Assessment of task-based image quality for abdominal CT protocols linked with national diagnostic reference levels.

OBJECTIVES: To assess task-based image quality for two abdominal protocols on various CT scanners. To establish a relationship between diagnostic reference levels (DRLs) and task-based image quality. METHODS: A protocol for the detection of focal liver lesions was used to scan an anthropomorphic abdominal phantom containing 8- and 5-mm low-contrast (20 HU) spheres at five CTDIvol levels (4, 8, 12, 16, and 20 mGy) on 12 CTs. Another phantom with high-contrast calcium targets (200 HU) was scanned at 2, 4, 6, 10, and 15 mGy using a renal stones protocol on the same CTs. To assess the detectability, a channelized Hotelling observer was used for low-contrast targets and a non-prewhitening observer with an eye filter was used for high contrast targets. The area under the ROC curve and signal to noise ratio were used as figures of merit. RESULTS: For the detection of 8-mm spheres, the image quality reached a high level (mean AUC over all CTs higher than 0.95) at 11 mGy. For the detection of 5-mm spheres, the AUC never reached a high level of image quality. Variability between CTs was found, especially at low dose levels. For the search of renal stones, the AUC was nearly maximal even for the lowest dose level. CONCLUSIONS: Comparable task-based image quality cannot be reached at the same dose level on all CT scanners. This variability implies the need for scanner-specific dose optimization. KEY POINTS: • There is an image quality variability for subtle low-contrast lesion detection in the clinically used dose range. • Diagnostic reference levels were linked with task-based image quality metrics. • There is a need for specific dose optimization for each CT scanner and clinical protocol.

Comparison of image quality and radiation dose between split-filter dual-energy images and single-energy images in single-source abdominal CT.

OBJECTIVES: To compare image quality and radiation dose of abdominal split-filter dual-energy CT (SF-DECT) combined with monoenergetic imaging to single-energy CT (SECT) with automatic tube voltage selection (ATVS). METHODS: Two-hundred single-source abdominal CT scans were performed as SECT with ATVS (n = 100) and SF-DECT (n = 100). SF-DECT scans were reconstructed and subdivided into composed images (SF-CI) and monoenergetic images at 55 keV (SF-MI). Objective and subjective image quality were compared among single-energy images (SEI), SF-CI and SF-MI. CNR and FOM were separately calculated for the liver (e.g. CNRliv) and the portal vein (CNRpv). Radiation dose was compared using size-specific dose estimate (SSDE). Results of the three groups were compared using non-parametric tests. RESULTS: Image noise of SF-CI was 18% lower compared to SEI and 48% lower compared to SF-MI (p < 0.001). Composed images yielded higher CNRliv over single-energy images (23.4 vs. 20.9; p < 0.001), whereas CNRpv was significantly lower (3.5 vs. 5.2; p < 0.001). Monoenergetic images overcame this inferiority in CNRpv and achieved similar results compared to single-energy images (5.1 vs. 5.2; p > 0.628). Subjective sharpness was equal between single-energy and monoenergetic images and diagnostic confidence was equal between single-energy and composed images. FOMliv was highest for SF-CI. FOMpv was equal for SEI and SF-MI (p = 0.78). SSDE was significant lower for SF-DECT compared to SECT (p < 0.022). CONCLUSIONS: The combined use of split-filter dual-energy CT images provides comparable objective and subjective image quality at lower radiation dose compared to single-energy CT with ATVS. KEY POINTS: • Split-filter dual-energy results in 18% lower noise compared to single-energy with ATVS. • Split-filter dual-energy results in 11% lower SSDE compared to single-energy with ATVS. • Spectral shaping of split-filter dual-energy leads to an increased dose-efficiency.

Impact of model-based iterative reconstruction on low-contrast lesion detection and image quality in abdominal CT: a 12-reader-based comparative phantom study with filtered back projection at different tube voltages.

