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Ultralow dose CT for pulmonary nodule detection with chest x-ray equivalent dose – a prospective intra-individual comparative study

  • Chest
  • Published:
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Abstract

Purpose

To prospectively evaluate the accuracy of ultralow radiation dose CT of the chest with tin filtration at 100 kV for pulmonary nodule detection.

Materials and methods

202 consecutive patients undergoing clinically indicated chest CT (standard dose, 1.8 ± 0.7 mSv) were prospectively included and additionally scanned with an ultralow dose protocol (0.13 ± 0.01 mSv). Standard dose CT was read in consensus by two board-certified radiologists to determine the presence of lung nodules and served as standard of reference (SOR). Two radiologists assessed the presence of lung nodules and their locations on ultralow dose CT. Sensitivity and specificity of the ultralow dose protocol was compared against the SOR, including subgroup analyses of different nodule sizes and types. A mixed effects logistic regression was used to test for independent predictors for sensitivity of pulmonary nodule detection.

Results

425 nodules (mean diameter 3.7 ± 2.9 mm) were found on SOR. Overall sensitivity for nodule detection by ultralow dose CT was 91%. In multivariate analysis, nodule type, size and patients BMI were independent predictors for sensitivity (p < 0.001).

Conclusions

Ultralow dose chest CT at 100 kV with spectral shaping enables a high sensitivity for the detection of pulmonary nodules at exposure levels comparable to plain film chest X-ray.

Keypoints

• 91% of all lung nodules were detected with ultralow dose CT

• Sensitivity for subsolid nodule detection is lower in ultralow dose CT (77.5%)

• The mean effective radiation dose in 202 patients was 0.13 mSv

• Ultralow dose CT seems to be feasible for lung cancer screening

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Abbreviations

ADMIRE:

advanced modelled iterative reconstruction

CT:

computed tomography

NLST:

the National Lung Screening Trial

IR:

iterative reconstruction

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Zurich, University Zurich, Ramistrasse, Zurich, Switzerland

    Michael Messerli

  2. Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Michael Messerli, Thomas Kluckert, Meinhard Knitel, Stephan Wälti, Lotus Desbiolles, Ralf W. Bauer, Sebastian Leschka & Simon Wildermuth

  3. Department of Radiology, CHU Sainte-Justine, University of Montreal, Montréal, Québec, Canada

    Stephan Wälti

  4. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany

    Fabian Rengier

  5. Department of Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    René Warschkow

  6. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland

    Hatem Alkadhi & Sebastian Leschka

Authors
  1. Michael Messerli
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  2. Thomas Kluckert
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Corresponding author

Correspondence to Michael Messerli.

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Guarantor

The scientific guarantor of this publication is Michael Messerli.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: MD Ralf W. Bauer is on the speakers’ bureau of Siemens Healthcare AG.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Messerli, M., Kluckert, T., Knitel, M. et al. Ultralow dose CT for pulmonary nodule detection with chest x-ray equivalent dose – a prospective intra-individual comparative study. Eur Radiol 27, 3290–3299 (2017). https://doi.org/10.1007/s00330-017-4739-6

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  • DOI: https://doi.org/10.1007/s00330-017-4739-6

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