewers 1 and 2, abdominal CT showed high accuracy (98% and 98%, respectively) as did pelvic CT. For both abdominal CT and pelvic CT, fracture detection in all anatomical regions of the pelvic bones was not significantly different for the two reviewers (P ≥ 0.25). Inter-observer agreement for all anatomical regions of the pelvic bones was excellent or good (k = 0.785-1.0). CONCLUSION Not only pelvic CT but also abdominal CT is acceptable for detection of pelvic fractures, in spite of its thicker sections and different reconstruction algorithm. Therefore, if abdominal CT has already been performed, additional pelvic CT might no longer be necessary in order to exclude a pelvic fracture.
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Affiliation(s)
- Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - So Hee Yoon
- Department of Radiology, National Police Hospital, Seoul, Republic of Korea
| | - Young Soo Chun
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hye-Soo Koo
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jong Soo Shin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Sauter A, Koehler T, Fingerle AA, Brendel B, Richter V, Rasper M, Rummeny EJ, Noël PB, Münzel D. Ultra Low Dose CT Pulmonary Angiography with Iterative Reconstruction. PLoS One 2016; 11:e0162716. [PMID: 27611830 PMCID: PMC5017721 DOI: 10.1371/journal.pone.0162716] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/26/2016] [Indexed: 01/01/2023] Open
Abstract
Objective Evaluation of a new iterative reconstruction algorithm (IMR) for detection/rule-out of pulmonary embolism (PE) in ultra-low dose computed tomography pulmonary angiography (CTPA). Methods Lower dose CT data sets were simulated based on CTPA examinations of 16 patients with pulmonary embolism (PE) with dose levels (DL) of 50%, 25%, 12.5%, 6.3% or 3.1% of the original tube current setting. Original CT data sets and simulated low-dose data sets were reconstructed with three reconstruction algorithms: the standard reconstruction algorithm “filtered back projection” (FBP), the first generation iterative reconstruction algorithm iDose and the next generation iterative reconstruction algorithm “Iterative Model Reconstruction” (IMR). In total, 288 CTPA data sets (16 patients, 6 tube current levels, 3 different algorithms) were evaluated by two blinded radiologists regarding image quality, diagnostic confidence, detectability of PE and contrast-to-noise ratio (CNR). Results iDose and IMR showed better detectability of PE than FBP. With IMR, sensitivity for detection of PE was 100% down to a dose level of 12.5%. iDose and IMR showed superiority to FBP regarding all characteristics of subjective (diagnostic confidence in detection of PE, image quality, image noise, artefacts) and objective image quality. The minimum DL providing acceptable diagnostic performance was 12.5% (= 0.45 mSv) for IMR, 25% (= 0.89 mSv) for iDose and 100% (= 3.57 mSv) for FBP. CNR was significantly (p < 0.001) improved by IMR compared to FBP and iDose at all dose levels. Conclusion By using IMR for detection of PE, dose reduction for CTPA of up to 75% is possible while maintaining full diagnostic confidence. This would result in a mean effective dose of approximately 0.9 mSv for CTPA.
