European Radiology

, Volume 20, Issue 3, pp 630–639 | Cite as

Evaluation of image quality and lesion perception by human readers on 3D CT colonography: comparison of standard and low radiation dose

  • Valeria A. Fisichella
  • Magnus Båth
  • Åse Allansdotter Johnsson
  • Fredrik Jäderling
  • Tommy Bergsten
  • Ulf Persson
  • Kristin Mellingen
  • Mikael Hellström



We compared the prevalence of noise-related artefacts and lesion perception on three-dimensional (3D) CT colonography (CTC) at standard and low radiation doses.


Forty-eight patients underwent CTC (64 × 0.625 mm collimation; tube rotation time 0.5 s; automatic tube current modulation: standard dose 40–160 mA, low dose 10–50 mA). Low- and standard-dose acquisitions were performed in the supine position, one after the other. The presence of artefacts (cobblestone and snow artefacts, irregularly delineated folds) and the presence of polyps were evaluated by five radiologists on 3D images at standard dose, the original low dose and a modified low dose, i.e. after manipulation of opacity on 3D.


The mean effective dose was 3.9 ± 1.3 mSv at standard dose and 1.03 ± 0.4 mSv at low dose. The number of images showing cobblestone artefacts and irregularly delineated folds at original and modified low doses was significantly higher than at standard dose (P < 0.0001). Most of the artefacts on modified low-dose images were mild. No significant difference in sensitivity between the dose levels was found for polyps ≥6 mm.


Reduction of the effective dose to 1 mSv significantly affects image quality on 3D CTC, but the perception of ≥6 mm lesions is not significantly impaired.


CT colonography Radiation exposure Image quality Threedimensional CT Colonic neoplasm 


