Automated attenuation-based tube voltage selection for body CTA: Performance evaluation of 192-slice dual-source CT.

OBJECTIVE: To assess radiation dose and image quality in body CT-angiography (CTA) with automated attenuation-based tube voltage selection (ATVS) on a 192-slice dual-source CT (DSCT). METHODS: Forty patients (69.5 ± 9.6 years) who had undergone body CTA with ATVS (ref.kVp 100, ref.mAs 90) using a 2x192-slice CT in single-source mode were retrospectively included. All patients had undergone prior CTA with a 2x128-slice CT and ATVS with identical imaging and contrast media protocols, serving for comparison. Images were reconstructed with iterative reconstruction at similar strength levels. Radiation dose was determined. Image quality was assessed semi-quantitatively (1:excellent, 5:non-diagnostic), aortic attenuation, noise and CNR were determined. RESULTS: As compared to 128-slice DSCT, 192-slice DSCT selected tube voltages were lower in 30 patients (75 %), higher in 3 (7.5 %), and similar in 7 patients (17.5 %). CTDIvol was lower with 192-slice DSCT (4.7 ± 1.9 mGy vs. 5.8 ± 2.1 mGy; p < 0.001). Subjective image quality, mean aortic attenuation (342 ± 67HU vs. 268 ± 67HU) and CNR (9.8 ± 2.5 vs. 8.2 ± 2.9) were higher with 192-slice DSCT (all p < 0.01), all datasets being diagnostic. CONCLUSION: Our study suggests that ATVS of 192-slice DSCT for body CTA is associated with an improved image quality and further radiation dose reduction of 19 % compared to 128-slice DSCT. KEY POINTS: • 192-slice DSCT allows imaging from 70 kVp to 150 kVp at 10 kVp increments. • 192-slice DSCT allows for radiation-dose reduction in body-CTA with ATVS. • Subjective and objective image quality increase compared to 128-slice DSCT.

Screening for interstitial lung disease in systemic sclerosis: performance of high-resolution CT with limited number of slices: a prospective study.

OBJECTIVES: Early diagnosis of interstitial lung disease (ILD), currently the main cause of death in systemic sclerosis (SSc), is needed. The gold standard is high-resolution CT (HRCT) of the chest, but regular screening faces the risk of increased radiation exposure. We performed a prospective validation of a dedicated, 9-slice HRCT protocol with reduced radiation dose for the detection of ILD in patients with SSc. METHODS: We analysed 170/205 consecutive patients with SSc. Whole-chest HRCT, serving as standard of reference, and the reduced HRCT with nine slices allocated according to a basal-apical gradient were obtained. ILD presence, extent (> or <20%) and diagnostic confidence were assessed. The reduced HRCT was independently analysed by two blinded radiologists, who also evaluated image quality. Radiation dose parameters were calculated. RESULTS: Standard chest HRCT showed ILD in 77/170 patients. With the reduced HRCT, 68/77 cases with ILD were identified (sensitivity 88.3%, both readers). The accuracy (91.8%, reader 1; 94.7%, reader 2), diagnostic confidence (98.8%, reader 1; 95.3%, reader 2) and image quality rates were high. Minimal ILD was correctly quantified in 73.1% (reader 1)/71.2% (reader 2) and extensive ILD in 88% (reader 1)/100% (reader 2). Importantly, the reduced HRCT had a significantly lower radiation dose. The mean dose length product (effective dose) was only 5.66±4.46 mGycm (0.08±0.06 mSv) compared with the standard protocol dose of 149.00±95.90 mGycm (2.09±1.34 mSv). CONCLUSIONS: The above-described reduced chest HRCT protocol reliably detects even mild SSc-ILD in clinical practice, with the advantage of a much lower radiation dose compared with standard whole-chest HRCT.

Split-bolus dual-energy CT urography: protocol optimization and diagnostic performance for the detection of urinary stones.

