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Pilot study to determine whether reduced-dose photon-counting detector chest computed tomography can reliably display Brody II score imaging findings for children with cystic fibrosis at radiation doses that approximate radiographs

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Abstract

Background

The Brody II score uses chest CT to guide therapeutic changes in children with cystic fibrosis; however, patients and providers are often reticent to undergo chest CT given concerns about radiation.

Objective

We sought to determine the ability of a reduced-dose photon-counting detector (PCD) chest CT protocol to reproducibly display pulmonary disease severity using the Brody II score for children with cystic fibrosis (CF) scanned at radiation doses similar to those of a chest radiograph.

Materials and methods

Pediatric patients with CF underwent non-contrast reduced-dose chest PCD-CT. Volumetric inspiratory and expiratory scans were obtained without sedation or anesthesia. Three pediatric radiologists with Certificates of Added Qualification scored each scan on an ordinal scale and assigned a Brody II score to grade bronchiectasis, peribronchial thickening, parenchymal opacity, air trapping and mucus plugging. We report image-quality metrics using descriptive statistics. To calculate inter-rater agreement for Brody II scoring, we used the Krippendorff alpha and intraclass correlation coefficient (ICC).

Results

Fifteen children with CF underwent reduced-dose PCD chest CT in both inspiration and expiration (mean age 8.9 years, range, 2.5–17.5 years; 4 girls). Mean volumetric CT dose index (CTDIvol) was 0.07 ± 0.03 mGy per scan. Mean effective dose was 0.12 ± 0.04 mSv for the total examination. All three readers graded spatial resolution and noise as interpretable on lung windows. The average Brody II score was 12.5 (range 4–19), with moderate inter-reader reliability (ICC of 0.61 [95% CI=0.27, 0.84]). Inter-rater reliability was moderate to substantial for bronchiectasis (0.52), peribronchial thickening (0.55), presence of opacity (0.62) and air trapping (0.70) and poor for mucus plugging (0.09).

Conclusion

Reduced-dose PCD-CT permits diagnostic image quality and reproducible identification of Brody II scoring imaging findings at radiation doses similar to those for chest radiography.

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Acknowledgments

Research reported in this work was supported by the Mayo Clinic Department of Radiology and the CT Clinical Innovation Center.

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Authors and Affiliations

  1. Department of Radiology, Pediatric Radiology Division, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Kelly K. Horst, Nathan C. Hull & Paul G. Thacker

  2. Department of Pediatrics, Pediatric Pulmonology Division, Mayo Clinic, Rochester, MN, USA

    Nadir Demirel

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Lifeng Yu, Jennifer S. McDonald, Cynthia H. McCollough & Joel G. Fletcher

  4. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Nicholas B. Larson

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Correspondence to Kelly K. Horst.

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Coauthors Cynthia H. McCollough, PhD, and Joel G. Fletcher, MD, disclose a research grant to the institution from Siemens Healthcare GmbH.

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Horst, K.K., Hull, N.C., Thacker, P.G. et al. Pilot study to determine whether reduced-dose photon-counting detector chest computed tomography can reliably display Brody II score imaging findings for children with cystic fibrosis at radiation doses that approximate radiographs. Pediatr Radiol 53, 1049–1056 (2023). https://doi.org/10.1007/s00247-022-05574-6

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