Prior iterative reconstruction (PIR) to lower radiation dose and preserve radiologist performance for multiphase liver CT: a multi-reader pilot study

  • Payam Mohammadinejad
  • Eric C. Ehman
  • Rogerio N. Vasconcelos
  • Sudhakar K. Venkatesh
  • David M. Hough
  • Ryan Lowe
  • Yong Suk Lee
  • Avinash Nehra
  • Shane Dirks
  • David R. HolmesIII
  • Rickey E. Carter
  • Bernard Schmidt
  • Ahmed F. Halaweish
  • Cynthia H. McCollough
  • Joel G. FletcherEmail author



Prior iterative reconstruction (PIR) spatially registers CT image data from multiple phases of enhancement to reduce image noise. We evaluated PIR in contrast-enhanced multiphase liver CT.


Patients with archived projection CT data with proven malignant or benign liver lesions, or without lesions, by reference criteria were included. Lower-dose PIR images were reconstructed using validated noise insertion from multiphase CT exams (50% dose in 2 phases, 25% dose in 1 phase). The phase of enhancement most relevant to the diagnostic task was selected for evaluation. Four radiologists reviewed routine-dose and lower-dose PIR images, circumscribing liver lesions and rating confidence for malignancy (0 to 100) and image quality. JAFROC Figures of Merit (FOM) were calculated.


31 patients had 60 liver lesions (28 primary hepatic malignancies, 6 hepatic metastases, 26 benign lesions). Pooled JAFROC FOM for malignancy for routine-dose CT was 0.615 (95% CI 0.464, 0.767) compared to 0.662 for PIR (95% CI 0.527, 0.797). The estimated FOM difference between the routine-dose and lower-dose PIR images was + 0.047 (95% CI − 0.023, + 0.116). Pooled sensitivity/specificity for routine-dose images was 70%/68% compared to 73%/66% for lower-dose PIR. Lower-dose PIR had lower diagnostic image quality (mean 3.8 vs. 4.2, p = 0.0009) and sharpness (mean 2.3 vs. 2.0, p = 0.0071).


PIR is a promising method to reduce radiation dose for multiphase abdominal CT, preserving observer performance despite small reductions in image quality. Further work is warranted.


Iterative reconstruction Radiation dosage Liver neoplasms Tomography, X-ray computed 



Authors wish to express appreciation to Kris Nunez for her assistance in preparation of the manuscript.


This work was funded in part by a research grant to the author’s institution from Siemens Healthineers.

Compliance with ethical standards

Conflict of interest

Dr. Halaweish is an employee of Siemens Healthineers. Drs. McCollough and Fletcher received grant support for their institution from Siemens Healthineers, which provided the offline computer workstation and prior iterative reconstruction software examined in this work.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Payam Mohammadinejad
    • 1
  • Eric C. Ehman
    • 1
  • Rogerio N. Vasconcelos
    • 1
  • Sudhakar K. Venkatesh
    • 1
  • David M. Hough
    • 1
  • Ryan Lowe
    • 1
  • Yong Suk Lee
    • 1
  • Avinash Nehra
    • 1
  • Shane Dirks
    • 1
  • David R. HolmesIII
    • 2
  • Rickey E. Carter
    • 3
  • Bernard Schmidt
    • 4
  • Ahmed F. Halaweish
    • 5
  • Cynthia H. McCollough
    • 1
  • Joel G. Fletcher
    • 1
    Email author
  1. 1.Department of RadiologyMayo ClinicRochesterUSA
  2. 2.Biomedical Imaging ResourceMayo ClinicRochesterUSA
  3. 3.Department of Health Sciences ResearchMayo ClinicJacksonvilleUSA
  4. 4.Siemens AGForchheimGermany
  5. 5.Siemens HealthineersMalvernUSA

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