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Affiliation(s)
- Andreas Sauter
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Thomas Koehler
- Philips GmbH, Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Alexander A Fingerle
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Bernhard Brendel
- Philips GmbH, Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Vivien Richter
- Department of diagnostic and interventional Radiology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Michael Rasper
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Ernst J Rummeny
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
| | - Peter B Noël
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany.,Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - Daniela Münzel
- Department of diagnostic and interventional Radiology, Technische Universität München, Munich, Germany
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Choi AD, Leifer ES, Yu J, Shanbhag SM, Bronson K, Arai AE, Chen MY. Prospective evaluation of the influence of iterative reconstruction on the reproducibility of coronary calcium quantification in reduced radiation dose 320 detector row CT. J Cardiovasc Comput Tomogr 2016; 10:359-63. [PMID: 27591767 PMCID: PMC7458582 DOI: 10.1016/j.jcct.2016.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/13/2016] [Accepted: 07/16/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) predicts coronary heart disease events and is important for individualized cardiac risk assessment. This report assesses the interscan variability of CT for coronary calcium quantification using image acquisition with standard and reduced radiation dose protocols and whether the use of reduced radiation dose acquisition with iterative reconstruction (IR; "reduced-dose/IR ") allows for similar image quality and reproducibility when compared to standard radiation dose acquisition with filtered back projection (FBP; "standard-dose/FBP") on 320-detector row computed tomography (320-CT). METHODS 200 consecutive patients (60 ± 9 years, 59% male) prospectively underwent two standard- and two reduced-dose acquisitions (800 total scans, 1600 reconstructions) using 320 slice CT and 120 kV tube voltage. Automated tube current modulation was used and for reduced-dose scans, prescribed tube current was lowered by 70%. Image noise and Agatston scores were determined and compared. RESULTS Regarding stratification by Agatston score categories (0, 1-10, 11-100, 101-400, >400), reduced-dose/IR versus standard-dose/FBP had excellent agreement at 89% (95% CI: 86-92%) with kappa 0.86 (95% CI: 0.81-0.90). Standard-dose/FBP rescan agreement was 93% (95% CI: 89-96%) with kappa = 0.91 (95% CI: 0.86-0.95) while reduced-dose/IR rescan agreement was similar at 91% (95% CI: 87-94%) with kappa 0.88 (95% CI: 0.83-0.93). Image noise was significantly higher but clinically acceptable for reduced-dose/IR (18 Hounsfield Unit [HU] mean) compared to standard-dose/FBP (16 HU; p < 0.0001). Median radiation exposure was 74% lower for reduced- (0.37 mSv) versus standard-dose (1.4 mSv) acquisitions. CONCLUSION Rescan agreement was excellent for reduced-dose image acquisition with iterative reconstruction and standard-dose acquisition with filtered back projection for the quantification of coronary calcium by CT. These methods make it possible to reduce radiation exposure by 74%. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov/ct2/show/NCT01621594. UNIQUE IDENTIFIER NCT01621594.
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Affiliation(s)
- Andrew D Choi
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Eric S Leifer
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeannie Yu
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sujata M Shanbhag
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathie Bronson
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew E Arai
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcus Y Chen
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Zhao P, Hou Y, Liu Q, Ma Y, Guo Q. Radiation dose reduction in cardiovascular CT angiography with iterative reconstruction (AIDR 3D) in a swine model: a model of paediatric cardiac imaging. Clin Radiol 2016; 71:716.e7-716.e14. [DOI: 10.1016/j.crad.2016.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 04/05/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
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Sandfort V, Ahlman MA, Jones EC, Selwaness M, Y Chen M, R Folio L, Bluemke DA. High pitch third generation dual-source CT: Coronary and cardiac visualization on routine chest CT. J Cardiovasc Comput Tomogr 2016; 10:282-8. [PMID: 27133589 PMCID: PMC4958576 DOI: 10.1016/j.jcct.2016.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/21/2016] [Accepted: 03/25/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chest CT scans are frequently performed in radiology departments but have not previously contained detailed depiction of cardiac structures. OBJECTIVES To evaluate myocardial and coronary visualization on high-pitch non-gated CT of the chest using 3rd generation dual-source computed tomography (CT). METHODS Cardiac anatomy of patients who had 3rd generation, non-gated high pitch contrast enhanced chest CT and who also had prior conventional (low pitch) chest CT as part of a chest abdomen pelvis exam was evaluated. Cardiac image features were scored by reviewers blinded to diagnosis and pitch. Paired analysis was performed. RESULTS 3862 coronary segments and 2220 cardiac structures were evaluated by two readers in 222 CT scans. Most patients (97.2%) had chest CT for oncologic evaluation. The median pitch was 2.34 (IQR 2.05, 2.65) in high pitch and 0.8 (IQR 0.8, 0.8) in low pitch scans (p < 0.001). High pitch CT showed higher image visualization scores for all cardiovascular structures compared with conventional pitch scans (p < 0.0001). Coronary arteries were visualized in 9 coronary segments per exam in high pitch scans versus 2 segments for conventional pitch (p < 0.0001). Radiation exposure was lower in the high pitch group compared with the conventional pitch group (median CTDIvol 10.83 vs. 12.36 mGy and DLP 790 vs. 827 mGycm respectively, p < 0.01 for both) with comparable image noise (p = 0.43). CONCLUSION Myocardial structure and coronary arteries are frequently visualized on non-gated 3rd generation chest CT. These results raise the question of whether the heart and coronary arteries should be routinely interpreted on routine chest CT that is otherwise obtained for non-cardiac indications.