PURPOSE: Prospective protocol optimization, determination of image quality and diagnostic performance of virtual non-enhanced images (VNEI) derived from split-bolus dual-energy computed tomography (DECT) urography in patients with urinary stones. METHODS: IRB-approved, prospective study of 100 patients who, after written informed consent, underwent single-energy, non-enhanced CT and split-bolus, contrast-enhanced DECT (30 + 50 mL of contrast media; combined nephro-urographic acquisition). DECT was performed using setting A (80/140 kVp) in the first 20, and setting B (100/140 kVp) in the second 20 patients. Tin filtration was used in all patients. After a pre-analysis of VNEI quality, 60 additional patients were examined using setting B. Two readers qualitatively and quantitatively determined image quality of all weighted-average DECT images regarding urinary tract opacification (n = 100), and all VNEI regarding quality of iodine subtraction and urinary stone detection (n = 80). True nonenhanced (TNEI) images were the standard of reference for statistical analysis (inter-reader variability and diagnostic performance characteristics). RESULTS: The urinary tract was completely opacified in 94% (94/100) of patients. Iodine subtraction was improved (p < 0.01) and image noise of VNEI was lower (p < 0.05) in DECT setting B. On VNEI, 83% (86/104) of urinary stones were correctly identified and 17% (18/104) were missed. Stones missed (2.5 mm, 1-4) were significantly smaller than stones correctly identified (5 mm, 2-27; p < 0.001). Diagnostic accuracy was 98% on a per-renal-unit basis and 96% on a per-patient basis. Inter-reader agreements were excellent (κ = 0.91-1.00; ICC = 0.86-0.99). CONCLUSIONS: Split-bolus DECT urography was technically feasible and quality of VNEI was improved with the 100/140 kVp setting. Detection of urinary stones <4 mm on VNEI was limited.

MRI signs helpful in the differentiation of patients with anterior ischaemic optic neuropathy and optic neuritis.

BACKGROUND/AIMS: The aim of this study was to identify specific MRI characteristics of anterior ischaemic optic neuropathy (AION) and optic neuritis (ON) that would aid in the differentiation between these two diagnoses. METHODS: We retrospectively analysed a consecutive case series including all patients with an MRI study of brain and orbit and the clinical diagnosis of either ON or AION. We examined the scans for restricted diffusion of the optic nerve, optic sheath diameter, enhancement and location of enhancement of the optic nerve and distribution of the white matter lesions. RESULTS: Fifty patients met the inclusion criteria. We found an accuracy of 0.98 for the discrimination between AION and ON based solely on parameters extracted from MRI data. Dominance analysis to determine the most influential parameters showed that the enhancement pattern of the optic nerve and distribution of the white matter lesions had the biggest impact on the classification and led to a discrimination accuracy of 0.9 when used alone. CONCLUSION: In patients with an inconclusive clinical diagnosis, optic nerve enhancement pattern and distribution of white matter lesions can aid in the diagnosis and differentiation between AION and ON. Diffusion-weighted imaging did not add significant information to the diagnosis or help to differentiate between the two conditions.

Screening for interstitial lung disease in systemic sclerosis: the diagnostic accuracy of HRCT image series with high increment and reduced number of slices.

OBJECTIVES: The objective of this study is to assess diagnostic accuracy for the detection of interstitial lung disease (ILD) in image series with high increment and reduced number of slices in patients with systemic sclerosis (SSc). METHODS: 45 patients with SSc underwent high-resolution CT (HRCT). Three series of secondary captures were reconstructed as follows: series 1, series with 10 mm increment and 1 mm slices; series 2, seven axial images with baso-apical gradient; series 3, three axial images were obtained at the apical, at the level of the carina and basal. The presence and extent of ILD, and the degree of diagnostic confidence were recorded. The effective dose for each image series was estimated. Standard HRCT was the standard of reference. RESULTS: The prevalence of ILD was 55% (25/45). Diagnostic sensitivity and accuracy of series 1, series 2 and series 3 were 100% and 94.4%, 94% and 97.8%, 92% and 97.8%, respectively. The extent of ILD was underestimated in series 3 (p<0.05) and was comparable to the standard HRCT in series 1 and 2 (p>0.05). Estimated dose reduction was more than 90% in all image series. CONCLUSIONS: HRCT image series with low sampling rate allow an accurate detection of ILD with very-low-radiation dose, making this approach potentially valuable for screening in patients with SSc.

