Dose-Wise Scanning in Visceral Computed Tomography Angiography: A Phantom Study

Virtual single source CT using dual source acquisition: Clinical applicability in run-off CT-angiography for intra-individual comparison of different scan protocols

PURPOSE

Virtual single source computed tomography (VSS-CT) acquisition on a dual source CT (DSCT) has been demonstrated to allow for dose-neutral intra-individual comparison of three acquisition protocols at different radiation dose levels (RDL) within one acquisition in a phantom. The purpose of this study was twofold: first to evaluate the applicability of VSS-CT in patients and second to optimize the task-dependent trade-off between radiation dose and image quality of lower extremity CT angiography (run-off CTA).

MATERIAL AND METHODS

In this IRB-approved prospective study 52 patients underwent run-off CTA between 06/2012 and 06/2013. VSS-CT acquisition was conducted using a first generation DSCT applying equal X-ray tube settings (120 kVp), collimation (2 × 32 × 0.6 mm), and slice thickness (1.0 mm) but different effective tube current-time products (tube A: 80 mAs, tube B: 40 mAs). Three different image datasets representing three different radiation dose levels (RDL40, RDL80, RDL120) were reconstructed using a soft kernel from the raw data of tube B, tube A or both tubes combined. Dose length products (DLP) of each raw data set were documented. Quantitative image quality (IQ) was assessed for five anatomical levels using image noise and contrast-to-noise ratio (CNR). To investigate dose efficiency of each acquisition, the dose-weighted CNR (CNRD) was determined. Qualitative IQ was evaluated by two blinded readers in consensus using a 5-point Likert scale and compared with a Friedman- and posthoc Wilcoxon test.

RESULTS

Mean DLP was 200 ± 40, 400 ± 90 and 600 ± 130 mGy·cm for the RDL40, RDL80 and RDL120, respectively. Image noise and CNR were best for RDL120 and decreased significantly for RDL80 and RDL40, independent of the anatomic level (p < 0.001). CNRD showed no significant differences at the abdominal and pelvic level between the investigated radiation dose levels. However, for thigh to foot level a significant increase of CNRD was noted between RDL120, RDL80 and RDL40. Significant differences of qualitative IQ were observed between RDL120 and RDL40 from the abdominal to the foot level, whereas no difference was seen for the other dose levels.

CONCLUSION

Radiation dose splitting with VSS-CT can be applied to run-off CTA facilitating intra-individual comparison of different acquisition protocols without additional radiation exposure. Furthermore, a radiation dose reduction potential for run-off CTA of approximately 1/3 as compared to the acquisition protocol recommended by the manufacturer could be identified in this study.

Ultra-high resolution C-Arm CT arthrography of the wrist: Radiation dose and image quality compared to conventional multidetector computed tomography

OBJECTIVE

Objective of this phantom and cadaveric study was to compare the effective radiation dose (ED) and image quality (IQ) between C-arm computed tomography (CACT) using an ultra-high resolution 1×1 binning with a standard 16-slice CT (MDCT) arthrography of the wrist.

METHODS

ED was determined with thermoluminescence dosimetry using an anthropomorphic phantom and different patient positions. Imaging was conducted in 10 human cadaveric wrists after tri-compartmental injection of diluted iodinated contrast material and a wire phantom. IQ of MDCT was compared with CACT reconstructed with a soft (CACT1) and sharp (CACT2) kernel. High and low contrast resolution was determined. Three radiologists assessed IQ of wrist structures and occurrence of image artifacts using a 5-point Likert scale.

RESULTS

ED of MDCT was comparable to standard CACT (4.3μSv/3.7μSv). High contrast resolution was best for CACT2, decreased to CACT1 and MDCT. Low contrast resolution increased between CACT2 and MDCT (P<0.001). IQ was best for CACT2 (1.3±0.5), decreased to CACT1 (1.9±0.6) and MDCT (3.5±0.6). Non-compromising artifacts were only reported for CACT.

CONCLUSIONS

The results of this phantom and cadaveric study indicate that ultra-high resolution C-Arm CT arthrography of the wrist bears the potential to outperform MDCT arthrography in terms of image quality and workflow at the cost of mildly increasing image artifacts while radiation dose to the patient is comparably low for both, MDCT and C-Arm CT.

Collimation and Image Quality of C-Arm Computed Tomography: Potential of Radiation Dose Reduction While Maintaining Equal Image Quality

OBJECTIVES

The aim of this study was to assess the potential for radiation dose reduction in collimated C-arm computed tomography (CACT) while maintaining the image quality of the full field of view (FFOV) acquisition.

MATERIAL AND METHODS

A whole-body anthropomorphic phantom representing a 70-kg male was used in this study. The upper abdomen of the phantom was imaged using an angiographic system (Artis Zeego Q; Siemens Healthcare, Germany) with either the standard detector radiation dose level (RDL; D100, 360 nGy) or 14 experimental reduced RDLs ranging from 95% (D95, 342 nGy) to 30% D100 (D30, 108 nGy). Either the FFOV (craniocaudal coverage, 18 cm) or a collimated field of view (CFOV; craniocaudal coverage, 6 cm) was applied. The organ dose was measured using thermoluminescence detector dosimetry, and the mean effective dose was computed according to the recommendations by the International Commission on Radiological Protection Publication 103. To compare the CFOV and the FFOV data sets, image quality was assessed in terms of high- and low-contrast resolution by calculating the modulation transfer function using the wire method as well as the image noise, signal-to-noise ratio, and contrast-to-noise ratio using a low-contrast insert placed in the upper abdomen (Δ50 HU).