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Affiliation(s)
- Veit Sandfort
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Mark A Ahlman
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Elizabeth C Jones
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Mariana Selwaness
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Marcus Y Chen
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Les R Folio
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
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Aghayev A, Murphy DJ, Keraliya AR, Steigner ML. Recent developments in the use of computed tomography scanners in coronary artery imaging. Expert Rev Med Devices 2016; 13:545-53. [PMID: 27140944 DOI: 10.1080/17434440.2016.1184968] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Within the past decade, substantial evolution of Coronary CT Angiography (CCTA) has affected evaluation and management of coronary artery disease. In particular, technical advancement of hardware technology and image reconstruction of CT scanners have played an important role in this context making it possible to acquire abundant data with excellent temporal and spatial resolution within a shorter scan time. In addition, a concern related to the high radiation exposure in the initial noninvasive coronary artery imaging has triggered improvement in dose reduction techniques. AREAS COVERED In this review article, we have focused on recent technological developments in CT scanners and the impact of these developments on CCTA parameters. Expert Commentary: CCTA plays an important role in coronary artery disease management, and technical development of the CT scanners can be expected to address and remedy technical limitations.
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Affiliation(s)
- Ayaz Aghayev
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - David J Murphy
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - Abhishek R Keraliya
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - Michael L Steigner
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
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Diagnostic Phase of Calcium Scoring Scan Applied as the Center of Acquisition Window of Coronary Computed Tomography Angiography Improves Image Quality in Minimal Acquisition Window Scan (Target CTA Mode) Using the Second Generation 320-Row CT. ScientificWorldJournal 2016; 2016:1017851. [PMID: 26977449 PMCID: PMC4764755 DOI: 10.1155/2016/1017851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 11/30/2022] Open
Abstract
Objective. To compare the image quality of coronary computed tomography angiography (CCTA) acquired under two conditions: 75% fixed as the acquisition window center (Group 75%) and the diagnostic phase for calcium scoring scan as the center (CS; Group CS). Methods. 320-row cardiac CT with a minimal acquisition window (scanned using “Target CTA” mode) was performed on 81 patients. In Group 75% (n = 40), CS was obtained and reconstructed at 75% and the center of the CCTA acquisition window was set at 75%. In Group CS (n = 41), CS was obtained at 75% and the diagnostic phase showing minimal artifacts was applied as the center of the CCTA acquisition window. Image quality was evaluated using a four-point scale (4-excellent) and the mean scores were compared between groups. Results. The CCTA scan diagnostic phase occurred significantly earlier in CS (75.7 ± 3.2% vs. 73.6 ± 4.5% for Groups 75% and CS, resp., p = 0.013). The mean Group CS image quality score (3.58 ± 0.63) was also higher than that for Group 75% (3.19 ± 0.66, p < 0.0001). Conclusions. The image quality of CCTA in Target CTA mode was significantly better when the center of acquisition window is adjusted using CS.
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Chien N, Wang TD, Chang YC, Lin PC, Tseng YH, Lee YF, Ko WC, Lee BC, Lee WJ. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals. ACTA CARDIOLOGICA SINICA 2016; 32:167-73. [PMID: 27122947 PMCID: PMC4816915 DOI: 10.6515/acs20150826a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/26/2015] [Indexed: 01/17/2023]
Abstract
UNLABELLED Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic individuals. KEY WORDS Acute chest pain • Computed tomography • Coronary artery disease • Health screening • Stable angina.
