Simultaneous assessment of heart and lungs with gated high-pitch ultra-low dose chest CT using artificial intelligence-based calcium scoring.

Purpose: The combined testing for coronary artery and pulmonary diseases is of clinical interest as risk factors are shared. In this study, a novel ECG-gated tin-filtered ultra-low dose chest CT protocol (GCCT) for integrated heart and lung acquisition and the applicability of artificial intelligence (AI)-based coronary artery calcium scoring were assessed. Methods: In a clinical registry of 10481 patients undergoing heart and lung CT, GCCT was applied in 44 patients on a dual-source CT. Coronary calcium scans (CCS) with 120 kVp, 100 kVp, and tin-filtered 100 kVp (Sn100) of controls, matched with regard to age, sex, and body-mass index, were retrieved from the registry (ntotal=176, 66.5 (59.4-74.0) years, 52 men). Automatic tube current modulation was used in all scans. In 20 patients undergoing GCCT and Sn100 CCS, Agatston scores were measured both semi-automatically by experts and by AI, and classified into six groups (0, <10, <100, <400, <1000, ≥1000). Results: Effective dose decreased significantly from 120 kVp CCS (0.50 (0.41-0.61) mSv) to 100 kVp CCS (0.34 (0.26-0.37) mSv) to Sn100 CCS (0.14 (0.11-0.17) mSv). GCCT showed higher values (0.28 (0.21-0.32) mSv) than Sn100 CCS but lower than 120 kVp and 100 kVp CCS (all p < 0.05) despite greater scan length. Agatston scores correlated strongly between GCCT and Sn100 CCS in semi-automatic and AI-based measurements (both ρ = 0.98, p < 0.001) resulting in high agreement in Agatston score classification (κ = 0.97, 95% CI 0.92-1.00; κ = 0.89, 95% CI 0.79-0.99). Regarding chest findings, further diagnostic steps were recommended in 28 patients. Conclusions: GCCT allows for reliable coronary artery disease and lung cancer screening with ultra-low radiation exposure. GCCT-derived Agatston score shows excellent agreement with standard CCS, resulting in equivalent risk stratification.

Ultra-low-dose computed tomography for torsion measurements of the lower extremities in children and adolescents.

BACKGROUND: Quantifying femoral and tibial torsion is crucial in the preoperative planning for derotation surgery in children and adolescents. The use of an ultra-low-dose computed tomography (CT) protocol might be possible for modern CT scanners and suitable for reliable torsion measurements even though the bones are not completely ossified. METHODS: This is a retrospective review of 77 children/adolescents (mean age 12.7 years) who underwent a lower extremity CT for torsion measurements on a 64-slice scanner. A stepwise dose reduction (70%, 50%, 30% of the original dose) was simulated. Torsion measurements were performed on all image datasets, and image noise, interrater agreement and subjective image quality were evaluated. Effective radiation dose of each original scan was estimated. As proof of concept, 24 children were scanned with an ultra-low-dose protocol, adapted from the 30% dose simulation, and the intra-class correlation coefficient (ICC) was determined. Ethics approval and informed consent were given. RESULTS: Torsion measurements at the simulated 30% dose level had equivalent interrater agreement compared to the 100% dose level (ICC ≥ 0.99 for all locations and dose levels). Image quality of almost all datasets was rated excellent, regardless of dose. The mean sum of the effective dose of the total torsion measurement was reduced by simulation from 0.460/0.490 mSv (boys/girls) at 100% dose to 0.138/0.147 mSv at 30%. The ICC of the proof-of-concept group was as good as that of the simulated 30% dose level. CONCLUSION: Pediatric torsion measurements of the lower extremities can be performed using an ultra-low-dose protocol without compromising diagnostic confidence.

Image Quality Assessment for Clinical Cadmium Telluride-Based Photon-Counting Computed Tomography Detector in Cadaveric Wrist Imaging.

