Feasibility of Dose-reduced Chest CT with Photon-counting Detectors: Initial Results in Humans.

Purpose To investigate whether photon-counting detector (PCD) technology can improve dose-reduced chest computed tomography (CT) image quality compared with that attained with conventional energy-integrating detector (EID) technology in vivo. Materials and Methods This was a HIPAA-compliant institutional review board-approved study, with informed consent from patients. Dose-reduced spiral unenhanced lung EID and PCD CT examinations were performed in 30 asymptomatic volunteers in accordance with manufacturer-recommended guidelines for CT lung cancer screening (120-kVp tube voltage, 20-mAs reference tube current-time product for both detectors). Quantitative analysis of images included measurement of mean attenuation, noise power spectrum (NPS), and lung nodule contrast-to-noise ratio (CNR). Images were qualitatively analyzed by three radiologists blinded to detector type. Reproducibility was assessed with the intraclass correlation coefficient (ICC). McNemar, paired t, and Wilcoxon signed-rank tests were used to compare image quality. Results Thirty study subjects were evaluated (mean age, 55.0 years ± 8.7 [standard deviation]; 14 men). Of these patients, 10 had a normal body mass index (BMI) (BMI range, 18.5-24.9 kg/m2; group 1), 10 were overweight (BMI range, 25.0-29.9 kg/m2; group 2), and 10 were obese (BMI ≥30.0 kg/m2, group 3). PCD diagnostic quality was higher than EID diagnostic quality (P = .016, P = .016, and P = .013 for readers 1, 2, and 3, respectively), with significantly better NPS and image quality scores for lung, soft tissue, and bone and with fewer beam-hardening artifacts (all P < .001). Image noise was significantly lower for PCD images in all BMI groups (P < .001 for groups 1 and 3, P < .01 for group 2), with higher CNR for lung nodule detection (12.1 ± 1.7 vs 10.0 ± 1.8, P < .001). Inter- and intrareader reproducibility were good (all ICC > 0.800). Conclusion Initial human experience with dose-reduced PCD chest CT demonstrated lower image noise compared with conventional EID CT, with better diagnostic quality and lung nodule CNR. © RSNA, 2017 Online supplemental material is available for this article.

Cardiac imaging with photon counting CT.

CT of the heart, in particular ECG-controlled coronary CT angiography (cCTA), has become clinical routine due to rapid technical progress with ever new generations of CT equipment. Recently, CT scanners with photon-counting detectors (PCD) have been introduced which have the potential to address some of the remaining challenges for cardiac CT, such as limited spatial resolution and lack of high-quality spectral data. In this review article, we briefly discuss the technical principles of photon-counting detector CT, and we give an overview on how the improved spatial resolution of photon-counting detector CT and the routine availability of spectral data can benefit cardiac applications. We focus on coronary artery calcium scoring, cCTA, and on the evaluation of the myocardium.

Photon-Counting Computed Tomography - Basic Principles, Potenzial Benefits, and Initial Clinical Experience.

BACKGROUND: Photon-counting computed tomography (PCCT) is a promising new technology with the potential to fundamentally change today's workflows in the daily routine and to provide new quantitative imaging information to improve clinical decision-making and patient management. METHOD: The content of this review is based on an unrestricted literature search on PubMed and Google Scholar using the search terms "Photon-Counting CT", "Photon-Counting detector", "spectral CT", "Computed Tomography" as well as on the authors' experience. RESULTS: The fundamental difference with respect to the currently established energy-integrating CT detectors is that PCCT allows counting of every single photon at the detector level. Based on the identified literature, PCCT phantom measurements and initial clinical studies have demonstrated that the new technology allows improved spatial resolution, reduced image noise, and new possibilities for advanced quantitative image postprocessing. CONCLUSION: For clinical practice, the potential benefits include fewer beam hardening artifacts, radiation dose reduction, and the use of new contrast agents. In this review, we will discuss basic technical principles and potential clinical benefits and demonstrate first clinical use cases. KEY POINTS: · Photon-counting computed tomography (PCCT) has been implemented in the clinical routine. · Compared to energy-integrating detector CT, PCCT allows the reduction of electronic image noise. · PCCT provides increased spatial resolution and a higher contrast-to-noise ratio. · The novel detector technology allows the quantification of spectral information. CITATION FORMAT: · Stein T, Rau A, Russe MF et al. Photon-Counting Computed Tomography - Basic Principles, Potenzial Benefits, and Initial Clinical Experience. Fortschr Röntgenstr 2023; 195: 691 - 698.

High-Pitch Photon-Counting Detector Computed Tomography Angiography of the Aorta: Intraindividual Comparison to Energy-Integrating Detector Computed Tomography at Equal Radiation Dose.