RESULTS

Collimated imaging (CFOV) covering 33% of the FFOV led to an increase in the x-ray tube output of 152% for CFOV (D100; FFOV, 95.5 mGy; CFOV, 147.7 mGy) to maintain the detector dose. The mean effective dose of D100 was 6.0 mSv (male) and 6.2 mSv (female) for the FFOV and 3.7 mSv (male) and 4.1 mSv (female) for the CFOV. High-contrast resolution was comparable for all acquisition protocols (mean 10% modulation transfer function ± 95% confidence interval; FFOV, 8.8 ± 0.1 line pairs/cm; CFOV, 8.8 ± 0.1 line pairs/cm). Low-contrast resolution was superior for the CFOV compared with that for the FFOV for each RDL (D100; image noise: FFOV, 34 ± 2 HU; CFOV, 22 ± 1 HU; contrast-to-noise ratio: FFOV, 1.3 ± 0.2; CFOV, 1.8 ± 0.3). Low-contrast resolution of the standard (D100) FFOV acquisition was achieved for the CFOV at 84% D100 of the FFOV and 54% D100 of the CFOV. Therefore, collimation up to 33% of the FFOV combined with the lower detector dose allows overall reduction of a patient's radiation exposure to 33% × 84% = 28% compared with FFOV acquisition. In the upper abdomen, this results in a nearly 50% reduction of the mean effective radiation dose (male, 2.0 mSv; female, 2.2 mSv) without loss of image quality compared with the standard FFOV acquisition.

CONCLUSIONS

Craniocaudal collimation in CACT should be used whenever possible to increase the image quality and reduce the patient's overall radiation exposure. Therefore, new smart acquisition protocols are required for collimated CACT to improve the trade-off between radiation exposure and image quality requirements considering the collimation used.

Virtual single-source computed tomography using dual-source acquisition: a new technique for the dose-neutral intraindividual comparison of different scan protocols

OBJECTIVES

The objective of this study was to compare the image quality of a standard single-source (SSS) computed tomography (CT) with that of a virtual single-source CT (VSS-CT) data set reconstructed from 2 raw data sets obtained by dual-source CT acquisition in abdominal CT to establish a radiation dose-neutral approach for the intraindividual comparison of 3 acquisition protocols at different radiation dose levels (RDLs).

MATERIALS AND METHODS

An abdominal phantom representing an 80-kg male was imaged using dual-source CT (SOMATOM Definition; Siemens Healthcare) at 3 RDLs with 120 kV(p) and different tube currents (low, standard, and high milliampere-second protocol). For each RDL, raw data were obtained once in single-source mode using x-ray tube A only and 5 times in dual-source mode using different ratios for tube current of x-ray tubes A and B (same total radiation dose; A/B: 90%/10%, 80%/20%, 70%/30%, 60%/40%, 50%/50%). For each RDL, SSS-CT and 5 virtual single-source image data sets (VSS-CT50 - 90) were reconstructed. To compare SSS-CT and VSS-CT data sets, image quality was assessed in terms of high- and low-contrast performance by calculating the modulation transfer function, image noise, noise power spectrum, and, for low contrast lesion detectability, the modified multiscale structural similarity index (MS-SSIM*). A maximum decrease of Δ = 5% of image quality compared with SSS-CT was defined as acceptable, and a noninferiority analysis with Δ was performed.

RESULTS

For modulation transfer function, noninferiority was observed for all VSS-CT data sets and RDL (P < 0.05). Image noise demonstrated an acceptable increase (<3.2%, P < 0.05) for each RDL and noise power spectrum showed only minor differences in the midfrequency range. The MS-SSIM* index demonstrated for the high RDL protocol a minor decrease for VSS-CT data sets (<2%, P < 0.05). For the standard and low RDL, the relative differences of the MS-SSIM* index increased and were only in 1 case above Δ (standard RDL, mean VSS-CT80 5.1%, P > 0.05).

CONCLUSIONS

The image quality obtained by virtual and SSS reconstruction using equivalent total radiation exposure to the patient showed only negligible differences in image quality. Therefore, this technique might allow an intraindividual comparison of full and reduced radiation dose protocols within 1 image acquisition step by simply splitting the radiation dose between the 2 x-ray tubes of a dual-source CT.

Diagnostic confidence of run-off CT-angiography as the primary diagnostic imaging modality in patients presenting with acute or chronic peripheral arterial disease

Objectives

To investigate the reliability of CT-angiography of the lower extremities (run-off CTA) to derive a treatment decision in patients with acute and chronic peripheral artery disease (PAD).

Materials and Methods

314 patients referred for run-off CTA were includ-ed in this retrospective study. First, diagnostic confidence of run-off CTA to derive a treat-ment decision was assessed in an interdisciplinary vascular conference using a 2 point scale (sufficient or not sufficient diagnostic confidence) and compared with the image quality eval-uated by two readers in consensus in four different levels (abdominopelvic, thigh, calf, foot arteries). Second, reliability of treatment decision was verified in all patients undergoing re-vascularization therapy.

Results

Diagnostic confidence of run-off CTA to derive a treatment deci-sion was sufficient in all patients with acute and in 97% of patients (215/221) with chronic PAD, whereas the rate of run-off CTA with non-diagnostic image quality was considerably higher in the calf and foot level (acute vs. chronic; calf: 28% vs.17%; foot: 52% vs. 20%). Reliability of treatment decision was superior for patients with chronic (123/133 = 92%) than for patients with acute PAD (64/78 = 82%, P = 0.02).

Conclusion

Run-off CTA is a reliable imaging modality for primary diag-nostic work-up of patients with acute and chronic PAD.