OBJECTIVES: To evaluate the impact of model-based iterative reconstruction (MBIR) on image quality and low-contrast lesion detection compared with filtered back projection (FBP) in abdominal computed tomography (CT) of simulated medium and large patients at different tube voltages. METHODS: A phantom with 45 hypoattenuating lesions was placed in two water containers and scanned at 70, 80, 100, and 120 kVp. The 120-kVp protocol served as reference, and the volume CT dose index (CTDIvol) was kept constant for all protocols. The datasets were reconstructed with MBIR and FBP. Image noise and contrast-to-noise-ratio (CNR) were assessed. Low-contrast lesion detectability was evaluated by 12 radiologists. RESULTS: MBIR decreased the image noise by 24% and 27%, and increased the CNR by 30% and 29% for the medium and large phantoms, respectively. Lower tube voltages increased the CNR by 58%, 46%, and 16% at 70, 80, and 100 kVp, respectively, compared with 120 kVp in the medium phantom and by 9%, 18% and 12% in the large phantom. No significant difference in lesion detection rate was observed (medium: 79-82%; large: 57-65%; P > 0.37). CONCLUSIONS: Although MBIR improved quantitative image quality compared with FBP, it did not result in increased low-contrast lesion detection in abdominal CT at different tube voltages in simulated medium and large patients. KEY POINTS: • MBIR improved quantitative image quality but not lesion detection compared with FBP. • Increased CNR by low tube voltages did not improve lesion detection. • Changes in image noise and CNR do not directly influence diagnostic accuracy.

Transatlantic Comparison of CT Radiation Doses in the Era of Radiation Dose-Tracking Software.

OBJECTIVE: The purpose of this study is to compare diagnostic reference levels from a local European CT dose registry, using radiation-tracking software from a large patient sample, with preexisting European and North American diagnostic reference levels. MATERIALS AND METHODS: Data (n = 43,761 CT scans obtained over the course of 2 years) for the European local CT dose registry were obtained from eight CT scanners at six institutions. Means, medians, and interquartile ranges of volumetric CT dose index (CTDIvol), dose-length product (DLP), size-specific dose estimate, and effective dose values for CT examinations of the head, paranasal sinuses, thorax, pulmonary angiogram, abdomen-pelvis, renal-colic, thorax-abdomen-pelvis, and thoracoabdominal angiogram were obtained using radiation-tracking software. Metrics from this registry were compared with diagnostic reference levels from Canada and California (published in 2015), the American College of Radiology (ACR) dose index registry (2015), and national diagnostic reference levels from local CT dose registries in Switzerland (2010), the United Kingdom (2011), and Portugal (2015). RESULTS: Our local registry had a lower 75th percentile CTDIvol for all protocols than did the individual internationally sourced data. Compared with our study, the ACR dose index registry had higher 75th percentile CTDIvol values by 55% for head, 240% for thorax, 28% for abdomen-pelvis, 42% for thorax-abdomen-pelvis, 128% for pulmonary angiogram, 138% for renal-colic, and 58% for paranasal sinus studies. CONCLUSION: Our local registry had lower diagnostic reference level values than did existing European and North American diagnostic reference levels. Automated radiation-tracking software could be used to establish and update existing diagnostic reference levels because they are capable of analyzing large datasets meaningfully.

Automatic tube current modulation for whole-body polytrauma CT with immobilization devices: is there an increase in radiation dose and degradation of image quality?

The objective of this study was the assessment of the image quality and radiation dose in polytrauma CT using immobilization devices. An anthropomorphic whole body and a liver phantom were scanned on a 128-slice CT scanner with four different protocols using automatic tube current modulation (120 kVp, 150 ref. mAs; 120 kV, 200 ref. mAs; 140 kVp, 150 ref. mAs; and 140 kVp, 200 ref. mAs) and four different setups (no immobilization device (setup A), vacuum mattress 1 (setup B), vacuum mattress 2 (setup C), and spineboard (setup D)). Qualitative and quantitative image quality parameters and radiation dose were assessed. Image noise increased on average by 6.6, 11.2, and 9.4 %, and CNR decreased by 11.2, 13.9, and 6.5 for setups B, C, and D, respectively, compared with setup A. The CTDIvol increased up to 6 % using immobilization devices. Severe streak artifacts, provoked by the inflation valve of the mattresses were detected at the level of the head and shoulder. Applying immobilization devices for whole-body CT with automatic tube current modulation increases the radiation dose and decreases the quantitative image quality slightly. Severe artifacts, induced by the inflation valve of the mattress, can influence the diagnostic accuracy at the level of the head and shoulder.