OBJECTIVES: Detailed visualization of bone microarchitecture is essential for assessment of wrist fractures in computed tomography (CT). This study aims to evaluate the imaging performance of a CT system with clinical cadmium telluride-based photon-counting detector (PCD-CT) compared with a third-generation dual-source CT scanner with energy-integrating detector technology (EID-CT). MATERIALS AND METHODS: Both CT systems were used for the examination of 8 cadaveric wrists with radiation dose equivalent scan protocols (low-/standard-/full-dose imaging: CTDIvol = 1.50/5.80/8.67 mGy). All wrists were scanned with 2 different operating modes of the photon-counting CT (standard-resolution and ultra-high-resolution). After reformatting with comparable reconstruction parameters and convolution kernels, subjective evaluation of image quality was performed by 3 radiologists on a 7-point scale. For estimation of interrater reliability, we report the intraclass correlation coefficient (absolute agreement, 2-way random-effects model). Signal-to-noise and contrast-to-noise ratios were calculated to provide semiquantitative assessment of image quality. RESULTS: Subjective image quality of standard-dose PCD-CT examinations in ultra-high-resolution mode was superior compared with full-dose PCD-CT in standard-resolution mode (P = 0.016) and full-dose EID-CT (P = 0.040). No difference was ascertained between low-dose PCD-CT in ultra-high-resolution mode and standard-dose scans with either PCD-CT in standard-resolution mode (P = 0.108) or EID-CT (P = 0.470). Observer evaluation of standard-resolution PCD-CT and EID-CT delivered similar results in full- and standard-dose scans (P = 0.248/0.509). Intraclass correlation coefficient was 0.876 (95% confidence interval, 0.744-0.925; P < 0.001), indicating good reliability. Between dose equivalent studies, signal-to-noise and contrast-to-noise ratios were substantially higher in photon-counting CT examinations (all P's < 0.001). CONCLUSIONS: Superior visualization of fine anatomy is feasible with the clinical photon-counting CT system in cadaveric wrist scans. The ultra-high-resolution scan mode suggests potential for considerable dose reduction over energy-integrating dual-source CT.

Advanced Modeled Iterative Reconstruction (ADMIRE) Facilitates Radiation Dose Reduction in Abdominal CT.

RATIONALE AND OBJECTIVES: This study aimed to determine the potential degree of radiation dose reduction achievable using Advanced Modeled Iterative Reconstruction (ADMIRE) in abdominal computed tomography (CT) while maintaining image quality. Moreover, this study compared differences in image noise reduction of this iterative algorithm with radiation dose reduction. METHODS: Eleven consecutive patients scheduled for abdominal CT were scanned according to our institute's standard protocol (100 kV, 289 reference mAs). Using a proprietary reconstruction software, CT images of these patients were reconstructed as either full-dose weighted filtered back projections or with simulated radiation dose reductions down to 10% of the full-dose level and ADMIRE at either strength 3 or strength 5. Images were marked with arrows pointing on anatomic structures of the abdomen, differing in their contrast to the surrounding tissue. Structures were grouped into high-, medium-, and low-contrast subgroups. In addition, the intrinsic noise of these structures was measured. That followed, image pairs were presented to observers, with five readers assessing image quality using two-alternative-forced-choice comparisons. In total, 3000 comparisons were performed that way. RESULTS: Both ADMIRE 3 and 5 decreased noise of the anatomic structures significantly compared to the filtered back projection, with an additional significant difference between ADMIRE 3 and 5. Radiation dose reduction potential for ADMIRE ranged from 29.0% to 53.5%, with no significant differences between ADMIRE 3 and 5 within the contrast subgroups.The potential levels of radiation dose reduction for ADMIRE 3 differed significantly between high-, medium-, and low-contrast structures, whereas for ADMIRE 5, there was only a significant difference between the high- and the medium-contrast subgroups. CONCLUSION: Although ADMIRE 5 permits significantly higher noise reduction potential than ADMIRE 3, it does not facilitate higher levels of radiation dose reduction. ADMIRE nonetheless holds remarkable potential for radiation dose reduction, which features a certain dependency on the contrast of the structure of interest. Applying ADMIRE with a strength of 3 in abdominal CT may permit radiation dose reduction of about 30%.

CT coronary calcium scoring with tin filtration using iterative beam-hardening calcium correction reconstruction.