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Affiliation(s)
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine
| | | | - Po-Chih Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine
| | | | | | | | - Bai-Chin Lee
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Wen-Jeng Lee
- Department of Medical Imaging
- Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
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Cai T, Rybicki FJ, Giannopoulos AA, Schultz K, Kumamaru KK, Liacouras P, Demehri S, Shu Small KM, Mitsouras D. The residual STL volume as a metric to evaluate accuracy and reproducibility of anatomic models for 3D printing: application in the validation of 3D-printable models of maxillofacial bone from reduced radiation dose CT images. 3D Print Med 2015; 1:2. [PMID: 30050971 PMCID: PMC6036610 DOI: 10.1186/s41205-015-0003-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 11/18/2022] Open
Abstract
Background The effects of reduced radiation dose CT for the generation of maxillofacial bone STL models for 3D printing is currently unknown. Images of two full-face transplantation patients scanned with non-contrast 320-detector row CT were reconstructed at fractions of the acquisition radiation dose using noise simulation software and both filtered back-projection (FBP) and Adaptive Iterative Dose Reduction 3D (AIDR3D). The maxillofacial bone STL model segmented with thresholding from AIDR3D images at 100 % dose was considered the reference. For all other dose/reconstruction method combinations, a “residual STL volume” was calculated as the topologic subtraction of the STL model derived from that dataset from the reference and correlated to radiation dose. Results The residual volume decreased with increasing radiation dose and was lower for AIDR3D compared to FBP reconstructions at all doses. As a fraction of the reference STL volume, the residual volume decreased from 2.9 % (20 % dose) to 1.4 % (50 % dose) in patient 1, and from 4.1 % to 1.9 %, respectively in patient 2 for AIDR3D reconstructions. For FBP reconstructions it decreased from 3.3 % (20 % dose) to 1.0 % (100 % dose) in patient 1, and from 5.5 % to 1.6 %, respectively in patient 2. Its morphology resembled a thin shell on the osseous surface with average thickness <0.1 mm. Conclusion The residual volume, a topological difference metric of STL models of tissue depicted in DICOM images supports that reduction of CT dose by up to 80 % of the clinical acquisition in conjunction with iterative reconstruction yields maxillofacial bone models accurate for 3D printing.
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Affiliation(s)
- Tianrun Cai
- Applied Imaging Science Lab, Department of Radiology, Brigham and Women's Hospital, Boston, MA USA
| | - Frank J Rybicki
- The Ottawa Hospital Research Institute and Medical Imaging, Ottawa, ON Canada.,Department of Radiology, University of Ottawa, Ottawa, ON Canada
| | - Andreas A Giannopoulos
- Applied Imaging Science Lab, Department of Radiology, Brigham and Women's Hospital, Boston, MA USA
| | - Kurt Schultz
- Toshiba Medical Research Institute USA, Vernon Hills, IL USA
| | | | - Peter Liacouras
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD USA
| | - Shadpour Demehri
- Division of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD USA
| | | | - Dimitris Mitsouras
- Department of Radiology, Brigham and Women's Hospital, Boston, MA USA.,Applied Imaging Science Lab, Department of Radiology, Brigham and Women's Hospital, Boston, MA USA
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Image Quality and Radiation Dose of CT Coronary Angiography with Automatic Tube Current Modulation and Strong Adaptive Iterative Dose Reduction Three-Dimensional (AIDR3D). PLoS One 2015; 10:e0142185. [PMID: 26599111 PMCID: PMC4657884 DOI: 10.1371/journal.pone.0142185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate image quality and radiation dose of CT coronary angiography (CTCA) scanned using automatic tube current modulation (ATCM) and reconstructed by strong adaptive iterative dose reduction three-dimensional (AIDR3D). Methods Eighty-four consecutive CTCA patients were collected for the study. All patients were scanned using ATCM and reconstructed with strong AIDR3D, standard AIDR3D and filtered back-projection (FBP) respectively. Two radiologists who were blinded to the patients' clinical data and reconstruction methods evaluated image quality. Quantitative image quality evaluation included image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). To evaluate image quality qualitatively, coronary artery is classified into 15 segments based on the modified guidelines of the American Heart Association. Qualitative image quality was evaluated using a 4-point scale. Radiation dose was calculated based on dose-length product. Results Compared with standard AIDR3D, strong AIDR3D had lower image noise, higher SNR and CNR, their differences were all statistically significant (P<0.05); compared with FBP, strong AIDR3D decreased image noise by 46.1%, increased SNR by 84.7%, and improved CNR by 82.2%, their differences were all statistically significant (P<0.05 or 0.001). Segments with diagnostic image quality for strong AIDR3D were 336 (100.0%), 486 (96.4%), and 394 (93.8%) in proximal, middle, and distal part respectively; whereas those for standard AIDR3D were 332 (98.8%), 472 (93.7%), 378 (90.0%), respectively; those for FBP were 217 (64.6%), 173 (34.3%), 114 (27.1%), respectively; total segments with diagnostic image quality in strong AIDR3D (1216, 96.5%) were higher than those of standard AIDR3D (1182, 93.8%) and FBP (504, 40.0%); the differences between strong AIDR3D and standard AIDR3D, strong AIDR3D and FBP were all statistically significant (P<0.05 or 0.001). The mean effective radiation dose was (2.55±1.21) mSv. Conclusion Compared with standard AIDR3D and FBP, CTCA with ATCM and strong AIDR3D could significantly improve both quantitative and qualitative image quality.
