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Sub-mSv CT imaging of pulmonary arteries using an iterative model reconstruction algorithm

Abstract
Philips CT Clinical Science Philips Healthcare • USA

Muenzel D, Koehler T, Brendel B, Brown KM, Zabic S, Fingerle AA, Rummeny EJ, Dobritz M, Noel PB.

Purpose
To investigate the improvement in diagnostic quality of iterative model reconstruction (IMR) algorithm for sub-mSv computed tomography angiography of the pulmonary arteries (CTA).

Method and Materials
Eighteen patients (single-center, IRB approved) were imaged on a Philips Brilliance iCT (Philips, Cleveland, OH) for visualization of the pulmonary arteries, eight with and ten without pulmonary artery embolism. All scans were performed at 120 kVp (average effective doses 4.34±1.99 mSv). Acquisitions with reduced radiation exposure were simulated from the original CT data to 15% of the tube current, resulting in a sub-mSv average dose of 0.65±0.30 mSv. Filtered back projection (FBP) was used to reconstruct the original data (protocol A); sub-mSv data were reconstructed using FBP (protocol B) and IMR (protocol C). The performance of IMR was assessed with respect to the image quality metrics image noise and contrast-to-noise ratio (CNR) and with respect to effective dose of each protocol. Two blinded readers determined subjective image quality and assessed the detectability of pulmonary artery embolism, where ground truth was obtained from protocol A.

Results 
With IMR noise could be subjectively removed, while the image texture (look and feel) of these images differed from FBP reconstructions. Specifically, with IMR, the noise is significantly reduced by a factor up to 20 (B vs. C). This is reflected by an improvement in the contrast-to-noise ratio and improved image quality with a median image quality score of 3 (IMR, B) vs. 1 (FBP, C), p < 0.05. With respect to diagnostics the angiographic datasets protocol A and C were identical, while B was worse: To detect pulmonary artery embolism in IMR and FBP low dose images, the sensitivity was 100% for IMR and 62.5% for FBP while specificity was 100% for both protocols.

Conclusion 
This simulation study indicates that by using IMR for reconstruction, pulmonary artery embolism can be detected accurately in scans with sub-mSv dose levels.

Clinical Relevance/Application 
IMR has the potential to reduce patient dose and improve image quality in clinical day-to-day routine.


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Abstract
iCT
Body, chest, chest CTA, FBP reconstruction, image quality, IMR, iterative model reconstruction, low dose, PE, pulmonary arteries, Thorax, Vascular
 

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