CT Radiation Dose Management: A Comprehensive Optimization Process for Improving Patient Safety.

Rising concerns of radiation exposure from computed tomography have caused various advances in dose reduction technologies. While proper justification and optimization of scans has been the main focus to address increasing doses, the value of dose management has been largely overlooked. The purpose of this article is to explain the importance of dose management, provide an overview of the available options for dose tracking, and discuss the importance of a dedicated dose team. The authors also describe how a digital radiation tracking software can be used for analyzing the big data on doses for auditing patient safety, scanner utilization, and productivity, all of which have enormous personal and institutional implications. (©) RSNA, 2016.

Feasibility of Dose Optimization in a Second-Generation Dual-Source CT Scanner for a Manufacturer-Recommended Urolithiasis Protocol for Imaging Renal Stones.

OBJECTIVE: The purpose of this article is to investigate the magnitude of dose optimization for a manufacturer-recommended urolithiasis protocol in a second-generation dual-source CT scanner. MATERIALS AND METHODS: Custom renal phantoms with 24 stones were scanned using the manufacturer-provided dual-energy CT protocol (tube A, 100 kVp and 210 reference mAs; tube B, 140 kVp and 162 reference mAs) and seven dose-optimized protocols in which the reference tube current-time product setting of tube A was reduced stepwise by 20 mAs. Detection and characterization of the stones was assessed. In the patient study, 25 patients underwent the manufacturer-provided dual-energy protocol and 25 patients underwent imaging with a dose-optimized protocol (tube A, 100 kVp and 90 reference mAs; tube B, 140 kVp and 70 reference mAs). Dose-length product (DLP), image noise, and contrast-to-noise ratio (CNR) were assessed. Subjective image quality was analyzed by three independent radiologists. RESULTS: In the phantom study, the reference tube current-time product of tube A could be reduced from 210 to 90 mAs without losing the accuracy of detection or characterization of the calculi. In the patient study, the dose-optimized protocol resulted in a significant reduction of the average DLP by 51% compared with the standard protocol (219.4 vs 443.5 mGy·cm, respectively; p = 0.0001). The image noise was higher, and the CNR was lower, in the dose-optimized group than in the standard-dose group (p < 0.05). The subjective overall image quality of the dose-optimized CT examinations was rated as good, and that of the standard-dose CT examinations was rated as excellent (p = 0.001). CONCLUSION: The in vitro and in vivo assessment revealed a potential for a 51% dose reduction of the manufacturer-recommended dual-energy CT protocol for urolithiasis without compromising the accuracy.

Assessment of image quality and low-contrast detectability in abdominal CT of obese patients: comparison of a novel integrated circuit with a conventional discrete circuit detector at different tube voltages.

OBJECTIVES: To compare image quality and low-contrast detectability of an integrated circuit (IC) detector in abdominal CT of obese patients with conventional detector technology at low tube voltages. METHODS: A liver phantom with 45 lesions was placed in a water container to mimic an obese patient and examined on two different CT systems at 80, 100 and 120 kVp. The systems were equipped with either the IC or conventional detector. Image noise was measured, and the contrast-to-noise-ratio (CNR) was calculated. Low-contrast detectability was assessed independently by three radiologists. Radiation dose was estimated by the volume CT dose index (CTDIvol). RESULTS: The image noise was significantly lower, and the CNR was significantly higher with the IC detector at 80, 100 and 120 kVp, respectively (P = 0.023). The IC detector resulted in an increased lesion detection rate at 80 kVp (38.1 % vs. 17.2 %) and 100 kVp (57.0 % vs. 41.0 %). There was no difference in the detection rate between the IC detector at 100 kVp and the conventional detector at 120 kVp (57.0 % vs. 62.2 %). The CTDIvol at 80, 100 and 120 kVp measured 4.5-5.2, 7.3-7.9 and 9.8-10.2 mGy, respectively. CONCLUSIONS: The IC detector at 100 kVp resulted in similar low-contrast detectability compared to the conventional detector with a 120-kVp protocol at a radiation dose reduction of 37 %.