OBJECTIVES: To investigate the diagnostic accuracy of CT coronary artery calcium scoring (CACS) with tin pre-filtration (Sn100kVp) using iterative beam-hardening correction (IBHC) calcium material reconstruction compared to the standard 120kVp acquisition. BACKGROUND: Third generation dual-source CT (DSCT) CACS with Sn100kVp acquisition allows significant dose reduction. However, the Sn100kVp spectrum is harder with lower contrast compared to 120kVp, resulting in lower calcium score values. Sn100kVp spectral correction using IBHC-based calcium material reconstruction may restore comparable calcium values. METHODS: Image data of 62 patients (56% male, age 63.9±9.2years) who underwent a clinically-indicated CACS acquisition using the standard 120kVp protocol and an additional Sn100kVp CACS scan as part of a research study were retrospectively analyzed. Datasets of the Sn100kVp scans were reconstructed using a dedicated spectral IBHC CACS reconstruction to restore the spectral response of 120kVp spectra. Agatston scores were derived from 120kVp and IBHC reconstructed Sn100kVp studies. Pearson's correlation coefficient was assessed and Agatston score categories and percentile-based risk categorization were compared. RESULTS: Median Agatston scores derived from IBHC Sn100kVp scans and 120kVp acquisition were 31.7 and 34.1, respectively (p=0.057). Pearson's correlation coefficient showed excellent correlation between the acquisitions (r=0.99, p<0.0001). Agatston score categories and percentile-based cardiac risk categories showed excellent agreement (ĸ=1.00 and ĸ=0.99), resulting in a low cardiac risk reclassification of 1.6% with the use of IBHC CACS reconstruction. Image noise was 24.9±3.6HU in IBHC Sn100kVp and 17.1±3.9HU in 120kVp scans (p<0.0001). The dose-length-product was 13.2±3.4mGycm with IBHC Sn100kVp and 59.1±22.9mGycm with 120kVp scans (p<0.0001), resulting in a significantly lower effective radiation dose (0.19±0.07mSv vs. 0.83±0.33mSv, p<0.0001) for IBHC Sn100kVp scans. CONCLUSION: Low voltage CACS with tin filtration using a dedicated IBHC CACS material reconstruction algorithm shows excellent correlation and agreement with the standard 120kVp acquisition regarding Agatston score and cardiac risk categorization, while radiation dose is significantly reduced by 75% to the level of a chest x-ray.

Computed Tomography of the Head and Neck Region for Tumor Staging-Comparison of Dual-Source, Dual-Energy and Low-Kilovolt, Single-Energy Acquisitions.

PURPOSE: The aim of this study was to intra-individually compare the image quality obtained by dual-source, dual-energy (DSDE) computed tomography (CT) examinations and different virtual monoenergetic reconstructions to a low single-energy (SE) scan. MATERIALS AND METHODS: Third-generation DSDE-CT was performed in 49 patients with histologically proven malignant disease of the head and neck region. Weighted average images (WAIs) and virtual monoenergetic images (VMIs) for low (40 and 60 keV) and high (120 and 190 keV) energies were reconstructed. A second scan aligned to the jaw, covering the oral cavity, was performed for every patient to reduce artifacts caused by dental hardware using a SE-CT protocol with 70-kV tube voltages and matching radiation dose settings. Objective image quality was evaluated by calculating contrast-to-noise ratios. Subjective image quality was evaluated by experienced radiologists. RESULTS: Highest contrast-to-noise ratios for vessel and tumor attenuation were obtained in 40-keV VMI (all P < 0.05). Comparable objective results were found in 60-keV VMI, WAI, and the 70-kV SE examinations. Overall subjective image quality was also highest for 40-keV, but differences to 60-keV VMI, WAI, and 70-kV SE were nonsignificant (all P > 0.05). High kiloelectron volt VMIs reduce metal artifacts with only limited diagnostic impact because of insufficiency in case of severe dental hardware. CTDIvol did not differ significantly between both examination protocols (DSDE: 18.6 mGy; 70-kV SE: 19.4 mGy; P = 0.10). CONCLUSIONS: High overall image quality for tumor delineation in head and neck imaging were obtained with 40-keV VMI. However, 70-kV SE examinations are an alternative and modified projections aligned to the jaw are recommended in case of severe artifacts caused by dental hardware.