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Image quality and dose optimisation for infant CT using a paediatric phantom. Eur Radiol 2015; 26:1387-95. [DOI: 10.1007/s00330-015-3951-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 07/24/2015] [Accepted: 07/28/2015] [Indexed: 01/17/2023]
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Subtraction coronary computed tomography in patients with severe calcification. Int J Cardiovasc Imaging 2015; 31:1635-42. [DOI: 10.1007/s10554-015-0746-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 08/14/2015] [Indexed: 12/21/2022]
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Mirsadraee S, Weir N, Connolly S, Murchison J, Reid J, Hirani N, Connell M, van Beek E. Feasibility of radiation dose reduction using AIDR-3D in dynamic pulmonary CT perfusion. Clin Radiol 2015; 70:844-51. [DOI: 10.1016/j.crad.2015.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/20/2015] [Accepted: 04/17/2015] [Indexed: 01/05/2023]
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Geyer LL, Schoepf UJ, Meinel FG, Nance JW, Bastarrika G, Leipsic JA, Paul NS, Rengo M, Laghi A, De Cecco CN. State of the Art: Iterative CT Reconstruction Techniques. Radiology 2015. [PMID: 26203706 DOI: 10.1148/radiol.2015132766] [Citation(s) in RCA: 439] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Lucas L Geyer
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - U Joseph Schoepf
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Felix G Meinel
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - John W Nance
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Gorka Bastarrika
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Jonathon A Leipsic
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Narinder S Paul
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Marco Rengo
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Andrea Laghi
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Carlo N De Cecco
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
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Deseive S, Chen MY, Korosoglou G, Leipsic J, Martuscelli E, Carrascosa P, Mirsadraee S, White C, Hadamitzky M, Martinoff S, Menges AL, Bischoff B, Massberg S, Hausleiter J. Prospective Randomized Trial on Radiation Dose Estimates of CT Angiography Applying Iterative Image Reconstruction. JACC Cardiovasc Imaging 2015; 8:888-96. [DOI: 10.1016/j.jcmg.2015.02.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/03/2015] [Accepted: 02/05/2015] [Indexed: 12/15/2022]
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Zhao L, Plank F, Kummann M, Burghard P, Klauser A, Dichtl W, Feuchtner G. Improved non-calcified plaque delineation on coronary CT angiography by sonogram-affirmed iterative reconstruction with different filter strength and relationship with BMI. Cardiovasc Diagn Ther 2015; 5:104-12. [PMID: 25984450 DOI: 10.3978/j.issn.2223-3652.2015.03.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/13/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE To prospectively compare non-calcified plaque delineation and image quality of coronary computed tomography angiography (CCTA) obtained with sinogram-affirmed iterative reconstruction (IR) with different filter strengths and filtered back projection (FBP). METHODS A total of 57 patients [28.1% females; body mass index (BMI) 29.2±6.5 kg/m(2)] were investigated. CCTA was performed using 128-slice dual-source CT. Images were reconstructed with standard FBP and sinogram-affirmed IR using different filter strength (IR-2, IR-3, IR-4) (SAFIRE, Siemens, Germany). Image quality of CCTA and a non-calcified plaque outer border delineation score were evaluated by using a 5-scale score: from 1= poor to 5= excellent. Image noise, contrast-to-noise ratio (CNR) of aortic root, left main (LM) and right coronary artery, and the non-calcified plaque delineation were quantified and compared among the 4 image reconstructions, and were compared between different BMI groups (BMI <28 and ≥28). Statistical analyses included one-way analysis of variance (ANOVA), least significant difference (LSD) and Kruskal-Wallis test. RESULTS There were 71.9% patients in FBP, 96.5% in IR-2, 96.5% in IR-3 and 98.2% in IR-4 who had overall CCTA image quality ≥3, and there were statistical differences in CCTA exam image quality score among those groups, respectively (P<0.001). Sixty-one non-calcified plaques were detected by IR-2 to IR-4, out of those 11 (18%) were missed by FBP. Plaque delineation score increased constantly from FBP (2.7±0.4) to IR-2 (3.2±0.3), to IR-3 (3.5±0.3) up to IR-4 (4.0±0.4), while CNRs of the non-calcifying plaque increased and image noise decreased, respectively. Similarly, CNR of aortic root, LM and right coronary artery improved and image noise declined from FBP to IR-2, IR-3 and IR-4. There were no significant differences of image quality and plaque delineation score between low and high BMI groups within same reconstruction (all P>0.05). Significant differences in image quality and plaque delineation scores among different image reconstructions both in low and high BMI groups (all P<0.001) were found. I4f revealed the highest image quality and plaque delineation score. CONCLUSIONS IR offers improved image quality and non-calcified plaque delineation as compared with FBP, especially if BMI is increasing. Importantly, 18% of non-calcified plaques were missed with FBP. IR-4 shows the best image quality score and plaque delineation score among the different IR-filter strength.