PURPOSE: The aims of this study were to determine the objective and subjective image quality of high-pitch computed tomography (CT) angiography of the aorta in clinical dual-source photon-counting detector CT (PCD-CT) and to compare the image quality to conventional dual-source energy-integrating detector CT (EID-CT) in the same patients at equal radiation dose. MATERIALS AND METHODS: Patients with prior CT angiography of the thoracoabdominal aorta acquired on third-generation dual-source EID-CT in the high-pitch mode and with automatic tube voltage selection (ATVS, reference tube voltage 100 kV) were included. Follow-up imaging was performed on a first-generation, clinical dual-source PCD-CT scanner in the high-pitch and multienergy (QuantumPlus) mode at 120 kV using the same contrast media protocol as with EID-CT. Radiation doses between scans were matched by adapting the tube current of PCD-CT. Polychromatic images for both EID-CT and PCD-CT (called T3D) and virtual monoenergetic images at 40, 45, 50, and 55 keV for PCD-CT were reconstructed. Computed tomography attenuation was measured in the aorta; noise was defined as the standard deviation of attenuation; contrast-to-noise ratio (CNR) was calculated. Subjective image quality (noise, vessel attenuation, vessel sharpness, and overall quality) was rated by 2 blinded, independent radiologists. RESULTS: Forty patients were included (mean age, 63 years; 8 women; mean body mass index [BMI], 26 kg/m2). There was no significant difference in BMI, effective diameter, or radiation dose between scans (all P's > 0.05). The ATVS in EID-CT selected 70, 80, 90, 100, 110, and 120 kV in 2, 14, 14, 7, 2, and 1 patients, respectively. Mean CNR was 17 ± 8 for EID-CT and 22 ± 7, 20 ± 6, 18 ± 5, 16 ± 5, and 12 ± 4 for PCD-CT at 40, 45, 50, 55 keV, and T3D, respectively. Contrast-to-noise ratio was significantly higher for 40 and 45 keV of PCD-CT as compared with EID-CT (both P's < 0.05). The linear regression model (adjusted R2, 0.38; P < 0.001) revealed that PCD-CT reconstruction (P < 0.001), BMI group (P = 0.007), and kV of the EID-CT scan (P = 0.01) were significantly associated with CNR difference, with an increase by 34% with PCD-CT for overweight as compared with normal weight patients. Subjective image quality reading revealed slight differences between readers for subjective vessel attenuation and sharpness, whereas subjective noise was rated significantly higher for 40 and 45 keV (P < 0.001) and overall quality similar (P > 0.05) between scans. CONCLUSIONS: High-pitch PCD-CT angiography of the aorta with VMI at 40 and 45 keV resulted in significantly increased CNR compared with EID-CT with ATVS at matched radiation dose. The CNR gain of PCD-CT increased in overweight patients. Taking into account the subjective analysis, VMI at 45 to 50 keV is proposed as the best trade-off between objective and subjective image quality.

High Temporal Resolution Dual-Source Photon-Counting CT for Coronary Artery Disease: Initial Multicenter Clinical Experience.

The aim of this paper is to evaluate the diagnostic image quality of spectral dual-source photon-counting detector coronary computed tomography angiography (PCD-CCTA) for coronary artery disease in a multicenter study. The image quality (IQ), assessability, contrast-to-noise ratio (CNR), Agatston score, and radiation exposure were measured. Stenoses were quantified and compared with invasive coronary angiography, if available. A total of 92 subjects (65% male, age 58 ± 14 years) were analyzed. The prevalence of significant coronary artery disease (CAD) (stenosis ≥ 50%) was 17% of all patients, the range of the Agatston score was 0−2965 (interquartile range (IQR) 0−135). The IQ was very good (one, IQR one−two), the CNR was very high (20 ± 10), and 5% of the segments were rated non-diagnostic. The IQ and assessability were higher in proximal coronary segments (p < 0.001). Agatston scores up to 600 did not significantly affect the assessability of the coronary segments (p = 0.3). Heart rate influenced assessability only at a high-pitch mode (p = 0.009). For the invasive coronary angiography (ICA) subgroup (n = nine), the diagnostic performance for CAD per segment was high (sensitivity 92%, specificity 96%), although the limited number of patients who underwent both diagnostic modalities limits the generalization of this finding at this stage. PCD-CCTA provides good image quality for low and moderate levels of coronary calcifications.

Computed tomography with a full FOV photon-counting detector in a clinical setting, the first experience.