Radiation dose reduction in parasinus CT by spectral shaping.

INTRODUCTION: Spectral shaping aims to narrow the X-ray spectrum of clinical CT. The aim of this study was to determine the image quality and the extent of radiation dose reduction that can be achieved by tin prefiltration for parasinus CT. METHODS: All scans were performed with a third generation dual-source CT scanner. A study protocol was designed using 100 kV tube voltage with tin prefiltration (200 mAs) that provides image noise levels comparable to a low-dose reference protocol using 100 kV without spectral shaping (25 mAs). One hundred consecutive patients were prospectively enrolled and randomly assigned to the study or control group. All patients signed written informed consent. The study protocol was approved by the local Institutional Review Board and applies to the HIPAA. Subjective and objective image quality (attenuation values, image noise, and contrast-to-noise ratio (CNR)) were assessed. Radiation exposure was assessed as volumetric CT dose index, and effective dose was estimated. Mann-Whitney U test was performed for radiation exposure and for image noise comparison. RESULTS: All scans were of diagnostic image quality. Image noise in air, in the retrobulbar fat, and in the eye globe was comparable between both groups (all p > 0.05). CNReye globe/air did not differ significantly between both groups (p = 0.7). Radiation exposure (1.7 vs. 2.1 mGy, p < 0.01) and effective dose (0.055 vs. 0.066 mSv, p < 0.01) were significantly reduced in the study group. CONCLUSION: Radiation dose can be further reduced by 17% for low-dose parasinus CT by tin prefiltration maintaining diagnostic image quality.

Accuracy and Radiation Dose Reduction Using Low-Voltage Computed Tomography Coronary Artery Calcium Scoring With Tin Filtration.

This study prospectively investigated the accuracy and radiation dose reduction of CT coronary artery calcium scoring (CACS) using a 100 kVp acquisition protocol with tin filtration (Sn100 kVp) compared with the standard 120 kVp acquisition protocol; 70 patients (59% men, 62.1 ± 10.7 years) who underwent a clinically indicated CACS acquisition using the standard 120 kVp protocol on a third-generation dual-source CT system were enrolled. An additional Sn100 kVp CACS scan was performed. Agatston scores and categories, percentile-based risk categorization, and radiation dose estimates were derived from 120 and Sn100 kVp studies and compared. Median Agatston scores from the Sn100 and 120 kVp acquisitions were 38.2 and 41.2, respectively (p <0.0001). Excellent correlation of Agatston scores was found between the 2 acquisitions (r = 0.99, p <0.0001). Although the Agatston scores were systematically lower with Sn100 than with 120 kVp, the comparison of Agatston score categories and percentile-based cardiac risk categories showed excellent agreement (κ = 0.98 and κ = 0.98). Image noise was 26.3 ± 5.7 Hounsfield units in Sn100 kVp and 17.6 ± 4.1 Hounsfield units in 120 kVP scans (p <0.0001). The dose-length product was 14.1 ± 3.7 mGy·cm with Sn100 kVp and 58.5 ± 23.5 mGy·cm with 120 kVp scans (p <0.0001), resulting in a significantly lower effective radiation dose (0.19 ± 0.05 vs 0.82 ± 0.32 mSv, p <0.0001) for Sn100 kVp scans. CACS using a low-voltage tin filtration protocol shows excellent correlation and agreement with the standard method with regard to the Agatston score and subsequent cardiac risk categorization, while achieving a 75% reduction in radiation dose.

Approaches to ultra-low radiation dose coronary artery calcium scoring based on 3rd generation dual-source CT: A phantom study.