Automated tube potential selection for standard chest and abdominal CT in follow-up patients with testicular cancer: comparison with fixed tube potential.

OBJECTIVE: To evaluate prospectively, in patients with testicular cancer, the radiation dose-saving potential and image quality of contrast-enhanced chest and abdominal CT with automated tube potential selection. METHODS: Forty consecutive patients with testicular cancer underwent contrast-enhanced arterio-venous chest and portal-venous abdominal CT with automated tube potential selection (protocol B; tube potential 80-140 kVp), which is based on the attenuation of the CT topogram. All had a first CT at 120 kVp (protocol A) using the same 64-section CT machine and similar settings. Image quality was assessed; dose information (CTDI(vol)) was noted. RESULTS: Image noise and attenuation in the liver and spleen were significantly higher for protocol B (P < 0.05 each), whereas attenuation in the deltoid and erector spinae muscles was similar. In protocol B, tube potential was reduced to 100 kVp in 18 chest and 33 abdominal examinations, and to 80 kVp in 5 abdominal CT examinations; it increased to 140 kVp in one patient. Image quality of examinations using both CT protocols was rated as diagnostic. CTDI(vol) was significantly lower for protocol B compared to protocol A (reduction by 12%, P < 0.01). CONCLUSION: In patients with testicular cancer, radiation dose of chest and abdominal CT can be reduced with automated tube potential selection, while image quality is preserved.

Low-dose CT of the lung: potential value of iterative reconstructions.

OBJECTIVES: To prospectively assess the impact of sinogram-affirmed iterative reconstruction (SAFIRE) on image quality of nonenhanced low-dose lung CT as compared to filtered back projection (FBP). METHODS: Nonenhanced low-dose chest CT (tube current-time product: 30 mAs) was performed on 30 patients at 100 kVp and on 30 patients at 80 kVp. Images were reconstructed with FBP and SAFIRE. Two blinded, independent readers measured image noise; two readers assessed image quality of normal anatomic lung structures on a five-point scale. Radiation dose parameters were recorded. RESULTS: Image noise in datasets reconstructed with FBP (57.4 ± 15.9) was significantly higher than with SAFIRE (31.7 ± 9.8, P < 0.001). Image quality was significantly superior with SAFIRE than with FBP (P < 0.01), without significant difference between FBP at 100 kVp and SAFIRE at 80 kVp (P = 0.68). Diagnostic image quality was present with FBP in 96% of images at 100 kVp and 88% at 80 kVp, and with SAFIRE in 100% at 100 kVp and 98% at 80 kVp. There were significantly more datasets with diagnostic image quality with SAFIRE than with FBP (P < 0.01). Mean CTDI(vol) and effective doses were 1.5 ± 0.7 mGy·cm and 0.7 ± 0.2 mSv at 100 kVp, and 1.4 ± 2.8 mGy · cm and 0.5 ± 0.2 mSv at 80 kVp (P < 0.001, both). CONCLUSIONS: Use of SAFIRE in low-dose lung CT reduces noise, improves image quality, and renders more studies diagnostic as compared to FBP. KEY POINTS: Low-dose computed tomography is an important thoracic investigation tool. Radiation dose can be less than 1 mSv with iterative reconstructions. Iterative reconstructions render more low-dose lung CTs diagnostic compared to conventional reconstructions.

Automated attenuation-based kilovoltage selection: preliminary observations in patients after endovascular aneurysm repair of the abdominal aorta.