Combining automated attenuation-based tube voltage selection and iterative reconstruction: a liver phantom study.

OBJECTIVES: To determine the value of combined automated attenuation-based tube-potential selection and iterative reconstructions (IRs) for optimising computed tomography (CT) imaging of hypodense liver lesions. METHODS: A liver phantom containing hypodense lesions was imaged by CT with and without automated attenuation-based tube-potential selection (80, 100 and 120 kVp). Acquisitions were reconstructed with filtered back projection (FBP) and sinogram-affirmed IR. Image noise and contrast-to-noise ratio (CNR) were measured. Two readers marked lesion localisation and rated confidence, sharpness, noise and image quality on a five-point scale (1 = worst, 5 = best). RESULTS: Image noise was lower (31-52%) and CNR higher (43-102%) on IR than on FBP images at all tube voltages. On 100-kVp and 80-kVp IR images, confidence and sharpness were higher than on 120-kVp FBP images. Scores for image quality score and noise as well as sensitivity for 100-kVp IR were similar or higher than for 120-kVp FBP and lower for 80-kVp IR. Radiation dose was reduced by 26% at 100 kVp and 56% at 80 kVp. CONCLUSIONS: Compared with 120-kVp FBP images, the combination of automated attenuation-based tube-potential selection at 100 kVp and IR provides higher image quality and improved sensitivity for detecting hypodense liver lesions in vitro at a dose reduced by 26%. KEY POINTS: • Combining automated tube voltage selection/iterative CT reconstruction improves image quality. • Attenuation values remain stable on IR compared with FBP images. • Lesion detection was highest on 100-kVp IR images.

Prospective randomised comparison of diagnostic confidence and image quality with normal-dose and low-dose CT pulmonary angiography at various body weights.

OBJECTIVES: To find a threshold body weight (BW) below 100 kg above which computed tomography pulmonary angiography (CTPA) using reduced radiation and a reduced contrast material (CM) dose provides significantly impaired quality and diagnostic confidence compared with standard-dose CTPA. METHODS: In this prospectively randomised study of 501 patients with suspected pulmonary embolism and BW <100 kg, 246 were allocated into the low-dose group (80 kVp, 75 ml CM) and 255 into the normal-dose group (100 kVp, 100 ml CM). Contrast-to-noise ratio (CNR) in the pulmonary trunk was calculated. Two blinded chest radiologists independently evaluated subjective image quality and diagnostic confidence. Data were compared between the normal-dose and low-dose groups in five BW subgroups. RESULTS: Vessel attenuation did not differ between the normal-dose and low-dose groups within each BW subgroup (P = 1.0). The CNR was higher with the normal-dose compared with the low-dose protocol (P < 0.006) in all BW subgroups except for the 90-99 kg subgroup (P = 0.812). Subjective image quality and diagnostic confidence did not differ between CT protocols in all subgroups (P between 0.960 and 1.0). CONCLUSIONS: Subjective image quality and diagnostic confidence with 80 kVp CTPA is not different from normal-dose protocol in any BW group up to 100 kg. KEY POINTS: • 80 kVp CTPA is safe in patients weighing <100 kg • Reduced radiation and iodine dose still provide high vessel attenuation • Image quality and diagnostic confidence with low-dose CTPA is good • Diagnostic confidence does not deteriorate in obese patients weighing <100 kg.

Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities.