OBJECTIVES: To investigate to what extent 3rd generation dual-source computed tomography (DSCT) can reduce radiation dose in coronary artery calcium scoring. METHODS: Image acquisition was performed using a stationary calcification phantom. Prospectively electrocardiogram (ECG)-triggered 120 kV sequential, and 120 and Sn100 kV ultra-high pitch (UHP) acquisitions were performed with different tube currents (80, 60, 40, 20 mA). Images were reconstructed using filtered back projection (FBP) and 3rd generation iterative reconstruction (IR). Contrast-to-noise ratio (CNR), Agatston score, calcium volume, and radiation dose were assessed. For statistical analysis Friedman tests and Wilcoxon rank sum tests were used. RESULTS: Even at reduced tube currents, the three acquisition techniques did not show significant differences in Agatston score (p=0.4) or calcium volume (p=0.08) with FBP reconstruction. Calcium volumes were significantly lower for 3rd generation IR compared to FBP reconstructions (p<0.01). CTDIvol for the 120 kV sequential, 120 and Sn100 kV UHP acquisitions at 80 and 20 mA were 1.2-0.37, 0.48-0.17, and 0.07-0.02 mGy, respectively. CONCLUSION: 3rd generation DSCT enabled a reduction of tube current in both the sequential and UHP acquisitions without significantly affecting coronary calcium scoring. Tin filtered 100 kV scanning may allow accurate quantification of calcium score without correction of the HU threshold.

A Novel Pairwise Comparison-Based Method to Determine Radiation Dose Reduction Potentials of Iterative Reconstruction Algorithms, Exemplified Through Circle of Willis Computed Tomography Angiography.

OBJECTIVES: The aim of this study was to determine the dose reduction potential of iterative reconstruction (IR) algorithms in computed tomography angiography (CTA) of the circle of Willis using a novel method of evaluating the quality of radiation dose-reduced images. MATERIALS AND METHODS: This study relied on ReconCT, a proprietary reconstruction software that allows simulating CT scans acquired with reduced radiation dose based on the raw data of true scans. To evaluate the performance of ReconCT in this regard, a phantom study was performed to compare the image noise of true and simulated scans within simulated vessels of a head phantom. That followed, 10 patients scheduled for CTA of the circle of Willis were scanned according to our institute's standard protocol (100 kV, 145 reference mAs). Subsequently, CTA images of these patients were reconstructed as either a full-dose weighted filtered back projection or with radiation dose reductions down to 10% of the full-dose level and Sinogram-Affirmed Iterative Reconstruction (SAFIRE) with either strength 3 or 5. Images were marked with arrows pointing on vessels of different sizes, and image pairs were presented to observers. Five readers assessed image quality with 2-alternative forced choice comparisons. RESULTS: In the phantom study, no significant differences were observed between the noise levels of simulated and true scans in filtered back projection, SAFIRE 3, and SAFIRE 5 reconstructions.The dose reduction potential for patient scans showed a strong dependence on IR strength as well as on the size of the vessel of interest. Thus, the potential radiation dose reductions ranged from 84.4% for the evaluation of great vessels reconstructed with SAFIRE 5 to 40.9% for the evaluation of small vessels reconstructed with SAFIRE 3. CONCLUSIONS: This study provides a novel image quality evaluation method based on 2-alternative forced choice comparisons. In CTA of the circle of Willis, higher IR strengths and greater vessel sizes allowed higher degrees of radiation dose reduction.

Computed Tomography Angiography of Carotid Arteries and Vertebrobasilar System: A Simulation Study for Radiation Dose Reduction.

Computed tomography angiography (CTA) of carotid arteries and vertebrobasilar system is a standardized procedure with excellent image quality, but radiation exposure remains a matter of concern. The aim of this study is to examine to what extent radiation dose can be lowered in relation to a standard protocol by simulating examinations with lower tube currents applying a dedicated software.Lower tube current was simulated by a dedicated noise insertion and reconstruction software (ReconCT). In a phantom study, true scans were performed with different dose protocols and compared to the results of simulated dose reductions of the same degree, respectively. In a patient study, 30 CTAs of supra-aortic vessels were reconstructed at a level of 100%, 75%, 50%, and 25% of the initial dose. Objective and subjective image analyses were performed.No significant noise differences between true scans and simulated scans of mimicked contrasted vessels were found. In the patient study, the quality scores of the 4 dose groups differed statistically significant; this difference vanished for the comparison of the 100% and 75% datasets after dichotomization into the categories of diagnostic and nondiagnostic image quality (P = .50).This study suggests an easy-to-implement method of simulating CTAs of carotid arteries and vertebrobasilar system with lower tube current for dose reduction by artificially adding noise to the original raw data. Lowering the radiation dose in a moderate extent to 75% of the original dose levels does not significantly alter the diagnostic image quality.