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Affiliation(s)
- Lei Zhao
- 1 Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Chaoyang District, Beijing 100029, China ; 2 Innsbruck Medical University, Department of Radiology, 3 Innsbruck Medical University, Department of Cardiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Tyrol, Austria
| | - Fabian Plank
- 1 Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Chaoyang District, Beijing 100029, China ; 2 Innsbruck Medical University, Department of Radiology, 3 Innsbruck Medical University, Department of Cardiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Tyrol, Austria
| | - Moritz Kummann
- 1 Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Chaoyang District, Beijing 100029, China ; 2 Innsbruck Medical University, Department of Radiology, 3 Innsbruck Medical University, Department of Cardiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Tyrol, Austria
| | - Philipp Burghard
- 1 Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Chaoyang District, Beijing 100029, China ; 2 Innsbruck Medical University, Department of Radiology, 3 Innsbruck Medical University, Department of Cardiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Tyrol, Austria
| | - Andrea Klauser
- 1 Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Chaoyang District, Beijing 100029, China ; 2 Innsbruck Medical University, Department of Radiology, 3 Innsbruck Medical University, Department of Cardiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Tyrol, Austria
| | - Wolfgang Dichtl
- 1 Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Chaoyang District, Beijing 100029, China ; 2 Innsbruck Medical University, Department of Radiology, 3 Innsbruck Medical University, Department of Cardiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Tyrol, Austria
| | - Gudrun Feuchtner
- 1 Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Chaoyang District, Beijing 100029, China ; 2 Innsbruck Medical University, Department of Radiology, 3 Innsbruck Medical University, Department of Cardiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Tyrol, Austria
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The Impact of Different Levels of Adaptive Iterative Dose Reduction 3D on Image Quality of 320-Row Coronary CT Angiography: A Clinical Trial. PLoS One 2015; 10:e0125943. [PMID: 25945924 PMCID: PMC4422621 DOI: 10.1371/journal.pone.0125943] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/22/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was the systematic image quality evaluation of coronary CT angiography (CTA), reconstructed with the 3 different levels of adaptive iterative dose reduction (AIDR 3D) and compared to filtered back projection (FBP) with quantum denoising software (QDS). Methods Standard-dose CTA raw data of 30 patients with mean radiation dose of 3.2 ± 2.6 mSv were reconstructed using AIDR 3D mild, standard, strong and compared to FBP/QDS. Objective image quality comparison (signal, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), contour sharpness) was performed using 21 measurement points per patient, including measurements in each coronary artery from proximal to distal. Results Objective image quality parameters improved with increasing levels of AIDR 3D. Noise was lowest in AIDR 3D strong (p≤0.001 at 20/21 measurement points; compared with FBP/QDS). Signal and contour sharpness analysis showed no significant difference between the reconstruction algorithms for most measurement points. Best coronary SNR and CNR were achieved with AIDR 3D strong. No loss of SNR or CNR in distal segments was seen with AIDR 3D as compared to FBP. Conclusions On standard-dose coronary CTA images, AIDR 3D strong showed higher objective image quality than FBP/QDS without reducing contour sharpness. Trial Registration Clinicaltrials.gov NCT00967876
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Iterative reconstruction in cardiac CT. J Cardiovasc Comput Tomogr 2015; 9:255-63. [PMID: 26088375 DOI: 10.1016/j.jcct.2015.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 12/29/2022]
Abstract
Iterative reconstruction (IR) has the ability to reduce image noise in CT without compromising diagnostic quality, which permits a significant reduction in effective radiation dose. This been increasingly integrated into clinical CT practice over the past 7 years and has been particularly important in the field of cardiac CT with multiple vendors introducing cardiac CT-compatible IR algorithms. The following review will summarize the principles of IR algorithms, studies validating their noise- and dose-reducing abilities, and the specific applications of IR in cardiac CT.
