European Radiology

, Volume 24, Issue 12, pp 2989–3002 | Cite as

Comparing five different iterative reconstruction algorithms for computed tomography in an ROC study

  • Kristin JensenEmail author
  • Anne Catrine T. Martinsen
  • Anders Tingberg
  • Trond Mogens Aaløkken
  • Erik Fosse
Computed Tomography



The purpose of this study was to evaluate lesion conspicuity achieved with five different iterative reconstruction techniques from four CT vendors at three different dose levels. Comparisons were made of iterative algorithm and filtered back projection (FBP) among and within systems.


An anthropomorphic liver phantom was examined with four CT systems, each from a different vendor. CTDIvol levels of 5 mGy, 10 mGy and 15 mGy were chosen. Images were reconstructed with FBP and the iterative algorithm on the system. Images were interpreted independently by four observers, and the areas under the ROC curve (AUCs) were calculated. Noise and contrast-to-noise ratios (CNR) were measured.


One iterative algorithm increased AUC (0.79, 0.95, and 0.97) compared to FBP (0.70, 0.86, and 0.93) at all dose levels (p < 0.001 and p = 0.047). Another algorithm increased AUC from 0.78 with FBP to 0.84 (p = 0.007) at 5 mGy. Differences at 10 and 15 mGy were not significant (p-values: 0.084–0.883). Three algorithms showed no difference in AUC compared to FBP (p-values: 0.008–1.000). All of the algorithms decreased noise (10–71 %) and improved CNR.


Only two algorithms improved lesion detection, even though noise reduction was shown with all algorithms.

Key Points

Iterative reconstruction algorithms affected lesion detection differently at different dose levels.

One iterative algorithm improved lesion detectability compared to filtered back projection.

Three algorithms did not significantly improve lesion detectability.

One algorithm improved lesion detectability at the lowest dose level.


Computed tomography Image reconstruction Radiological phantom Liver 



Thanks to Erlend Andersen, Joanna Fenn Kristiansen, Wendy Garborg, and Rima Seputytë for help with phantom scanning, and thanks to Per Kristian Hol and Kristin Forså for image evaluation.

The scientific guarantor of this publication is Anne Catrine Martinsen. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Kyrre Emblem kindly provided statistical advice for this manuscript. Institutional Review Board approval was not required because this was a phantom study. Methodology: diagnostic or prognostic multicenter study.


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Kristin Jensen
    • 1
    • 2
    Email author
  • Anne Catrine T. Martinsen
    • 1
    • 2
  • Anders Tingberg
    • 3
  • Trond Mogens Aaløkken
    • 4
  • Erik Fosse
    • 1
    • 5
  1. 1.The Intervention CentreRikshospitaletOsloNorway
  2. 2.lnstitute of PhysicsUniversity of OsloOsloNorway
  3. 3.Department of Medical Radiation PhysicsLund University, Skåne University HospitalMalmöSweden
  4. 4.Department of Radiology and Nuclear MedicineRikshospitaletOsloNorway
  5. 5.lnstitute of Clinical MedicineUniversity of OsloOsloNorway

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