Iterative image reconstruction techniques for CT coronary artery calcium quantification: comparison with traditional filtered back projection in vitro and in vivo.

PURPOSE: To investigate in vitro and in vivo the use of image-based and raw data-based iterative reconstruction algorithms for quantification of coronary artery calcium by using the Agatston score and subsequent cardiac risk stratification. MATERIALS AND METHODS: In vitro data were obtained by using a moving anthropomorphic cardiac phantom containing calcium inserts of different concentrations and sizes. With institutional review board approval and HIPAA compliance, coronary calcium imaging data of 110 consecutive patients (mean age ± standard deviation, 58.2 years ± 9.8; 48 men) were reconstructed with filtered back projection (FBP), iterative reconstruction in image space (IRIS), and sinogram-affirmed iterative reconstruction (SAFIRE). Image noise was measured and the Agatston score was obtained for all reconstructions. Assignment to Agatston scores and percentile-based cardiac risk categories was compared. Statistical analysis included the Cohen κ coefficient and Friedman and Wilcoxon testing. RESULTS: In vitro, mean Agatston scores ± standard deviation for FBP (638.9 ± 9.6), IRIS (622.7 ± 15.2), and SAFIRE (631.4 ± 17.6) were comparable (P = .30). The smallest phantom calcifications were more frequently detected when iterative reconstruction techniques were used. The Agatston scores in the patient cohort were not significantly different among FBP, IRIS, and SAFIRE in paired comparisons (median Agatston score [25th and 75th percentiles]: 76.0 [20.6, 243.9], 76.4 [22, 249.3], and 75.7 [21.5, 49.1], respectively; P = .20 each). Comparison of categorization based on Agatston score percentiles showed excellent agreement for both IRIS and SAFIRE with FBP (κ = 0.975 [0.942-1.00] and κ = 0.963 [0.922-1.00], respectively). The mean effective dose was 1.02 mSv ± 0.51. Mean image noise was significantly (P < .001) higher with FBP than that with iterative reconstructions. CONCLUSION: In comparison with FBP, iterative reconstruction techniques do not have a profound effect on the reproducible quantification of coronary calcium according to Agatston score and subsequent cardiac risk classification, although risk reclassification may occur in a small subset of subjects.

Monitoring internal organ motion with continuous wave radar in CT.

PURPOSE: To avoid motion artifacts in medical imaging or to minimize the exposure of healthy tissues in radiation therapy, medical devices are often synchronized with the patient's respiratory motion. Today's respiratory motion monitors require additional effort to prepare the patients, e.g., mounting a motion belt or placing an optical reflector on the patient's breast. Furthermore, they are not able to measure internal organ motion without implanting markers. An interesting alternative to assess the patient's organ motion is continuous wave radar. The aim of this work is to design, implement, and evaluate such a radar system focusing on application in CT. METHODS: The authors designed a radar system operating in the 860 MHz band to monitor the patient motion. In the intended application of the radar system, the antennas are located close to the patient's body inside the table of a CT system. One receive and four transmitting antennas are used to avoid the requirement of exact patient positioning. The radar waves propagate into the patient's body and are reflected at tissue boundaries, for example at the borderline between muscle and adipose tissue, or at the boundaries of organs. At present, the authors focus on the detection of respiratory motion. The radar system consists of the hardware mentioned above as well as of dedicated signal processing software to extract the desired information from the radar signal. The system was evaluated using simulations and measurements. To simulate the radar system, a simulation model based on radar and wave field equations was designed and 4D respiratory-gated CT data sets were used as input. The simulated radar signals and the measured data were processed in the same way. The radar system hardware and the signal processing algorithms were tested with data from ten volunteers. As a reference, the respiratory motion signal was recorded using a breast belt simultaneously with the radar measurements. RESULTS: Concerning the measurements of the test persons, there is a very good correlation (ρ = 0.917) between the respiratory motion phases received by the radar system and the external motion monitor. Our concept of using an array of transmitting antennas turned out to be widely insensitive to the positioning of the test persons. A time shift between the respiratory motion curves recorded with the radar system and the motion curves from the external respiratory monitor was observed which indicates a slight difference between internal organ motion and motion detected by the external respiratory monitor. The simulations were in good accordance with the measurements. CONCLUSIONS: A continuous wave radar operating in the near field of the antennas can be used to determine the respiratory motion of humans accurately. In contrast to trigger systems used today, the radar system is able to measure motion inside the body. If such a monitor was routinely available in clinical CT, it would be possible optimizing the scan start with respect to the respiratory state of the patient. Breathing commands would potentially widely be avoided, and as far as uncooperative patients or children are concerned, less sedation might be necessary. Further applications of the radar system could be in radiation therapy or interventional imaging for instance.

