Reduction of the radiation dose and the amount of contrast material in hepatic dynamic CT using low tube voltage and adaptive iterative dose reduction 3-dimensional

Atsushi Nakamoto, Kiyohito Yamamoto, Makoto Sakane, Go Nakai, Akira Higashiyama, Hiroshi Juri, Shushi Yoshikawa, Yoshifumi Narumi, Atsushi Nakamoto, Kiyohito Yamamoto, Makoto Sakane, Go Nakai, Akira Higashiyama, Hiroshi Juri, Shushi Yoshikawa, Yoshifumi Narumi

Abstract

The purpose of this study was to prospectively evaluate the image quality and the diagnostic ability of low tube voltage and reduced contrast material dose hepatic dynamic computed tomography (CT) reconstructed with adaptive iterative dose reduction 3-dimensional (AIDR 3D).Eighty-nine patients underwent hepatic dynamic CT using one of the 2 protocols: tube voltage of 120 kVp, contrast dose of 600 mgI/kg, and filtered back projection in Protocol A (n = 46), and tube voltage of 100 kVp, contrast dose of 500 mgI/kg, and AIDR 3D in Protocol B (n = 43). The volume CT dose index (CTDIvol) and size-specific dose estimates (SSDEs) were compared between the 2 groups. Objective image noise and tumor to liver contrast-to-noise ratio (CNR) were also compared. Three radiologists independently reviewed image quality. The jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed to compare diagnostic performance.The mean CTDIvol and SSDE of Protocol B (14.3 and 20.2, respectively) were significantly lower than those of Protocol A (22.1 and 31.4, P < .001). There were no significant differences in either objective image noise or CNR. In the qualitative analysis, 2 readers assigned significant lower scores to images of Protocol B for at least one of the 3 phases regarding overall image quality (P < .05). There was no significant difference in the JAFROC1 figure of merit between protocols.Low tube voltage CT with AIDR 3D yielded a reduction in radiation dose and in the amount of contrast material while maintaining diagnostic performance.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A male in his sixties who underwent hepatic dynamic computed tomography with both Protocols A and B within 3 months. The conspicuity of 2 hepatocellular carcinomas (arrows) in arterial phase images (A: Protocol A; B: Protocol B) and equilibrium phase images (C: Protocol A; D: Protocol B) is almost equivalent for these 2 protocols. Streak artifacts caused by ribs and spine are slightly more prominent in Protocol B (arrowhead).
Figure 2
Figure 2
Initial computed tomography (CT) (A: Protocol B) and follow-up CT (B: Protocol A) images of a female in her seventies with hepatocellular carcinoma. The contrast between the hepatocellular carcinoma and the liver parenchyma is almost equivalent for both protocols. A faint blotchy appearance may be seen in Protocol B.

