Skip to main content
SpringerLink
Log in

Low-dose CT imaging of the acute abdomen using model-based iterative reconstruction: a prospective study

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Objectives

Performance of a modified abdominopelvic CT protocol reconstructed using full iterative reconstruction (IR) was assessed for imaging patients presenting with acute abdominal symptoms.

Materials and methods

Fifty-seven patients (17 male, 40 female; mean age of 56.5 ± 8 years) were prospectively studied. Low-dose (LD) and conventional-dose (CD) CTs were contemporaneously acquired between November 2015 and March 2016. The LD and CD protocols imparted radiation exposures approximating 10–20% and 80–90% those of routine abdominopelvic CT, respectively. The LD images were reconstructed with model-based iterative reconstruction (MBIR), and CD images with hybrid IR (40% adaptive statistical iterative reconstruction (ASIR)). Image quality was assessed quantitatively and qualitatively. Independent clinical interpretations were performed with a 6-week delay between reviews.

Results

A 74.7% mean radiation dose reduction was achieved: LD effective dose (ED) 2.38 ± 1.78 mSv (size-specific dose estimate (SSDE) 3.77 ± 1.97 mGy); CD ED 7.04 ± 4.89 mSv (SSDE 10.74 ± 5.5 mGy). LD-MBIR images had significantly lower objective and subjective image noise compared with CD-ASIR (p < 0.0001). Noise reduction for LD-MBIR studies was greater for patients with BMI < 25 kg/m2 than those with BMI ≥ 25 kg/m2 (5.36 ± 3.2 Hounsfield units (HU) vs. 4.05 ± 3.1 HU, p < 0.0001). CD-ASIR studies had significantly better contrast resolution, and diagnostic acceptability (p < 0.0001 for all). LD-MBIR studies had significantly lower streak artifact (p < 0.0001). There was no difference in sensitivity for primary findings between the low-dose and conventional protocols with the exception of one case of enteritis.

Conclusions

Low-dose abdominopelvic CT performed with MBIR is a feasible radiation dose reduction strategy for imaging patients presenting with acute abdominal pain.

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
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

ASIR:

Adaptive statistical iterative reconstruction

ATCM:

Automated tube current modulation

BMI:

Body mass index

CD:

Conventional dose

DLP:

Dose-length product

FBP:

Filtered back projection

GE:

General Electric

IBM:

International Business Machines Corporation

IR:

Iterative reconstruction

LD:

Low dose

MBIR:

Model-based iterative reconstruction

SAFIRE:

Sinogram affirmed iterative reconstruction

SSDE:

Size-specific dose estimate

ED:

Effective dose

SNR:

Signal-to-noise ratio

References

  1. Shah KH, Slovis BH, Runde D, Godbout B, Newman DH, Lee J (2013) Radiation exposure among patients with the highest CT scan utilization in the emergency department. Emerg Radiol 20(6):485–491

    Article  PubMed  Google Scholar 

  2. Griffey RT, Sodickson A (2009) Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. Am J Roentgenol 192(4):887–892

    Article  Google Scholar 

  3. Mettler FA Jr et al (2008) Medical radiation exposure in the U.S. in 2006: preliminary results. Health Phys 95(5):502–507

    Article  CAS  PubMed  Google Scholar 

  4. Seyal AR, Arslanoglu A, Abboud SF, Sahin A, Horowitz JM, Yaghmai V (2015) CT of the abdomen with reduced tube voltage in adults: a practical approach. Radiographics 35(7):1922–1939

    Article  PubMed  Google Scholar 

  5. Kalra MK, Maher MM, Sahani DV, Blake MA, Hahn PF, Avinash GB, Toth TL, Halpern E, Saini S (2003) Low-dose CT of the abdomen: evaluation of image improvement with use of noise reduction filters pilot study. Radiology 228(1):251–256

    Article  PubMed  Google Scholar 

  6. Kalra MK, Maher MM, Toth TL, Kamath RS, Halpern EF, Saini S (2004) Comparison of Z-axis automatic tube current modulation technique with fixed tube current CT scanning of abdomen and pelvis. Radiology 232(2):347–353

    Article  PubMed  Google Scholar 

  7. Prakash P, Kalra MK, Kambadakone AK, Pien H, Hsieh J, Blake MA, Sahani DV (2010) Reducing abdominal CT radiation dose with adaptive statistical iterative reconstruction technique. Investig Radiol 45(4):202–210

    Article  Google Scholar 

  8. O’Neill SB et al (2013) A prospective feasibility study of sub-millisievert abdominopelvic CT using iterative reconstruction in Crohn’s disease. Eur Radiol 23(9):2503–2512

    Article  PubMed  Google Scholar 

  9. Deak Z et al (2013) Filtered back projection, adaptive statistical iterative reconstruction, and a model-based iterative reconstruction in abdominal CT: an experimental clinical study. Radiology 266(1):197–206

    Article  PubMed  Google Scholar 

  10. Notohamiprodjo S, Deak Z, Meurer F, Maertz F, Mueck FG, Geyer LL, Wirth S (2015) Image quality of iterative reconstruction in cranial CT imaging: comparison of model-based iterative reconstruction (MBIR) and adaptive statistical iterative reconstruction (ASiR). Eur Radiol 25(1):140–146

    Article  CAS  PubMed  Google Scholar 

  11. Herin E et al (2015) Use of model-based iterative reconstruction (MBIR) in reduced-dose CT for routine follow-up of patients with malignant lymphoma: dose savings, image quality and phantom study. Eur Radiol 25(8):2362–2370