OBJECTIVES: to assess the feasibility of CT with an integrated photon-counting-detector system (PC-CT) in the body imaging of clinical patients. METHODS: 120 examinations using photon counting detector CT were evaluated in six groups: 1/ a standard-dose lung, 2/ low-dose lung, 3/ ultra-high resolution (UHR) lung, 4/ standard-dose abdominal, 5/ lower-dose abdominal, 6/ UHR abdominal CTA. All CT examinations were performed on a single-source prototype device equipped with a photon counting detector covering a 50 cm scan field of view. Standard dose examinations were performed with the use of detector element size of 0.4 mm, ultra-high-resolution examinations with the detector element size of 0.2 mm, respectively. The stability of the system during imaging was tested. The diagnostic quality of the acquired images was assessed based on the imaging of key structures and the noise level in five-point scale, the effective dose equivalent, dose length product and noise level, and also relation to body mass index and body surface area were compared with three similar groups of CT images made with energy integrating high end scanner. The parameters were evaluated using Wilcoxon test for independent samples, the independence was tested using Kruskal-Wallis test. RESULTS: When PC-CT images radiation dose is compared with the similar imaging using energy integrating CT, the PC-CT shows lower dose in ultra-high resolution mode, the dose is significantly lower (p < 0.0001), the standard dose examinations were performed with the comparable radiation doses. PC-CT exhibited the significantly higher ratio between parenchyma signal and background noise both in lung and in abdominal imaging (p < 0.0001). CONCLUSIONS: PC-CT showed imaging stability and excellent diagnostic quality at dose values that are comparable or better to the quality of energy integrating CT, the better signal and improved resolution is most important advantage of photon counting detector CT over energy integrating detector CT.

Photon-counting CT review.

Photon-counting detectors are a promising new technology for computed tomography (CT) systems. They provide energy-resolved CT data at very high spatial resolution without electronic noise and with improved tissue contrasts. This review article gives an overview of the principles of photon-counting detector CT, of potential clinical benefits and limitations, and of the experience gained so far in pre-clinical installations.

Coronary artery calcium scoring with photon-counting CT: first in vivo human experience.

To evaluate the performance of photon-counting detector (PCD) computed tomography (CT) for coronary artery calcium (CAC) score imaging at standard and reduced radiation doses compared to conventional energy-integrating detector (EID) CT. A dedicated cardiac CT phantom, ten ex vivo human hearts, and ten asymptomatic volunteers underwent matched EID and PCD CT scans at different dose settings without ECG gating. CAC score, contrast, and contrast-to-noise ratio (CNR) were calculated in the cardiac CT phantom. CAC score accuracy and reproducibility was assessed in the ex vivo hearts. Standard radiation dose (120 kVp, reference mAs = 80) in vivo CAC scans were compared against dose-reduced CAC scans (75% dose reduction; reference mAs = 20) for image quality and CAC score reproducibility. Interstudy agreement was assessed by using intraclass correlation (ICC), linear regression, and Bland-Altman analysis with 95% confidence interval limits of agreement (LOA). Calcium-soft tissue contrast and CNR were significantly higher for the PCD CAC scans in the cardiac CT phantom (all P < 0.01). Ex vivo hearts: CAC score reproducibility was significantly higher for the PCD scans at the lowest dose setting (50 mAs) (P = 0.002); score accuracy was similar for both detector systems at all dose settings. In vivo scans: the agreement between standard dose and low dose CAC score was significantly better for the PCD than for the EID with narrower LOA in Bland-Altman analysis, linear regression slopes closer to 1 (0.96 vs. 0.84), and higher ICC values (0.98 vs. 0.93, respectively). Phantom and in vivo human studies showed PCD may significantly improve CAC score image quality and/or reduce CAC score radiation dose while maintaining diagnostic image quality.

Measurement of temporal resolution in dual source CT.

This work assesses the temporal resolution of dual-source computed tomography (CT) in a visually intuitive manner. Exploiting the principles of ring artifact creation, a phantom containing a highly attenuating delta function signal (a wire) was rotated at the same speed as the gantry, creating a partial ring artifact where the angular extent of the artifact provides a direct indication of the temporal resolution. A demonstration of the effect of the evaluated 165 and 83 ms nominal temporal resolutions on motion artifacts in cardiac CT is provided using patient data.

Dose Efficiency of Quarter-Millimeter Photon-Counting Computed Tomography: First-in-Human Results.