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Radiation dose reduction for coronary artery calcium scoring at 320-detector CT with adaptive iterative dose reduction 3D. Int J Cardiovasc Imaging 2015; 31:1045-52. [DOI: 10.1007/s10554-015-0637-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/05/2015] [Indexed: 12/20/2022]
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Abstract
OBJECTIVE. The purpose of this study was to comprehensively study estimated radiation doses for subjects included in the main analysis of the Combined Non-invasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography (CORE320) study ( ClinicalTrials.gov identifier NCT00934037), a clinical trial comparing combined CT angiography (CTA) and perfusion CT with the reference standard catheter angiography plus myocardial perfusion SPECT. SUBJECTS AND METHODS. Prospectively acquired data on 381 CORE320 subjects were analyzed in four groups of testing related to radiation exposure. Radiation dose estimates were compared between modalities for combined CTA and perfusion CT with respect to covariates known to influence radiation exposure and for the main clinical outcomes defined by the trial. The final analysis assessed variations in radiation dose with respect to several factors inherent to the trial. RESULTS. The mean radiation dose estimate for the combined CTA and perfusion CT protocol (8.63 mSv) was significantly (p < 0.0001 for both) less than the average dose delivered from SPECT (10.48 mSv) and the average dose from diagnostic catheter angiography (11.63 mSv). There was no significant difference in estimated CTA-perfusion CT radiation dose for subjects who had false-positive or false-negative results in the CORE320 main analyses in a comparison with subjects for whom the CTA-perfusion CT findings were in accordance with the reference standard SPECT plus catheter angiographic findings. CONCLUSION. Radiation dose estimates from CORE320 support clinical implementation of a combined CT protocol for assessing coronary anatomy and myocardial perfusion.
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Palacio D, Betancourt S, Gladish GW. Screening for coronary heart disease in asymptomatic patients using multidetector computed tomography: calcium scoring and coronary computed tomography angiography. Semin Roentgenol 2014; 50:111-7. [PMID: 25770341 DOI: 10.1053/j.ro.2014.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Diana Palacio
- Department of Radiology, University of Arizona, College of Medicine, Tucson, AZ.
| | - Sonia Betancourt
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory W Gladish
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
OBJECTIVE The purpose of this article is to describe the evaluation of congenital coronary artery fistulas (CAFs) with MDCT angiography with ECG gating (MDCTA), including the clinical manifestations, scanning techniques, differential diagnosis, and other imaging methods that may be used. CONCLUSION Congenital CAFs are rare coronary artery anomalies of termination. MDCTA is a first-line modality for pretreatment planning, and imaging findings should be recognized because CAFs may be detected incidentally.