  1. 1.
    Levin B, Lieberman DA, McFarland B et al (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58:130–160CrossRefPubMedGoogle Scholar
  2. 2.
    Brenner DJ, Georgsson MA (2005) Mass screening with CT colonography: should the radiation exposure be of concern. Gastroenterology 129:328–337CrossRefPubMedGoogle Scholar
  3. 3.
    American College of Radiology (2006) ACR practice guideline for the performance of computed tomography (CT) colonography in adults. American College of Radiology, Reston, VAGoogle Scholar
  4. 4.
    Macari M, Bini EJ, Xue X, Milano A, Katz SS, Resnick D, Chandarana H, Krinsky G, Klingenbeck K, Marshall CH, Megibow AJ (2002) Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection. Radiology 224:383–392CrossRefPubMedGoogle Scholar
  5. 5.
    Van Gelder RE, Venema HW, Serlie IW, Nio CY, Determann RM, Tipker CA, Vos FM, Glas AS, Bartelsman JF, Bossuyt PM, Laméris JS, Stoker J (2002) CT colonography at different radiation dose levels: feasibility of dose reduction. Radiology 224:25–33CrossRefPubMedGoogle Scholar
  6. 6.
    Iannaccone R, Laghi A, Catalano C, Brink JA, Mangiapane F, Trenna S, Piacentini F, Passariello R (2003) Detection of colorectal lesions: lower-dose multi-detector row helical CT colonography compared with conventional colonoscopy. Radiology 229:775–781CrossRefPubMedGoogle Scholar
  7. 7.
    Van Gelder RE, Venema HW, Florie J, Nio CY, Serlie IW, Schutter MP, van Rijn JC, Vos FM, Glas AS, Bossuyt PM, Bartelsman JF, Laméris JS, Stoker J (2004) CT colonography: feasibility of substantial dose reduction–comparison of medium to very low doses in identical patients. Radiology 232:611–620CrossRefPubMedGoogle Scholar
  8. 8.
    Cohnen M, Vogt C, Beck A, Andersen K, Heinen W, vom Dahl S, Aurich V, Haeussinger D, Moedder U (2004) Feasibility of MDCT colonography in ultra-low-dose technique in the detection of colorectal lesions: comparison with high-resolution video colonoscopy. Am J Roentgenol 183:1355–1359Google Scholar
  9. 9.
    Vogt C, Cohnen M, Beck A, vom Dahl S, Aurich V, Mödder U, Häussinger D (2004) Detection of colorectal polyps by multislice CT colonography with ultra-low-dose technique: comparison with high-resolution videocolonoscopy. Gastrointest Endosc 60:201–209CrossRefPubMedGoogle Scholar
  10. 10.
    Iannaccone R, Catalano C, Mangiapane F, Murakami T, Lamazza A, Fiori E, Schillaci A, Marin D, Nofroni I, Hori M, Passariello R (2005) Colorectal polyps: detection with low-dose multi-detector row helical CT colonography versus two sequential colonoscopies. Radiology 237:927–937CrossRefPubMedGoogle Scholar
  11. 11.
    Capuñay CM, Carrascosa PM, Bou-Khair A, Castagnino N, Ninomiya I, Carrascosa JM (2005) Low radiation dose multislice CT colonography in children: experience after 100 studies. Eur J Radiol 56:398–402CrossRefPubMedGoogle Scholar
  12. 12.
    Florie J, van Gelder RE, Schutter MP, van Randen A, Venema HW, de Jager S, van der Hulst VP, Prent A, Bipat S, Bossuyt PM, Baak LC, Stoker J (2007) Feasibility study of computed tomography colonography using limited bowel preparation at normal and low-dose levels study. Eur Radiol 17:3112–3122CrossRefPubMedGoogle Scholar
  13. 13.
    Tack D, De Maertelaer V, Gevenois PA (2003) Dose reduction in multidetector CT using attenuation-based online tube current modulation. Am J Roentgenol 181:331–334Google Scholar
  14. 14.
    Graser A, Wintersperger BJ, Suess C, Reiser MF, Becker CR (2006) Dose reduction and image quality in MDCT colonography using tube current modulation. Am J Roentgenol 187:695–701CrossRefGoogle Scholar
  15. 15.
    Fisichella V, Jäderling F, Horvath S, Stotzer PO, Kilander A, Hellström M (2009) Primary three-dimensional analysis with perspective-filet view versus primary two-dimensional analysis: evaluation of lesion detection by inexperienced readers at computed tomographic colonography in symptomatic patients. Acta Radiol 50:244–255CrossRefPubMedGoogle Scholar
  16. 16.
    Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, Wong RK, Nugent PA, Mysliwiec PA, Schindler WR (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200CrossRefPubMedGoogle Scholar
  17. 17.
    Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263CrossRefPubMedGoogle Scholar
  18. 18.
    IEC (1999) International standard of IEC 60601-2-44. Medical electrical equipment - part 2–44: particular requirements for the safety of x-ray equipment for computed tomographyGoogle Scholar
  19. 19.
    Bongartz G, Golding SJ, Jurik AG et al (1999) European guidelines on quality criteria for computed tomography. Report EUR 16262 EN. Office for Official Publications of the European Communities, LuxembourgGoogle Scholar
  20. 20.
    Carrascosa P, Capuñay C, Martín López E, Ulla M, Castiglioni R, Carrascosa J (2007) Multidetector CT colonoscopy: evaluation of the perspective-filet view virtual colon dissection technique for the detection of elevated lesions. Abdom Imaging 32:582–588CrossRefPubMedGoogle Scholar
  21. 21.
    McFarland EG, Brink JA, Loh J, Wang G, Argiro V, Balfe DM, Heiken JP, Vannier MW (1997) Visualization of colorectal polyps with spiral CT colography: evaluation of processing parameters with perspective volume rendering. Radiology 205:701–707PubMedGoogle Scholar
  22. 22.
    Börjesson S, Håkansson M, Båth M, Kheddache S, Svensson S, Tingberg A, Grahn A, Ruschin M, Hemdal B, Mattsson S, Månsson LG (2005) A software tool for increased efficiency in observer performance studies in radiology. Radiat Prot Dosimetry 114:45–52CrossRefPubMedGoogle Scholar
  23. 23.
    Båth M, Månsson LG (2007) Visual grading characteristics (VGC) analysis: a non-parametric rank-invariant statistical method for image quality evaluation. Br J Radiol 80:169–176CrossRefPubMedGoogle Scholar
  24. 24.
    Mang T, Maier A, Plank C, Mueller-Mang C, Herold C, Schima W (2007) Pitfalls in multi-detector row CT colonography: a systematic approach. Radiographics 27:431–454CrossRefPubMedGoogle Scholar
  25. 25.
    Kurt Rossmann Laboratories for Radiologic Image Research at the University of Chicago (2009) Software download. Accessed on the 19 February 2009
  26. 26.
    Chakraborty DP (2009) JAFROC-1 software.
  27. 27.
    Chakraborty DP (2008) Validation and statistical power comparison of methods for analyzing free-response observer performance studies. Acad Radiol 15:1554–1566CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Valeria A. Fisichella
    • 1
    • 2
  • Magnus Båth
    • 3
    • 4
  • Åse Allansdotter Johnsson
    • 1
    • 2
  • Fredrik Jäderling
    • 5
  • Tommy Bergsten
    • 6
  • Ulf Persson
    • 7
  • Kristin Mellingen
    • 8
  • Mikael Hellström
    • 1
    • 2
  1. 1.Department of RadiologySahlgrenska University HospitalGothenburgSweden
  2. 2.Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  3. 3.Department of Medical Physics and Biomedical EngineeringSahlgrenska University HospitalGothenburgSweden
  4. 4.Department of Radiation PhysicsUniversity of GothenburgGothenburgSweden
  5. 5.Department of RadiologySt. Göran’s HospitalStockholmSweden
  6. 6.Department of RadiologyVästra Frölunda HospitalGothenburgSweden
  7. 7.Department of RadiologyLindesberg HospitalLindesbergSweden
  8. 8.Department of RadiologyUllevål University HospitalOsloNorway

Personalised recommendations