OBJECTIVE: The objective of our study was to assess prospectively the impact of automated attenuation-based kilovoltage selection on image quality and radiation dose in patients undergoing body CT angiography (CTA) after endovascular aneurysm repair (EVAR) of the abdominal aorta. SUBJECTS AND METHODS: Thirty-five patients (five women, 30 men; mean age ± SD, 69 ± 13 years; mean body mass index ± SD, 27.3 ± 4.5 kg/m(2)) underwent 64-MDCT angiography of the thoracoabdominal aorta using a fixed 120-kVp protocol (scan A: 120 mAs [reference]; rotation time, 0.33 second; pitch, 1.2) and, within a median time interval of 224 days, using a protocol with automated kilovoltage selection (scan B: tube voltage, 80-140 kVp). Subjective image quality (5-point scale: 1 [excellent] to 5 [nondiagnostic]) and objective image quality (aortic attenuation at four locations of the aortoiliac system, noise, contrast-to-noise ratio [CNR]) were assessed independently by two blinded radiologists. The volume CT dose index (CTDI(vol)) was compared between scans A and B. RESULTS: The subjective image quality of scans A and B was similar (median score for both, 1; range, 1-4; p = 0.74), with all datasets being of diagnostic quality. Automated attenuation-based kilovoltage selection led to a reduction to 80 kVp in one patient (2.9%) and 100 kVp in 18 patients (51.4%). Fifteen of 35 patients (42.9%) were scanned at 120 kVp, whereas in one patient (2.9%) the kilovoltage setting increased to 140 kVp. Image noise (scan A vs scan B: mean ± SD, 12.8 ± 2.3 vs 13.7 ± 2.9 HU, respectively) was significantly (p < 0.05) higher in scan B than in scan A, whereas CNR was similar among scans (A vs B: mean ± SD, 15.7 ± 7.0 vs 16.9 ± 9.7; p = 0.43). The CTDI(vol) was significantly lower in scan B (mean ± SD, 8.9 ± 2.9 mGy; scan A, 10.6 ± 1.5 mGy; average reduction, 16%; p = 0.002) despite a higher tube current-exposure time product (B vs A: mean ± SD, 152 ± 27 vs 141 ± 29 mAs; p = 0.01). CONCLUSION: In patients undergoing follow-up after EVAR of the abdominal aorta, body CTA using automated attenuation-based kilovoltage selection yields similar subjective image quality and CNR at a significantly reduced dose compared with a protocol that uses 120 kVp.

Raw data-based iterative reconstruction in body CTA: evaluation of radiation dose saving potential.

OBJECTIVE: To evaluate prospectively, in patients undergoing body CTA, the radiation dose saving potential of raw data-based iterative reconstruction as compared to filtered back projection (FBP). METHODS: Twenty-five patients underwent thoraco-abdominal CTA with 128-slice dual-source CT, operating both tubes at 120 kV. Full-dose (FD) images were reconstructed with FBP and were compared to half-dose (HD) images with FBP and HD-images with sinogram-affirmed iterative reconstruction (SAFIRE), both reconstructed using data from only one tube-detector-system. Image quality and sharpness of the aortic contour were assessed. Vessel attenuation and noise were measured, contrast-to-noise-ratio was calculated. RESULTS: Noise as image quality deteriorating artefact occurred in 24/25 (96%) HD-FBP but not in FD-FBP and HD-raw data-based iterative reconstruction datasets (p < 0.001). Other artefacts occurred with similar prevalence among the datasets. Sharpness of the aortic contour was higher for FD-FBP and HD-raw data-based iterative reconstruction as compared to HD-FBP (p < 0.001). Aortoiliac attenuation was similar among all datasets (p > 0.05). Lowest noise was found for HD-raw data-based iterative reconstruction (7.23HU), being 9.4% lower than that in FD-FBP (7.98HU, p < 0.05) and 30.8% lower than in HD-FBP images (10.44HU, p < 0.001). Contrast-to-noise-ratio was lower in HD-FBP (p < 0.001) and higher in HD-raw data-based iterative reconstruction (p < 0.001) as compared to FD-FBP. CONCLUSION: Intra-individual comparisons of image quality of body CTA suggest that raw data-based iterative reconstruction allows for dose reduction >50% while maintaining image quality. Key Points • Raw data-based iterative reconstruction reduces image noise and improves image quality as compared to filtered back projection • At a similar radiation dose, raw data-based iterative reconstruction improves the sharpness of vessel contours • In body CTA a dose reduction of >50% might be possible when using raw data-based iterative reconstructions, while image quality can be maintained.