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Wong DTL, Soh SY, Ko BSH, Cameron JD, Crossett M, Nasis A, Troupis J, Meredith IT, Seneviratne SK. Superior CT coronary angiography image quality at lower radiation exposure with second generation 320-detector row CT in patients with elevated heart rate: a comparison with first generation 320-detector row CT. Cardiovasc Diagn Ther 2014; 4:299-306. [PMID: 25276615 DOI: 10.3978/j.issn.2223-3652.2014.08.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study aims to compare the image quality of second generation versus first generation 320-computed tomography coronary angiography (CTCA) in patients with heart rate ≥65 bpm as it has not been specifically reported. METHODS Consecutive patients who underwent CTCA using second-generation-320-detector-row-CT were prospectively enrolled. A total of 50 patients with elevated (≥65 bpm) heart rate and 50 patients with controlled (<65 bpm) heart rate were included. Age and gender matched patients who were scanned with the first-generation-320-detector-row-CT were retrospectively identified. Image quality in each coronary artery segment was assessed by two blinded CT angiographers using the five-point Likert scale. RESULTS In the elevated heart rate cohorts, while there was no significant difference in heart rate during scan-acquisition (66 vs. 69 bpm, P=0.308), or body mass index (28.5 vs. 29.6, P=0.464), the second generation scanner was associated with better image quality (3.94±0.6 vs. 3.45±0.8, P=0.001), and with lower radiation (2.8 vs. 4.3 mSv, P=0.009). There was no difference in scan image quality for the controlled heart rate cohorts. CONCLUSIONS The second generation CT scanner provides better image quality at lower radiation dose in patients with elevated heart rate (≥65 bpm) compared to first generation CT scanner.
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Affiliation(s)
- Dennis T L Wong
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Siang Y Soh
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Brian S H Ko
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - James D Cameron
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Marcus Crossett
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Arthur Nasis
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - John Troupis
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Ian T Meredith
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Sujith K Seneviratne
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
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The Ethics of Publishing Dual Exposure Scans Involving Ionizing Radiation When Validated Alternatives Exist. JACC Cardiovasc Imaging 2014; 7:963-4. [DOI: 10.1016/j.jcmg.2014.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/18/2022]
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Yamashiro T, Miyara T, Honda O, Kamiya H, Murata K, Ohno Y, Tomiyama N, Moriya H, Koyama M, Noma S, Kamiya A, Tanaka Y, Murayama S, for the investigators of ACTIve Study Group. Adaptive Iterative Dose Reduction Using Three Dimensional Processing (AIDR3D) improves chest CT image quality and reduces radiation exposure. PLoS One 2014; 9:e105735. [PMID: 25153797 PMCID: PMC4143266 DOI: 10.1371/journal.pone.0105735] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the advantages of Adaptive Iterative Dose Reduction using Three Dimensional Processing (AIDR3D) for image quality improvement and dose reduction for chest computed tomography (CT). Methods Institutional Review Boards approved this study and informed consent was obtained. Eighty-eight subjects underwent chest CT at five institutions using identical scanners and protocols. During a single visit, each subject was scanned using different tube currents: 240, 120, and 60 mA. Scan data were converted to images using AIDR3D and a conventional reconstruction mode (without AIDR3D). Using a 5-point scale from 1 (non-diagnostic) to 5 (excellent), three blinded observers independently evaluated image quality for three lung zones, four patterns of lung disease (nodule/mass, emphysema, bronchiolitis, and diffuse lung disease), and three mediastinal measurements (small structure visibility, streak artifacts, and shoulder artifacts). Differences in these scores were assessed by Scheffe's test. Results At each tube current, scans using AIDR3D had higher scores than those without AIDR3D, which were significant for lung zones (p<0.0001) and all mediastinal measurements (p<0.01). For lung diseases, significant improvements with AIDR3D were frequently observed at 120 and 60 mA. Scans with AIDR3D at 120 mA had significantly higher scores than those without AIDR3D at 240 mA for lung zones and mediastinal streak artifacts (p<0.0001), and slightly higher or equal scores for all other measurements. Scans with AIDR3D at 60 mA were also judged superior or equivalent to those without AIDR3D at 120 mA. Conclusion For chest CT, AIDR3D provides better image quality and can reduce radiation exposure by 50%.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
- * E-mail:
| | - Tetsuhiro Miyara
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Osamu Honda
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hisashi Kamiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima-shi, Fukushima, Japan
| | - Mitsuhiro Koyama
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Satoshi Noma
- Department of Radiology, Tenri Hospital, Tenri, Nara, Japan
| | - Ayano Kamiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Yuko Tanaka
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
- Center for Clinical Training, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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