Skip to main content

Advertisement

SpringerLink
Log in

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

An Erratum to this article was published on 05 April 2016

Abstract

Objective

To investigate the detection rate of pulmonary nodules in ultralow-dose CT acquisitions.

Materials and methods

In this lung phantom study, 232 nodules (115 solid, 117 ground-glass) of different sizes were randomly distributed in a lung phantom in 60 different arrangements. Every arrangement was acquired once with standard radiation dose (100 kVp, 100 references mAs) and once with ultralow radiation dose (80 kVp, 6 mAs). Iterative reconstruction was used with optimized kernels: I30 for ultralow-dose, I70 for standard dose and I50 for CAD. Six radiologists examined the axial 1-mm stack for solid and ground-glass nodules. During a second and third step, three radiologists used maximum intensity projection (MIPs), finally checking with computer-assisted detection (CAD), while the others first used CAD, finally checking with the MIPs.

Results

The detection rate was 95.5 % with standard dose (DLP 126 mGy*cm) and 93.3 % with ultralow-dose (DLP: 9 mGy*cm). The additional use of either MIP reconstructions or CAD software could compensate for this difference. A combination of both MIP reconstructions and CAD software resulted in a maximum detection rate of 97.5 % with ultralow-dose.

Conclusion

Lung cancer screening with ultralow-dose CT using the same radiation dose as a conventional chest X-ray is feasible.

Key points

• 93.3 % of all lung nodules were detected with ultralow-dose CT.

• A sensitivity of 97.5 % is possible with additional image post-processing.

• The radiation dose is comparable to a standard radiography in two planes.

• Lung cancer screening with ultralow-dose CT is feasible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CAD:

Computer-aided detection

MIP:

Maximum intensity projection

References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Kaneko M, Eguchi K, Ohmatsu H et al (1996) Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 201:798–802

    Article  CAS  PubMed  Google Scholar 

  3. Henschke CI, Yankelevitz DF, Libby DM et al (2006) Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 355:1763–1771

    Article  PubMed  Google Scholar 

  4. The National Lung Screening Trial Team (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409

    Article  Google Scholar 

  5. Field JK, van Klaveren R, Pedersen JH et al (2013) European randomized lung cancer screening trials: post NLST. J Surg Oncol 108:280–286

    Article  PubMed  Google Scholar 

  6. van Iersel CA, de Koning HJ, Draisma G et al (2007) Risk-based selection from the general population in a screening trial: selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer multi-slice CT screening trial (NELSON). Int J Cancer 120:868–874

    Article  PubMed  Google Scholar 

  7. Wender R, Fontham ETH, Barrera E et al (2013) American cancer society lung cancer screening guidelines. CA Cancer J Clin 63:106–117

    Article  Google Scholar 

  8. Jaklitsch MT, Jacobson FL, Austin JHM et al (2012) The American association for thoracic surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg 144:33–38

    Article  PubMed  Google Scholar 

  9. Nair A, Hansell DM (2011) European and North American lung cancer screening experience and implications for pulmonary nodule management. Eur Radiol 21:2445–2454

    Article  PubMed  Google Scholar 

  10. Kauczor H-U, Bonomo L, Gaga M, et al. (2015) ESR/ERS white paper on lung cancer screening. Eur Respir J ERJ–00330–2015. doi: 10.1183/09031936.00033015

  11. Mahadevia PJ, Fleisher LA, Frick KD et al (2003) Lung cancer screening with helical computed tomography in older adult smokers: a decision and cost-effectiveness analysis. JAMA J Am Med Assoc 289:313–322

    Article  Google Scholar 

  12. Swensen SJ, Jett JR, Sloan JA et al (2002) Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med 165:508–513

    Article  PubMed  Google Scholar 

  13. Brenner DJ (2004) Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology 231:440–445

    Article  PubMed  Google Scholar 

  14. Baumueller S, Winklehner A, Karlo C et al (2012) Low-dose CT of the lung: potential value of iterative reconstructions. Eur Radiol 22:2597–2606

    Article  PubMed  Google Scholar 

  15. Neroladaki A, Botsikas D, Boudabbous S et al (2013) Computed tomography of the chest with model-based iterative reconstruction using a radiation exposure similar to chest X-ray examination: preliminary observations. Eur Radiol 23:360–366

    Article  PubMed  Google Scholar 

  16. Gordic S, Morsbach F, Schmidt B et al (2014) Ultralow-Dose chest computed tomography for pulmonary nodule detection: first performance evaluation of single energy scanning with spectral shaping. Invest Radiol 49:465–473

    Article  PubMed  Google Scholar 

  17. Valencia R, Denecke T, Lehmkuhl L et al (2006) Value of axial and coronal maximum intensity projection (MIP) images in the detection of pulmonary nodules by multislice spiral CT: comparison with axial 1-mm and 5-mm slices. Eur Radiol 16:325–332

    Article  PubMed  Google Scholar 

  18. Christe A, Leidolt L, Huber A et al (2013) Lung cancer screening with CT: evaluation of radiologists and different computer assisted detection software (CAD) as first and second readers for lung nodule detection at different dose levels. Eur J Radiol 82:e873–e878

    Article  CAS  PubMed  Google Scholar 

  19. Zhao Y, de Bock GH, Vliegenthart R et al (2012) Performance of computer-aided detection of pulmonary nodules in low-dose CT: comparison with double reading by nodule volume. Eur Radiol 22:2076–2084