OBJECTIVE: Splenic lesions are commonly encountered and are often incidental in nature. Benign splenic vascular neoplasms include hemangioma, hamartoma, lymphangioma, extra-medullary hematopoiesis (EMH), and sclerosing angiomatoid nodular transformation (SANT). Uncommonly encountered entities of the spleen include focal EMH, focal myeloma, angiomyolipoma, and SANT. Primary splenic angiosarcoma is the most common malignant nonhematolymphoid malignancy of the spleen. Lymphoma, myeloma, and metastases are the other malignant entities involving the spleen. The clinical presentation, key imaging findings, and associations of benign, neoplastic, and malignant diseases that can involve the spleen will be discussed. CONCLUSION: Radiologists can use multimodality imaging to diagnose entities involving the spleen by recognizing key imaging features and considering patient characteristics. However, biopsy may be warranted for definitive diagnosis when imaging findings are nonspecific.

Hybrid iterative reconstruction technique for abdominal CT protocols in obese patients: assessment of image quality, radiation dose, and low-contrast detectability in a phantom.

OBJECTIVE: The purpose of this study was to assess the impact of a noise reduction technique on image quality, radiation dose, and low-contrast detectability in abdominal CT for obese patients. MATERIALS AND METHODS: A liver phantom with 12 different tumors was designed, and fat rings were added to mimic intermediately sized and large patients. The intermediate and large phantoms were scanned with our standard abdominal CT protocol (image noise level of 15 HU and filtered back projection [FBP]). The large phantom was scanned with five different noise levels (10, 12.5, 15, 17.5, and 20 HU). All datasets for the large phantom were reconstructed with FBP and the noise reduction technique. The image noise and the contrast-to-noise ratio (CNR) were assessed. Tumor detection was independently performed by three radiologists in a blinded fashion. RESULTS: The application of the noise reduction method to the large phantom decreased the measured image noise (range, -14.5% to -37.0%) and increased the CNR (range, 26.7-70.6%) compared with FBP at the same noise level (p < 0.001). However, noise reduction was unable to improve the sensitivity for tumor detection in the large phantom compared with FBP at the same noise level (p > 0.05). Applying a noise level of 15 HU, the overall sensitivity for tumor detection in the intermediate and large phantoms with FBP measured 75.5% and 87.7% and the radiation doses measured 42.0 and 23.7 mGy, respectively. CONCLUSION: Although noise reduction significantly improved the quantitative image quality in simulated large patients undergoing abdominal CT compared with FBP, no improvement was observed for low-contrast detectability.

Iterative reconstruction algorithm for CT: can radiation dose be decreased while low-contrast detectability is preserved?

PURPOSE: To compare the low-contrast detectability and image quality of computed tomography (CT) at different radiation dose levels reconstructed with iterative reconstruction (IR) and filtered back projection (FBP). MATERIALS AND METHODS: A custom liver phantom with 12 simulated hypoattenuating tumors (diameters of 5, 10, 15, and 20 mm; tumor-to-liver contrast values of -10, -20, and -40 HU) was designed. The phantom was scanned with a standard abdominal CT protocol with a volume CT dose index of 21.6 mGy (equivalent 100% dose) and four low-dose protocols (20%, 40%, 60%, and 80% of the standard protocol dose). CT data sets were reconstructed with IR and FBP. Image noise was measured, and the tumors' contrast-to-noise ratios (CNRs) were calculated. Tumor detection was independently assessed by three radiologists who were blinded to the CT technique used. A total of 840 simulated tumors were presented to the radiologists. Statistical analyses included analysis of variance. RESULTS: IR yielded an image noise reduction of 43.9%-63.9% and a CNR increase of 74.1%-180% compared with FBP at the same dose level (P < .001). The overall sensitivity for tumor detection was 64.7%-85.3% for IR and 66.3%-85.7% for FBP at the 20%-100% doses, respectively. There was no significant difference in the sensitivity for tumor detection between IR and FBP at the same dose level (P = .99). The sensitivity of the protocol at the 20% dose with FBP and IR was significantly lower than that of the protocol at the 100% dose with FBP and IR (P = .019). CONCLUSION: As the radiation dose at CT decreases, the IR algorithm does not preserve the low-contrast detectability. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122349/-/DC1.

