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Sub-milliSievert (sub-mSv) CT colonography: a prospective comparison of image quality and polyp conspicuity at reduced-dose versus standard-dose imaging

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To prospectively compare reduced-dose (RD) CT colonography (CTC) with standard-dose (SD) imaging using several reconstruction algorithms.

Methods

Following SD supine CTC, 40 patients (mean age, 57.3 years; 17 M/23 F; mean BMI, 27.2) underwent an additional RD supine examination (targeted dose reduction, 70–90 %). DLP, CTDIvol, effective dose, and SSDE were compared. Several reconstruction algorithms were applied to RD series. SD-FBP served as reference standard. Objective image noise, subjective image quality and polyp conspicuity were assessed.

Results

Mean CTDIvol and effective dose for RD series was 0.89 mGy (median 0.65) and 0.6 mSv (median 0.44), compared with 3.8 mGy (median 3.1) and 2.8 mSv (median 2.3) for SD series, respectively. Mean dose reduction was 78 %. Mean image noise was significantly reduced on RD-PICCS (24.3 ± 19HU) and RD-MBIR (19 ± 18HU) compared with RD-FBP (90 ± 33), RD-ASIR (72 ± 27) and SD-FBP (47 ± 14 HU). 2D image quality score was higher with RD-PICCS, RD-MBIR, and SD-FBP (2.7 ± 0.4/2.8 ± 0.4/2.9 ± 0.6) compared with RD-FBP (1.5 ± 0.4) and RD-ASIR (1.8 ± 0.44). A similar trend was seen with 3D image quality scores. Polyp conspicuity scores were similar between SD-FBP/RD-PICCS/RD-MBIR (3.5 ± 0.6/3.2 ± 0.8/3.3 ± 0.6).

Conclusion

Sub-milliSievert CTC performed with iterative reconstruction techniques demonstrate decreased image quality compared to SD, but improved image quality compared to RD images reconstructed with FBP.

Key points

• CT colonography dose can be substantially lowered using advanced iterative reconstruction techniques.

• Iterative reconstruction techniques (MBIR/PICCS) reduce image noise and improve image quality.

• The PICCS/MBIR-reconstructed, reduced-dose series shows decreased 2D/3D image quality compared to the standard-dose series.

• Polyp conspicuity was similar on standard-dose images compared to reduced-dose images reconstructed with MBIR/PICCS.

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Acknowledgements

The scientific guarantor of this publication is the first author, Dr. Meghan G. Lubner. The authors of this manuscript declare financial relationships as detailed below:

M. Lubner: Grant funding GE Medical (GE-AUR Radiology Research Academic Fellowship, GERRAF)

B. Dustin Pooler, Doug Kitchin, Ke Li: None

Jie Tang: Now an employee of GE Medical

David H. Kim: Consultant, Viatronix, Inc; Co-founder VirtuoCTC, LLC; Medical Advisory Board, Digital Artforms, Inc.

Guanghong Chen: Research funding from GE, Siemens AG, Hologic

Perry J. Pickhardt: Consultant, Check-Cap Ltd; Consultant, Viatronix; Consultant, Mindways; Consultant, Braintree; Co-founder of VirtuoCTC, LLC

This work was partially supported by the Society of Abdominal Radiology Howard S. Stern Research award and National Institute of Health (NIH) grant funding R01CA169331.

One of the authors, Dr. Alejandro Munoz del Rio, has significant statistical expertise.

Institutional review board approval was obtained, and written informed consent was obtained from all subjects in this study.

This is an ongoing prospective trial, so a portion of this cohort was previously reported in a manuscript describing preliminary results of the entire cohort, published in AJR and a manuscript accepted for publication in Abdominal Imaging:

Lubner MG, Pickhardt PJ, Kim DH, Tang J, Del Rio AM, Chen GH. Prospective Evaluation of prior image constrained compressed sensing (PICCS) algorithm in abdominal CT: a comparison of reduced dose with standard dose imaging. Abdom Imaging 2014 Jun 19, epub ahead of print.

Pooler BD, Lubner MG, Kim DH, Ryckman EM, Sivalingam S, Tang J, Nakada SY, Chen GH, Pickhardt PJ. Prospective Trial for the Detection of Urolithiasis at Ultra-low-dose (Sub-mSV) Non-contrast CT: Direct Comparison against Routine Low-dose Reference Standard. J Urol 2014 May 21, epub ahead of print.

Pickhardt PJ, Lubner MG, Kim DH, Tang J, Ruma JA, del Rio AM, Chen GH. Abdominal CT with model-based interative Reconstruction (MBIR): initial results of a prospective trial comparing ultralow-dose with standard-dose imaging. AJR 2012; 199 (3): 1266–74.

This is a prospective case–control or case-matched study performed at one institution.

Author information

Authors and Affiliations

  1. Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792-3252, USA

    Meghan G. Lubner, B. Dustin Pooler, Douglas R. Kitchin, Ke Li, David H. Kim, Alejandro Munoz del Rio, Guang-Hong Chen & Perry J. Pickhardt

  2. Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Jie Tang, Ke Li & Guang-Hong Chen

Authors
  1. Meghan G. Lubner
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  2. B. Dustin Pooler
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  3. Douglas R. Kitchin
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  4. Jie Tang
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  5. Ke Li
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  6. David H. Kim
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  7. Alejandro Munoz del Rio
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  8. Guang-Hong Chen
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  9. Perry J. Pickhardt
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Corresponding author

Correspondence to Meghan G. Lubner.

Additional information

This work was presented as an oral presentation at the Society of Abdominal Radiology meeting in March 2014.

Appendix 1

Appendix 1

Table 3 Abdominal CTC “standard-dose” protocol utilized in the prospective trial*
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Lubner, M.G., Pooler, B.D., Kitchin, D.R. et al. Sub-milliSievert (sub-mSv) CT colonography: a prospective comparison of image quality and polyp conspicuity at reduced-dose versus standard-dose imaging. Eur Radiol 25, 2089–2102 (2015). https://doi.org/10.1007/s00330-015-3603-9

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