    Article  PubMed  Google Scholar 

  12. Neroladaki A, Botsikas D, Boudabbous S, Becker CD, Montet X (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(2):360–366

    Article  PubMed  Google Scholar 

  13. Mieville FA et al (2013) Model-based iterative reconstruction in pediatric chest CT: assessment of image quality in a prospective study of children with cystic fibrosis. Pediatr Radiol 43(5):558–567

    Article  PubMed  Google Scholar 

  14. Murphy KP, Crush L, McLaughlin PD, O’Sullivan HS, Twomey M, Lynch S, Bye J, McSweeney SE, O’Connor OJ, Shanahan F, Maher MM (2015) The role of pure iterative reconstruction in conventional dose CT enterography. Abdom Imaging 40(2):251–257

    Article  PubMed  Google Scholar 

  15. Shuman WP, Chan KT, Busey JM, Mitsumori LM, Choi E, Koprowicz KM, Kanal KM (2014) Standard and reduced radiation dose liver CT images: adaptive statistical iterative reconstruction versus model-based iterative reconstruction-comparison of findings and image quality. Radiology 273(3):793–800

    Article  PubMed  Google Scholar 

  16. Marin D, Nelson RC, Schindera ST, Richard S, Youngblood RS, Yoshizumi TT, Samei E (2010) Low-tube-voltage, high-tube-current multidetector abdominal CT: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm--initial clinical experience. Radiology 254(1):145–153

    Article  PubMed  Google Scholar 

  17. O’Connor OJ et al (2010) Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients. Radiology 257(3):820–829

    Article  PubMed  Google Scholar 

  18. Bongartz G et al (1999) European guidelines on quality criteria for computed tomography. EUR 16262, Luxembourg

  19. Bongartz G et al (2004) European guidelines for multislice computed tomography, funded by the European Commission, contract number FIGM-CT2000-20078-CT-TIP. http://www.drs.dk/guidelines/ct/quality/index.htm. Accessed 26 May 2018

  20. Singh S, Kalra MK, Hsieh J, Licato PE, Do S, Pien HH, Blake MA (2010) Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Radiology 257(2):373–383

    Article  PubMed  Google Scholar 

  21. Katsura M, Sato J, Akahane M, Matsuda I, Ishida M, Yasaka K, Kunimatsu A, Ohtomo K (2013) Comparison of pure and hybrid iterative reconstruction techniques with conventional filtered back projection: image quality assessment in the cervicothoracic region. Eur J Radiol 82(2):356–360

    Article  PubMed  Google Scholar 

  22. Katsura M, Matsuda I, Akahane M, Sato J, Akai H, Yasaka K, Kunimatsu A, Ohtomo K (2012) Model-based iterative reconstruction technique for radiation dose reduction in chest CT: comparison with the adaptive statistical iterative reconstruction technique. Eur Radiol 22(8):1613–1623

    Article  PubMed  Google Scholar 

  23. Nelson RC, Feuerlein S, Boll DT (2011) New iterative reconstruction techniques for cardiovascular computed tomography: how do they work, and what are the advantages and disadvantages? J Cardiovasc Comput Tomogr 5(5):286–292

    Article  PubMed  Google Scholar 

  24. Othman AE et al (2017) Evaluation of reduced-dose CT for acute non-traumatic abdominal pain: evaluation of diagnostic accuracy in comparison to standard-dose CT. Acta Radiol 59(1):4–12

  25. Kielar AZ, Patlas MN, Katz DS (2016) Oral contrast for CT in patients with acute non-traumatic abdominal and pelvic pain: what should be its current role? Emerg Radiol 23(5):477–481

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland

    Fiachra Moloney, Karl James, Maria Twomey, David Ryan, Richard G. Kavanagh, Niamh Moore, Mary Jane Murphy, Brian W. Carey, Sean E. McSweeney, Michael M. Maher & Owen J. O’Connor

  2. School of Medicine, University College Cork, Cork, Ireland

    Tyler M. Grey & Amber Downes

  3. GE Healthcare, Chicago, IL, USA

    Jackie Bye

  4. Department of Emergency Medicine, Cork University Hospital, Cork, Ireland

    Conor Deasy

  5. Department of Surgery, Cork University Hospital, University College Cork, Cork, Ireland

    Emmett Andrews

  6. Department of Medicine, Cork University Hospital, University College Cork, Cork, Ireland

    Fergus Shanahan

  7. Alimentary Pharmabiotic Center, Cork, Ireland

    Fergus Shanahan, Michael M. Maher & Owen J. O’Connor

Authors
  1. Fiachra Moloney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karl James
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Twomey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tyler M. Grey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amber Downes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard G. Kavanagh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Niamh Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mary Jane Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jackie Bye
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Brian W. Carey
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sean E. McSweeney
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Conor Deasy
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Emmett Andrews
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Fergus Shanahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Michael M. Maher
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Owen J. O’Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian W. Carey.

Ethics declarations

Ethical approval was granted and informed consent obtained from patients presenting with acute abdominal symptoms to the emergency department in a tertiary referral hospital between November 2015 and March 2016.

Conflict of interest

Ms. Jackie Bye is an employee of General Electric Healthcare and provided CT applications support for this project. The other authors declare that there is no conflict of interest regarding the publication of this paper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moloney, F., James, K., Twomey, M. et al. Low-dose CT imaging of the acute abdomen using model-based iterative reconstruction: a prospective study. Emerg Radiol 26, 169–177 (2019). https://doi.org/10.1007/s10140-018-1658-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-018-1658-z

Keywords

Search

Navigation