Validation of dual-source single-tube reconstruction as a method to obtain half-dose images to evaluate radiation dose and noise reduction: phantom and human assessment using CT colonography and sinogram-affirmed iterative reconstruction (SAFIRE).

OBJECTIVE: To evaluate a method for obtaining half-dose CT images for observer studies evaluating lower-dose CT. METHODS: Phantoms of varying sizes were scanned at multiple tube potentials using dose-matched dual-source (DS) and single-source (SS) protocols. Images from single-tube reconstruction of DS data were compared with SS images acquired at half-original CTDIvol. Thirty patients underwent supine SS and dose-matched prone DS CT colonography (CTC). Half-dose prone images were reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE). Two radiologists scored image quality on 2-dimensional (2D) and 3D images. RESULTS: Image noise was similar between half-dose SS images and DS images reconstructed from one tube only with tube potential of 120 kV or more for phantoms 40 cm or smaller (P < 0.05). For both readers, the patients' CTC image quality scores were more than 84% concordant between SS or DS CTC images, and half-dose-prone CTC images with SAFIRE had 84% or more concordance with routine-dose CTC except for 3D image noise. CONCLUSIONS: In appropriately sized patients, DS acquisition with single-tube reconstruction can create half-dose images, permitting comparison to full-dose images. For CTC, there is comparable image quality for colonic evaluation between full-dose and half-dose images reconstructed with SAFIRE.

Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection.

OBJECTIVES: To compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) using a novel iterative reconstruction algorithm versus traditional filtered back projection (FBP) and to estimate the potential for radiation dose savings. METHODS: Sixty five consecutive patients (48 men; 59.3 ± 7.7 years) prospectively underwent cCTA and coronary catheter angiography (CCA). Full radiation dose data, using all projections, were reconstructed with FBP. To simulate image acquisition at half the radiation dose, 50% of the projections were discarded from the raw data. The resulting half-dose data were reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE). Full-dose FBP and half-dose iterative reconstructions were compared with regard to image noise and image quality, and their respective accuracy for stenosis detection was compared against CCA. RESULTS: Compared with full-dose FBP, half-dose iterative reconstructions showed significantly (p = 0.001 - p = 0.025) lower image noise and slightly higher image quality. Iterative reconstruction improved the accuracy of stenosis detection compared with FBP (per-patient: accuracy 96.9% vs. 93.8%, sensitivity 100% vs. 100%, specificity 94.6% vs. 89.2%, NPV 100% vs. 100%, PPV 93.3% vs. 87.5%). CONCLUSIONS: Iterative reconstruction significantly reduces image noise without loss of diagnostic information and holds the potential for substantial radiation dose reduction from cCTA.

Quantitative whole heart stress perfusion CT imaging as noninvasive assessment of hemodynamics in coronary artery stenosis: preliminary animal experience.