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ebner L, Bütikofer Y, Ott D et al (2015) Lung nodule detection by microdose CT versus chest radiography (standard and dual-energy subtracted). Am J Roentgenol. doi:10.2214/AJR.14.12921

    Google Scholar 

  21. ICRP (2007) The 2007 recommendations of the international commission on radiological protection. ICRP publication 103. Ann ICRP 37:1–332

    Article  Google Scholar 

  22. Zar JH (2010) Biostatistical analysis. Prentice-Hall/Pearson, Upper Saddle River

    Google Scholar 

  23. Wilcoxon F (1946) Individual comparisons of grouped data by ranking methods. J Econ Entomol 39:269

    Article  CAS  PubMed  Google Scholar 

  24. Light RJ (1971) Measures of response agreement for qualitative data: some generalizations and alternatives. Psychol Bull 76:365–377

    Article  Google Scholar 

  25. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  26. Schoonjans F, Zalata A, Depuydt CE, Comhaire FH (1995) MedCalc: a new computer program for medical statistics. Comput Methods Programs Biomed 48:257–262

    Article  CAS  PubMed  Google Scholar 

  27. Veronesi G, Maisonneuve P, Spaggiari L et al (2014) Diagnostic performance of low-dose computed tomography screening for lung cancer over five years. J Thorac Oncol 9:935–939

    Article  PubMed  Google Scholar 

  28. Doo KW, Kang E-Y, Yong HS et al (2014) Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study. Eur Radiol 24:3269–3276

    Article  PubMed  Google Scholar 

  29. Godoy MCB, Kim TJ, White CS et al (2013) Benefit of computer-aided detection analysis for the detection of subsolid and solid lung nodules on thin- and thick-section CT. Am J Roentgenol 200:74–83

    Article  Google Scholar 

  30. Li Q, Li F, Doi K (2008) Computerized detection of lung nodules in thin-section CT images by use of selective enhancement filters and an automated rule-based classifier. Acad Radiol 15:165–175

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Slattery MM, Foley C, Kenny D et al (2012) Long-term follow-up of non-calcified pulmonary nodules (<10 mm) identified during low-dose CT screening for lung cancer. Eur Radiol 22:1923–1928

    Article  PubMed  Google Scholar 

  32. Henschke CI, Yankelevitz DF, Naidich DP et al (2004) CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans. Radiology 231:164–168

    Article  PubMed  Google Scholar 

  33. Travis WD, Brambilla E, Noguchi M et al (2011) International association for the study of lung cancer/American thoracic society/european respiratory society: international multidisciplinary classification of lung adenocarcinoma. Proc Am Thorac Soc 8:381–385

    Article  PubMed  Google Scholar 

  34. MacMahon H, Austin JHM, Gamsu G et al (2005) Guidelines for management of small pulmonary nodules detected on CT Scans: a statement from the fleischner society. Radiology 237:395–400

    Article  PubMed  Google Scholar 

  35. Horeweg N, van Rosmalen J, Heuvelmans MA et al (2014) Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol 15:1332–1341

    Article  PubMed  Google Scholar 

  36. Bach PB, Mirkin JN, Oliver TK et al (2012) Benefits and harms of ct screening for lung cancer: a systematic review. JAMA 307:2418–2429

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. McMahon PM, Kong CY, Bouzan C et al (2011) Cost-Effectiveness of CT screening for lung cancer in the U.S. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer 6:1841–1848

    Google Scholar 

  38. Priola AM, Priola SM, Giaj-Levra M et al (2013) Clinical implications and added costs of incidental findings in an early detection study of lung cancer by using low-dose spiral computed tomography. Clin Lung Cancer 14:139–148

    Article  PubMed  Google Scholar 

  39. Bergh KAM, Essink-Bot M-L, Borsboom GJJM, et al. (2010) Long-term effects of lung cancer CT screening on health-related quality of life (NELSON). Eur Respir J erj01234–2010. doi: 10.1183/09031936.00123410

  40. Vansteenkiste J, Dooms C, Mascaux C, Nackaerts K (2012) Screening and early detection of lung cancer. Ann Oncol 23:x320–x327

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Dr. Andreas Christe. 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. This study has received funding by the Bernese Cancer League, the Jubilee Foundation Swisslife and the Swiss Fight Against Cancer Foundation. The funders had no role in data collection, study design and analysis, preparation of the manuscript or decision to publish. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this was a phantom study. No study subjects or cohorts have been previously reported. Methodology: prospective, experimental, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland

    Adrian Huber, Julia Landau, Lukas Ebner, Yanik Bütikofer, Lars Leidolt, Barbara Brela, Michelle May, Johannes Heverhagen & Andreas Christe

  2. Department of Polyvalent and Oncological Radiology, University Hospital Pitié-Salpêtrière, Paris, France

    Adrian Huber

  3. Department of Radiology, Duke University Medical Center, Durham, NC, USA

    Lukas Ebner

Authors
  1. Adrian Huber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Landau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lukas Ebner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yanik Bütikofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lars Leidolt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barbara Brela
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michelle May
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Johannes Heverhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andreas Christe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrian Huber.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00330-016-4325-3.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huber, A., Landau, J., Ebner, L. et al. Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging. Eur Radiol 26, 3643–3652 (2016). https://doi.org/10.1007/s00330-015-4192-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-4192-3

Keywords

Search

Navigation