Clinical impact of an adaptive statistical iterative reconstruction algorithm for detection of hypervascular liver tumours using a low tube voltage, high tube current MDCT technique.

OBJECTIVES: To investigate the impact of an adaptive statistical iterative reconstruction (ASiR) algorithm on diagnostic accuracy and confidence for the diagnosis of hypervascular liver tumours, as well as the reader's perception of image quality, using a low tube voltage (80 kVp), high tube current computed tomography (CT) technique. METHODS: Forty patients (29 men, 11 women) with 65 hypervascular liver tumours underwent dual energy CT. The 80 kV set of the dual energy acquisition was reconstructed with standard filtered backprojection (FBP) and ASiR at different blending levels. Lesion contrast-to-noise ratio (CNR), reader's confidence for lesion detection and characterisation, and reader's evaluation of image quality were recorded. RESULTS: ASiR yielded significantly higher CNR values compared with FBP (P < 0.0001 for all comparisons). Reader's perception of lesion conspicuity and confidence in the diagnosis of malignancy were also higher with 60 % and 80 % ASiR, compared with FBP (P = 0.01 and < 0.001, respectively). Compared with FBP, ASiR yielded nearly significantly lower specificity for lesion detection and a substantial decrease in the reader's perception of image quality. CONCLUSIONS: Compared with the standard FBP algorithm, ASiR significantly improves conspicuity of hypervascular liver lesions. This improvement may come at the cost of decreased specificity and reader's perception of image quality.

Material differentiation in forensic radiology with single-source dual-energy computed tomography.

The goal of this study was to investigate the use of dual-energy computed tomography (CT) in differentiating frequently encountered foreign material on CT images using a standard single-source CT scanner. We scanned 20 different, forensically relevant materials at two X-Ray energy levels (80 and 130 kVp) on CT. CT values were measured in each object at both energy levels. Intraclass correlation coefficient (ICC) was used to determine intra-reader reliability. Analysis of variance (ANOVA) was performed to assess significance levels between X-Ray attenuation at 80 and 130 kVp. T test was used to investigate significance levels between mean HU values of individual object pairings at single energy levels of 80 and 130 kVp, respectively. ANOVA revealed that the difference in attenuation between beam energies of 80 kVp compared to 130 kVp was statistically significant (p < 0.005) for all materials except brass and lead. ICC was excellent at 80 kVp (0.999, p < 0.001) and at 130 kVp (0.998, p < 0.001). T test showed that using single energy levels of 80 and 130 kVp respectively 181/190 objects pairs could be differentiated from one another based on HU measurements. Using the combined information from both energy levels, 189/190 object pairs could be differentiated. Scanning with different energy levels is a simple way to apply dual-energy technique on a regular single-energy CT and improves the ability to differentiate foreign bodies with CT, based on their attenuation values.

Nonlinear three-dimensional noise filter with low-dose CT angiography: effect on the detection of small high-contrast objects in a phantom model.

PURPOSE: To study the effect of a nonlinear noise filter on the detection of simulated endoleaks in a phantom with 80- and 100-kVp multidetector computed tomographic (CT) angiography. MATERIALS AND METHODS: An aortic aneurysm phantom, including iodinated endoleaks, was constructed. Multidetector CT angiography with use of 80-, 100-, and 120-kVp tube voltages was performed for simulated intermediate-sized and large patients (estimated body weights, 72-85 kg and 118-142 kg, respectively). Images obtained with 80 and 100 kVp were postprocessed by using a nonlinear noise filter. CT images containing 1152 endoleaks and images with no endoleaks were randomized and independently analyzed by three radiologists blinded to the location of the endoleaks. Diagnostic confidence and image quality were rated by using subjective scales. Analysis of variance was used for statistical assessment. RESULTS: In simulated intermediate-sized patients, energy reduction from 120 to 100 kVp and from100 to 80 kVp did not decrease image quality when images with reduced kilovoltage were filtered (P = .2692 and P > .99, respectively). Readers detected more endoleaks on the filtered 100-kVp images than on the nonfiltered images in simulated large patients (83 vs 75 lesions, P = .041). The number of detected endoleaks and the confidence rate were similar at 100 kVp with a filter and at 120 kVp in simulated large patients (P = .339 and P = .211, respectively). CONCLUSION: In a phantom, the nonlinear noise filter can prevent decreased image quality with use of 80- and 100-kVp abdominal multidetector CT angiography at a wide range of simulated body weights and may facilitate a better detection rate of endoleaks in heavy patients.