PURPOSE: To quantify differences in regional myocardial perfusion in coronary artery stenosis by the use of dual source computed tomography (DSCT) in an animal model. MATERIAL AND METHODS: In 5 pigs, an 80% stenosis of the left anterior descending artery was successfully induced by partial balloon occlusion (ischemia group). Five animals served as control group. All animals underwent contrast enhanced whole heart DSCT (Definition Flash, Siemens, Germany) perfusion imaging using a prototype electrocardiogram -triggered dynamic scan mode. Imaging was performed at rest as well as under stress conditions during continuous infusion of adenosine (240 mg/kg/min). For contrast enhancement 60 mL Iopromide 300 (Ultravist 300, Bayer-Schering Pharma, Berlin, Germany) were injected at a rate of 6 mL/s. Myocardial blood flow (MBF), first pass distribution volume, and intravascular blood volume were volumetrically quantified. RESULTS: In the control group MBF increased significantly from 98.2 mL/100 mL/min to 134.0 mL/100 mL/min if adenosine was administered (P = 0.0153). There were no significant differences in the perfusion parameters comparing the control and ischemia group at rest. In the ischemia group MBF under stress was 74.0 +/- 21.9 mL/100 mL/min in the poststenotic myocardium and 117.4 +/- 18.6 mL/100 mL/min in the remaining normal myocardium (P = 0.0024). CONCLUSION: DSCT permits quantitative whole heart perfusion imaging. As this technique is able to show the hemodynamic effect of high grade coronary artery stenosis, it exceeds the present key limitation of cardiac computed tomography, which currently only allows a morphologic assessment of coronary artery stenosis.

High-pitch spiral acquisition: a new scan mode for coronary CT angiography.

Coronary CT angiography allows high-quality imaging of the coronary arteries when state-of-the-art CT systems are used. However, radiation exposure has been a concern. We describe a new scan mode that uses a very high-pitch spiral acquisition, "Flash Spiral," which has been developed specifically for low-dose imaging with dual-source CT. The scan mode uses a pitch of 3.2 to acquire a spiral CT data set, while covering the entire volume of the heart in one cardiac cycle. Data acquisition is prospectively triggered by the electrocardiogram and starts in late systole to be completed within one cardiac cycle. Images are reconstructed with a temporal resolution that corresponds to one-quarter of the gantry rotation time. Throughout the data set, subsequent images are reconstructed at later time instants in the cardiac cycle. In a patient with a heart rate of 49 beats/min, the Flash Spiral scan mode was used with a first-generation dual-source CT system and allowed artifact-free visualization of the coronary arteries with a radiation exposure of 1.7 mSv for a 12-cm scan range at 120 kVp tube voltage.

Structure-activity considerations and in vitro approaches to assess the genotoxicity of 19 methane-, benzene- and toluenesulfonic acid esters.

Sulfonic acid esters are considered as potentially alkylating agents that may exert genotoxic effects in bacterial and mammalian cell systems. One possible source of human exposure stems from drug synthesis when the salt-forming agents methanesulfonic acid, benzenesulfonic acid or p-toluenesulfonic acid are used together with alcoholic solvents such as methanol, ethanol and propanol. In this study computer-assisted structural considerations and in vitro approaches (Ames mutagenicity test using Salmonella typhimurium strains TA98 and TA100, and the micronucleus test using L5178Y mouse lymphoma cells) were used to assess the genotoxic properties of 19 sulfonic esters. While all esters may be principally active as genotoxicants based on the presence of the sulfonate moiety, the statistical correlative multiple computer automated structure evaluation (MCASE) system (MC4PC version 1.0) using the Ames mutagenicity A2I module (version 1.54), rank-ordered the activity of the benzenesulfonic acid esters in the Ames test negligible due to an inactivating modulator and a deactivating fragment, whereas the methane- and toluenesulfonic acid esters were predicted to be positive in this test. In the Ames test, with the exception of the p-toluenesulfonic acid ethyl and iso-butyl esters, all compounds came out positive in Salmonella strain TA100. Methanesulfonic iso-propyl, sec-butyl and benzenesulfonic acid iso-propyl ester also showed mutagenic potential in strain TA98. In general, differences between results seen in Ames tests performed with or without metabolic activation were rather small. In L5178Y mouse lymphoma cells, benzenesulfonic acid n- and iso-butyl ester and p-toluenesulfonic acid iso-butyl ester did not increase the number of cells containing micronuclei. The other esters were positive in this micronucleus test; however, methanesulfonic acid iso-butyl ester was found to be only weakly positive at excessively cytotoxic concentrations. These compounds were generally found to be more potent with regard to micronucleus induction when tested without metabolic activation (20 h treatment). In conclusion, the iso-propyl esters of the three sulfonic acids under study were found to be the strongest mutagens, either when tested in the Ames test or the micronucleus assay, whereas p-toluenesulfonic acid iso-butyl ester was the only compound shown to be devoid of a genotoxic potential in both tests.