MR imaging of degenerative disc disease.

Magnet resonance imaging (MRI) is the most commonly used imaging modality for diagnosis of degenerative disc disease (DDD). Lack of precise observations and documentation of aspects within the complex entity of DDD might partially be the cause of poor correlation of radiographic findings to clinical symptoms. This literature review summarizes the current knowledge on MRI in DDD and outlines the diagnostic limitations. The review further sensitizes the reader toward awareness of potentially untended aspects of DDD and the interaction of DDD and endplate changes. A summary of the available classifications for DDD is provided.

Graft Patency in Long-term Survivors after Renovisceral Debranching with VORTEC.

PURPOSE: This study was designed to evaluate retrospectively the long-term stent-graft patency after renovisceral revascularization with Viabahn Open Revascularization Technique (VORTEC) using computed tomography angiography (CTA) and magnetic resonance angiography (MRA). METHODS: In 34 patients (seven women; mean age 72 ± 8 years) with aortic aneurysm, 63 renovisceral vessels (i.e., 54 renal, nine visceral arteries) were revascularized with VORTEC between 2004 and 2009. All patients obtained a pre- and postinterventional CTA and at least one follow-up CTA or MRA after 6 or more months following intervention (median follow up: 43 months). Detection of bypass occlusion, bypass stenosis, infolding, stent-graft fractures and dislocations, and kidney shrinkage were noted by two readers in consensus. Furthermore, mortality during follow-up was assessed using the medical report. RESULTS: During follow-up, 12.6 % of stent-grafts occluded. Cumulative patency rate was 95.2 ± 2.7 % at 12 months, 87.7 ± 4.4 % at 24 and 36 months, and 84.7 ± 5.2 % at 48, 60, 72, 84, and 89 months, respectively. Overall, 19 % of stent-grafts (12/63) developed bypass stenosis (<50 %, 10 stent-grafts; > 50 %, 2 stent-grafts), in one case stenosis (>70 %) was suspected to be hemodynamically significant. No secondary dislocation, no infolding of renovisceral stent-grafts, and no stent-graft fracture occurred. Kidney shrinkage occurred in nine patients, primarily in patients with an occluded Viabahn (n = 7). Eleven patients (32.3 %) died within the follow-up time period. CONCLUSIONS: In long-term survivors after VORTEC cumulative patency rate remained high, and no stent-graft fractures or secondary dislocations occurred.

Interpretation of bedside chest X-rays in the ICU: is the radiologist still needed?

PURPOSE: To compare diagnostic accuracy of intensivists to radiologists in reading bedside chest X-rays. METHODS: In a retrospective trial, 33 bedside chest X-rays were evaluated by five radiologists and five intensivists with different experience. Images were evaluated for devices and lung pathologies. Interobserver agreement and diagnostic accuracy were calculated. Computed tomography served as reference standard. RESULTS: Seniors had higher diagnostic accuracy than residents (mean-ExpB(Senior)=1.456; mean-ExpB(Resident)=1.635). Interobserver agreement for installations was more homogenously distributed between radiologists compared to intensivists (ExpB(Rad)=1.204-1.672; ExpB(Int)=1.005-2.368). Seniors had comparable diagnostic accuracy. CONCLUSION: No significant difference in diagnostic performance was seen between seniors of both disciplines, whereas the resident intensivists might still benefit from an interdisciplinary dialogue.