References

    1. Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Engl J Med 2007;357:2277–84.
    1. Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012;380:499–505.
    1. Marin D, Nelson RC, Samei E, et al. Hypervascular liver tumors: low tube voltage, high tube current multidetector CT during late hepatic arterial phase for detection - initial clinical experience. Radiology 2009;251:771–9.
    1. Nakayama Y, Awai K, Funama Y, et al. Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 2005;237:945–51.
    1. Nakaura T, Awai K, Oda S, et al. Low-kilovoltage, high-tube-current MDCT of liver in thin adults: pilot study evaluating radiation dose, image quality, and display settings. AJR Am J Roentgenol 2011;196:1332–8.
    1. Yanaga Y, Awai K, Nakaura T, et al. Hepatocellular carcinoma in patients weighing 70 kg or less: initial trial of compact-bolus dynamic CT with low-dose contrast material at 80 kVp. AJR Am J Roentgenol 2011;196:1324–31.
    1. Lee CH, Kim KA, Lee J, et al. Using low tube voltage (80kVp) quadruple phase liver CT for the detection of hepatocellular carcinoma: two-year experience and comparison with Gd-EOB-DTPA enhanced liver MRI. Eur J Radiol 2012;81:e605–11.
    1. Ichikawa T, Motosugi U, Morisaka H, et al. Volumetric low-tube-voltage CT imaging for evaluating hypervascular hepatocellular carcinoma; effects on radiation exposure, image quality, and diagnostic performance. Jpn J Radiol 2013;31:521–9.
    1. Marin D, Nelson RC, Schindera ST, et al. Low-tube-voltage, high-tube-current multidetector abdominal CT: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm - initial clinical experience. Radiology 2010;254:145–53.
    1. Hur S, Lee JM, Kim SJ, et al. 80-kVp CT using iterative reconstruction in image space algorithm for the detection of hypervascular hepatocellular carcinoma: phantom and initial clinical experience. Korean J Radiol 2012;13:152–64.
    1. Nakaura T, Nakamura S, Maruyama N, et al. Low contrast agent and radiation dose protocol for hepatic dynamic CT of thin adults at 256-detector row CT: effect of low tube voltage and hybrid iterative reconstruction algorithm on image quality. Radiology 2012;264:445–54.
    1. Namimoto T, Oda S, Utsunomiya D, et al. Improvement of image quality at low-radiation dose and low-contrast material dose abdominal CT in patients with cirrhosis: intraindividual comparison of low tube voltage with iterative reconstruction algorithm and standard tube voltage. J Comput Assist Tomogr 2012;36:495–501.
    1. Marin D, Choudhury KR, Gupta RT, et al. Clinical impact of an adaptive statistical iterative reconstruction algorithm for detection of hypervascular liver tumours using a low tube voltage, high tube current MDCT technique. Eur Radiol 2013;23:3325–35.
    1. Takahashi H, Okada M, Hyodo T, et al. Can low-dose CT with iterative reconstruction reduce both the radiation dose and the amount of iodine contrast medium in a dynamic CT study of the liver? Eur J Radiol 2014;83:684–91.
    1. Noda Y, Kanematsu M, Goshima S, et al. Reducing iodine load in hepatic CT for patients with chronic liver disease with a combination of low-tube-voltage and adaptive statistical iterative reconstruction. Eur J Radiol 2015;84:11–8.
    1. Zhang X, Li S, Liu W, et al. Double-low protocol for hepatic dynamic CT scan: effect of low tube voltage and low-dose iodine contrast agent on image quality. Medicine 2016;95:e4004.
    1. Juri H, Tsuboyama T, Kumano S, et al. Detection of bladder cancer: comparison of low-dose scans with AIDR 3D and routine-dose scans with FBP on the excretory phase in CT urography. Br J Radiol 2016;89:20150495.
    1. Wallihan DB, Podberesky DJ, Sullivan J, et al. Diagnostic performance and dose comparison of filtered back projection and adaptive iterative dose reduction three-dimensional CT enterography in children and young adults. Radiology 2015;276:233–42.
    1. Onishi H, Kockelkoren R, Kim T, et al. Low-dose pelvic computed tomography using adaptive iterative dose reduction 3-dimensional algorithm: a phantom study. J Comput Assist Tomogr 2015;39:629–34.
    1. Nitta N, Ikeda M, Sonoda A, et al. Images acquired using 320-MDCT with adaptive iterative dose reduction with wide-volume acquisition: visual evaluation of image quality by 10 radiologists using an abdominal phantom. AJR Am J Roentgenol 2014;202:2–12.
    1. Gervaise A, Osemont B, Louis M, et al. Standard dose versus low-dose abdominal and pelvic CT: comparison between filtered back projection versus adaptive iterative dose reduction 3D. Diagn Interv Imaging 2014;95:47–53.
    1. Matsuki M, Murakami T, Juri H, et al. Impact of adaptive iterative dose reduction (AIDR) 3D on low-dose abdominal CT: comparison with routine-dose CT using filtered back projection. Acta Radiol 2013;54:869–75.
    1. Juri H, Matsuki M, Itou Y, et al. Initial experience with adaptive iterative dose reduction 3D to reduce radiation dose in computed tomographic urography. J Comput Assist Tomogr 2013;37:52–7.
    1. Juri H, Matsuki M, Inada Y, et al. Low-dose computed tomographic urography using adaptive iterative dose reduction 3-dimensional: comparison with routine-dose computed tomography with filtered back projection. J Comput Assist Tomogr 2013;37:426–31.
    1. Chen CM, Lin YY, Hsu MY, et al. Performance of adaptive iterative dose reduction 3D integrated with automatic tube current modulation in radiation dose and image noise reduction compared with filtered-back projection for 80-kVp abdominal CT: Anthropomorphic phantom and patient study. Eur J Radiol 2016;85:1666–72.
    1. Chakraborty DP, Berbaum KS. Observer studies involving detection and localization: modeling, analysis, and validation. Med Phys 2004;31:2313–30.
    1. Chakraborty DP. Analysis of location specific observer performance data: validated extensions of the jackknife free-response (JAFROC) method. Acad Radiol 2006;13:1187–93.
    1. Chakraborty DP. Validation and statistical power comparison of methods for analyzing free-response observer performance studies. Acad Radiol 2008;15:1554–66.
    1. Christner JA, Braun NN, Jacobsen MC, et al. Size-specific dose estimates for adult patients at CT of the torso. Radiology 2012;265:841–7.
    1. American Association of Physicists in Medicine. Size-Specific Dose Estimate (SSDE) in Pediatric and Adult Body CT Examinations (Task Group 204). AAPM, College Park, MD, 2011.
    1. Zachrisson S, Vikgren J, Svalkvist A, et al. Effect of clinical experience of chest tomosynthesis on detection of pulmonary nodules. Acta Radiol 2009;50:884–91.
    1. Nakamoto A, Kim T, Hori M, et al. Clinical evaluation of image quality and radiation dose reduction in upper abdominal computed tomography using model-based iterative reconstruction; comparison with filtered back projection and adaptive statistical iterative reconstruction. Eur J Radiol 2015;84:1715–23.
    1. Singh S, Kalra MK, Hsieh J, et al. Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Radiology 2010;257:373–83.
    1. Schindera ST, Odedra D, Raza SA, et al. Iterative reconstruction algorithm for CT: can radiation dose be decreased while low-contrast detectability is preserved? Radiology 2013;269:511–8.
    1. Jensen K, Martinsen AC, Tingberg A, et al. Comparing five different iterative reconstruction algorithms for computed tomography in an ROC study. Eur Radiol 2014;24:2989–3002.
    1. Schindera ST, Odedra D, Mercer D, et al. Hybrid iterative reconstruction technique for abdominal CT protocols in obese patients: assessment of image quality, radiation dose, and low-contrast detectability in a phantom. AJR Am J Roentgenol 2014;202:W146–52.
    1. McCollough CH, Yu L, Kofler JM, et al. Degradation of CT low-contrast spatial resolution due to the use of iterative reconstruction and reduced dose levels. Radiology 2015;276:499–506.
    1. Nakamoto A, Tanaka Y, Juri H, et al. Diagnostic performance of reduced-dose CT with a hybrid iterative reconstruction algorithm for the detection of hypervascular liver lesions: a phantom study. Eur Radiol 2017;27:2995–3003.

Source: PubMed

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