European Radiology

, Volume 24, Issue 4, pp 817–826 | Cite as

Image quality assessment of ultra low-dose chest CT using sinogram-affirmed iterative reconstruction

  • So Won Lee
  • Yookyung KimEmail author
  • Sung Shine Shim
  • Jeong Kyong Lee
  • Seok Jeong Lee
  • Yon Ju Ryu
  • Jung Hyun Chang



To assess the image quality of ultra-low-dose computed tomography (ULDCT) using sinogram-affirmed iterative reconstruction (SAFIRE) compared to reduced dose CT (RDCT).


Eighty-one consecutive patients underwent non-enhanced ULDCT using 80 kVp and 30 mAs and contrast-enhanced RDCT using automated tube potential selection and tube current modulation. CT images were reconstructed with SAFIRE. Image noise and subjective image quality of normal structures and various pulmonary lesions were assessed.


The mean effective doses were 0.29 ± 0.03 and 2.88 ± 1.11 mSv for ULDCT and RDCT, respectively. ULDCT had significantly higher noise (p < 0.001). Image quality of five normal structures was diagnostic in 91.1 % of ULDCT and 100 % of RDCT. With ULDCT, the frequencies of non-diagnostic image quality were 2.0 (1/50), 4.6 (13/280), 25.5 (14/55), and 40.0 (8/20)% for BMIs of < 20, 20–25, 25–30, and >30. In the assessment of pulmonary lesions, non-diagnostic image quality was observed for 11.2 % of all lesions, 60.9 % of decreased attenuation (significantly more frequent for upper lung lesions), and 23.5 % of ground-glass nodules.


ULDCT generates diagnostic images in patients with a BMI ≤25, but is of limited use for lesions with decreased attenuation, ground-glass nodules, or those located in the upper lobe.

Key Points

Iterative reconstruction enables ultra-low-dose CT (ULDCT) with very low radiation doses.

Image quality of ULDCT depends on the patient body mass index (BMI).

Selection of kVp and mAs depends on both BMI and lesion type.

• Diagnosis of pulmonary emphysema or ground-glass nodules requires higher radiation doses.


Computed tomography Iterative reconstruction Radiation dose reduction 



The scientific guarantor of this publication is Yookyung Kim. The authors of this manuscript declare no relationships with any companies whose products or services are related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this article. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • So Won Lee
    • 1
  • Yookyung Kim
    • 1
    • 3
    Email author
  • Sung Shine Shim
    • 1
  • Jeong Kyong Lee
    • 1
  • Seok Jeong Lee
    • 2
  • Yon Ju Ryu
    • 2
  • Jung Hyun Chang
    • 2
  1. 1.Department of RadiologySchool of Medicine, Ewha Womans UniversitySeoulSouth Korea
  2. 2.Division of Pulmonology in the Department of Internal MedicineSchool of Medicine, Ewha Womans UniversitySeoulSouth Korea
  3. 3.Department of RadiologyEwha Womans University Mokdong HospitalSeoulKorea

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