Evaluation of calcium loss after transcatheter aortic valve implantation.

OBJECTIVES: Aortic valve calcification and changes after transcatheter aortic valve implantation (TAVI) were specifically assessed by computed tomography (CT). The main difference between TAVI and the conventional technique is the compression of the cusps of the calcified native valve against the aortic wall before implantation. The objective of this study was to quantify the segmented calcification in the area of the basal annular plane before and after TAVI. METHODS: The CT scans of 20 patients (13 male and 7 female; mean age: 82.9 ± 8.1 years) were assessed. The aortic valve calcification was segmented; derived from this segmentation volume, mass and Hounsfield units (HU)/density of the calcifications on the annulus and cusps before and after TAVI were evaluated. Pre- and postoperative data were compared regarding potential calcification loss and calcification distances to the left and right coronary ostia. RESULTS: Significantly lower postprocedural mean volumes and masses for all cusps (P < 0.001) were found. The mean differences in the volume for the non-coronary, right-coronary and left-coronary cusp were -156.8 ± 53.73, -155.5 ± 62.54 and -115 ± 57.53 mm(3), respectively, and differences in mass were -88.78 ± 29.48, -95.2 ± 39.27 and -71.56 ± 35.62 mg, respectively. Over all cusps, mean HU increased after intervention [784.41 ± 92.5 HU (pre) and 818.63 ± 78.71 HU (post); P < 0.004]. In 80.03% of all cusps, calcification loss was found; all patients were affected. Significantly lower (P < 0.047) postprocedural mean distances were found from the left and right coronary ostia to the next calcification point. CONCLUSIONS: Our results show a significant loss of calcification in all patients after TAVI, with a reduction in the calcification distances to the coronary ostia and the compression of calcification in the area of the device landing zone. The clinical implications of this finding need to be investigated further.

Iterative reconstructions versus filtered back-projection for urinary stone detection in low-dose CT.

RATIONALE AND OBJECTIVES: To evaluate prospectively, in patients with suspected or known urinary stone disease, the image quality and diagnostic confidence of nonenhanced abdominal low-dose computed tomography (CT) with iterative reconstruction (IR) compared to filtered back-projection (FBP). MATERIALS AND METHODS: Fifty consecutive patients with suspected (n = 33) or known (n = 17) urinary stone disease underwent nonenhanced abdominal low-dose CT (120 kVp, 30 effective mAs, 1.6 ± 0.5 mSv). Reconstructions were performed with sinogram-affirmed IR and with FBP. Attenuation (in Hounsfield units) was measured in subcutaneous fat and urinary bladder; image noise was determined. Two readers assessed image quality, number and location of urinary calculi were recorded, and diagnostic confidence was assessed. Statistical analyses included Mann-Whitney, Friedman's two-way, Wilcoxon signed rank, Pearson's, and Spearman's rank order correction tests. RESULTS: Attenuation of urinary bladder (P = .208, reader 1; P = .123, reader 2) and fat (P = .568, reader 1; P = .834, reader 2) was similar among FBP and IR datasets. Image noise was reduced in IR datasets by 40.1% (P < .001). IR improved image quality (P < .01), and obesity as factor impairing image quality was noted in FBP but not in IR images (P < .05). There was no significant difference in number of calculi in datasets reconstructed with IR and FBP (P = .102, reader 1; P = .059, reader 2). Diagnostic confidence regarding identification of urinary calculi improved with IR (P < .05, reader 1; P < .01, reader 2). CONCLUSION: IR improves image quality and confidence for diagnosing urinary stone disease in abdominal low-dose CT.

Thoraco-abdominal high-pitch dual-source CT angiography: experimental evaluation of injection protocols with an anatomical human vascular phantom.