Iterative reconstruction algorithm for abdominal multidetector CT at different tube voltages: assessment of diagnostic accuracy, image quality, and radiation dose in a phantom study.

PURPOSE: To assess the diagnostic accuracy, image quality, and radiation dose of an iterative reconstruction algorithm compared with a filtered back projection (FBP) algorithm for abdominal computed tomography (CT) at different tube voltages. MATERIALS AND METHODS: A custom liver phantom with 45 simulated hypovascular liver tumors (diameters of 5, 10, and 15 mm; tumor-to-liver contrast of 10, 25, and 50 HU) was placed in a cylindrical water container that mimicked an intermediate-sized patient. The phantom was scanned at 120, 100, and 80 kVp. The CT data sets were reconstructed with FBP and iterative reconstruction. The image noise was measured, and the contrast-to-noise ratio (CNR) of the tumors was calculated. The radiation dose was assessed with the volume CT dose index. Tumor detection was independently performed by three radiologists. Statistical analysis included analysis of variance. RESULTS: Compared with the FBP data set at 120 kVp, the iterative reconstruction data set collected at 100 kVp demonstrated significantly lower mean image noise (20.9 and 16.7 HU, respectively; P < .001) and greater mean CNRs for the simulated tumors (P < .001). The iterative reconstruction data set collected at 120 kVp yielded the highest sensitivity for tumor detection, while the FBP data set at 80 kVp yielded the lowest. The sensitivity for the iterative reconstruction data set at 100 kVp was comparable with that for the FBP data set at 120 kVp (79.3% and 74.9%, respectively; P > .99). The volume CT dose index decreased by 39.8% between the 120-kVp protocol and the 100-kVp protocol and by 70.3% between the 120-kVp protocol and the 80-kVp protocol. CONCLUSION: Results of this phantom study suggest that a 100-kVp abdominal CT protocol with an iterative reconstruction algorithm for simulated intermediate-sized patients increases the image quality and maintains the diagnostic accuracy at a reduced radiation dose when compared with a 120-kVp protocol with an FBP algorithm.

An education and training programme for radiological institutes: impact on the reduction of the CT radiation dose.

OBJECTIVES: To establish an education and training programme for the reduction of CT radiation doses and to assess this programme's efficacy. METHODS: Ten radiological institutes were counselled. The optimisation programme included a small group workshop and a lecture on radiation dose reduction strategies. The radiation dose used for five CT protocols (paranasal sinuses, brain, chest, pulmonary angiography and abdomen) was assessed using the dose-length product (DLP) before and after the optimisation programme. The mean DLP values were compared with national diagnostic reference levels (DRLs). RESULTS: The average reduction of the DLP after optimisation was 37% for the sinuses (180 vs. 113 mGycm, P < 0.001), 9% for the brain (982 vs. 896 mGycm, P < 0.05), 24% for the chest (425 vs. 322 mGycm, P < 0.05) and 42% for the pulmonary arteries (352 vs. 203 mGycm, P < 0.001). No significant change in DLP was found for abdominal CT. The post-optimisation DLP values of the sinuses, brain, chest, pulmonary arteries and abdomen were 68%, 10%, 20%, 55% and 15% below the DRL, respectively. CONCLUSIONS: The education and training programme for radiological institutes is effective in achieving a substantial reduction in CT radiation dose.