OBJECTIVE: To experimentally evaluate three different contrast injection protocols at thoraco-abdominal high-pitch dual-source computed tomography angiography (CTA), with regard to level and homogeneity of vascular enhancement at different cardiac outputs. MATERIALS AND METHODS: A uniphasic, a biphasic as well as an individually tailored contrast protocol were tested using a human vascular phantom. Each protocol was scanned at 5 different cardiac outputs (3-5L/min, steps of 0.5L/min) using an extracorporeal cardiac pump. Vascular enhancement of the thoraco-abdominal aorta was measured every 5 cm. Overall mean enhancement of each protocol and mean enhancement for each cardiac output within each protocol were calculated. Enhancement homogeneity along the z-axis was evaluated for each cardiac output and protocol. RESULTS: Overall mean enhancement was significantly higher in the uniphasic than in the other two protocols (all p<.05), whereas the difference between the biphasic and tailored protocol was not significant (p=.76). Mean enhancement among each of the 5 cardiac outputs within each protocol was significantly different (all p<.05). Only within the tailored protocol mean enhancement differed not significantly at cardiac outputs of 3.5L/min vs. 5L/min (484 ± 25 HU vs. 476 ± 19 HU, p=.14) and 4 vs. 5L/min (443 ± 49 HU vs. 476 ± 19 HU, p=.05). Both, uniphasic and tailored protocol yielded homogenous enhancement at all cardiac outputs, whereas the biphasic protocol failed to achieve homogenous enhancement. CONCLUSION: This phantom study suggests that diagnostic and homogenous enhancement at thoraco-abdominal high-pitch dual-source CTA is feasible with either a uniphasic or an individually tailored contrast protocol.

Automated attenuation-based tube potential selection for thoracoabdominal computed tomography angiography: improved dose effectiveness.

PURPOSE: To introduce a novel algorithm of automated attenuation-based tube potential selection and to assess its impact on image quality and radiation dose of body computed tomography angiography (CTA). MATERIALS AND METHODS: In all, 40 patients (mean age 71±11.8 years, body mass index (BMI) 25.7±3.8 kg/m², range 18.8-33.8 kg/m²) underwent 64-slice thoracoabdominal CTA (contrast material: 80 mL, 5 mL/s) using an automated tube potential selection algorithm (CAREkV), which optimizes tube-potential (70-140 kV) and tube-current (138.8±18.6 effective mAs, range 106-177 mAs) based on the attenuation profile of the topogram and on the diagnostic task. Image quality was semiquantitatively assessed by 2 blinded and independent readers (scores 1: excellent to 5: nondiagnostic). Attenuation and noise were measured by another 2 blinded and independent readers. Contrast-to-noise ratio was calculated. The CT dose index (CTDIvol) was recorded and compared with the estimated CTDIvol of a standard 120 kV protocol without using the algorithm in each patient. Selected tube potentials were correlated with BMI and attenuation of the topogram. RESULTS: Diagnostic image quality was obtained in all patients (excellent: 14; good: 21; moderate: 5; interreader agreement: κ=0.78). Mean attenuation, noise, and contrast-to-noise ratio were 260.8±63.5 Hounsfield units, 15.5±3.3 Hounsfield units, and 14±4.2, respectively, with good to excellent agreement between readers (r=0.50-0.99, P<0.01 each). Automated attenuation-based tube potential selection resulted in a kV-reduction from 120 to 100 kV in 23 patients and to 80 kV in 1 patient, whereas tube potential increased to 140 kV in 1 patient. Automatically selected tube potential showed a significant correlation with both BMI (r=0.427, P<0.05) and attenuation of the topogram (r=0.831, P<0.001). CTDIvol (7.95±2.6 mGy) was significantly lower when using the algorithm compared with the standard 120 kV protocol (10.59±1.8 mGy, P<0.001), corresponding to an overall dose reduction of 25.1%. CONCLUSION: Automated attenuation-based tube potential selection based on the attenuation profile of the topogram is feasible, provides a diagnostic image quality of body CTA, and reduces overall radiation dose by 25% as compared with a standard protocol with 120 kV.