PURPOSE: The aim of this study was to assess the clinical feasibility, image quality, and radiation dose implications of 0.25-mm imaging mode in a cohort of humans, achieved by dividing the photon-counting detector (PCD) size in half compared with standard-resolution photon-counting computed tomography (CT) (0.5 mm). METHODS: In this technical feasibility study, a whole-body prototype PCD-CT scanner was studied in the 0.25 mm detector mode (measured at isocenter). A high-resolution PCD-CT protocol was first tested in phantom and canine studies in terms of image noise and spatial resolution. Then, 8 human subjects (mean age, 58 ± 8 years; 2 men) underwent axial PCD 0.25-mm scans of the brain, the thorax, and at the level of the upper left kidney. Filtered backprojection reconstruction was performed with a sharp kernel (B70) for standard-resolution and high-resolution data at 0.5-mm isotropic image voxel. High-resolution data, in addition, were reconstructed with an ultrasharp kernel (U70) at 0.25-mm isotropic voxels. RESULTS: Image reconstructions from the PCD 0.25-mm detector system led to an improvement in resolution from 9 to 18 line pairs/cm in a line pair phantom. Modulation transfer function improved from 9.5 to 15.8 line pairs/cm at 10% modulation transfer function. When fully exploiting this improvement, image noise increased by 75% compared with dose-matched 0.5-mm slice PCD standard-resolution acquisition. However, when comparing with standard-resolution data at same in-plane resolution and slice thickness, the PCD 0.25-mm detector mode showed 19% less image noise in phantom, animal, and human scans. CONCLUSION: High-resolution photon-counting CT in humans showed improved image quality in terms of spatial resolution and image noise compared with standard-resolution photon-counting.

Photon-Counting Computed Tomography for Vascular Imaging of the Head and Neck: First In Vivo Human Results.

PURPOSE: The purpose of this study was to evaluate image quality of a spectral photon-counting detector (PCD) computed tomography (CT) system for evaluation of major arteries of the head and neck compared with conventional single-energy CT scans using energy-integrating detectors (EIDs). METHODS: In this institutional review board-approved study, 16 asymptomatic subjects (7 men) provided informed consent and received both PCD and EID contrast-enhanced CT scans of the head and neck (mean age, 58 years; range, 46-75 years). Tube settings were (EID: 120 kVp/160 mA vs PCD: 140 kVp/108 mA) for all volunteers. Quantitative analysis included measurements of mean attenuation, image noise, and contrast-to-noise ratio (CNR). Spectral PCD data were used to reconstruct virtual monoenergetic images and iodine maps. A head phantom was used to validate iodine concentration measurements in PCD images only. Two radiologists blinded to detector type independently scored the image quality of different segments of the arteries, as well as diagnostic acceptability, image noise, and severity of artifacts of the PCD and EID images. Reproducibility was assessed with intraclass correlation coefficient. Linear mixed models that account for within-subject correlation of analyzed arterial segments were used. Linear regression and Bland-Altman analysis with 95% limits of agreement were used to calculate the accuracy of material decomposition. RESULTS: Photon-counting detector image quality scores were significantly higher compared with EID image quality scores with lower image noise (P < 0.01) and less image artifacts (P < 0.001). Photon-counting detector image noise was 9.1% lower than EID image noise (8.0 ± 1.3 HU vs 8.8 ± 1.5 HU, respectively, P < 0.001). Arterial segments showed artifacts on EID images due to beam hardening that were not present on PCD images. On PCD images of the head phantom, there was excellent correlation (R = 0.998) between actual and calculated iodine concentrations without significant bias (bias: -0.4 mg/mL [95% limits of agreements: -1.1 to 0.4 mg/mL]). Iodine maps had 20.7% higher CNR compared with nonspectral PCD (65.2 ± 9.0 vs 54.0 ± 4.5, P = 0.01), and virtual monoenergetic image at 70 keV showed similar CNR to nonspectral images (52.6 ± 4.2 vs 54.0 ± 4.5, P = 0.39). CONCLUSIONS: Photon-counting CT has the potential to improve the image quality of carotid and intracranial CT angiography compared with single-energy EID CT.

Quarter-millimeter spectral coronary stent imaging with photon-counting CT: Initial experience.

PURPOSE: To evaluate the performance and clinical feasibility of 0.25 mm resolution mode of a dual-energy photon-counting detector (PCD) computed tomography (CT) system for coronary stent imaging and to compare the results to state-of-the-art dual-energy energy-integrating detector (EID) CT. MATERIALS AND METHODS: Coronary stents with different diameters (2.0-4.0 mm) were examined inside a coronary artery phantom consisting of plastic tubes filled with iodine-based and gadolinium-based contrast material diluted to approximate clinical concentrations (n = 18). EID images were acquired using 2nd and 3rd generation dual-source CT systems (SOMATOM Flash and SOMATOM Force, Siemens Healthcare) at 0.60 mm (defined as standard-resolution (SR)) isotropic voxel size. Radiation-dose matched PCD images were acquired using a human prototype PCD system (Siemens Healthcare) at 0.50 mm (SR) and 0.25 mm (HR) imaging modes. Images were reconstructed using optimized convolution kernels. RESULTS: Dual-energy HR PCD images significantly better stent lumen visualization (median: 69.5%, IQR: 61.2-78.9%) over dual-energy EID, and standard-resolution PCD images (median: 53.2-57.4%, all P < 0.01). HR PCD acquisitions reconstructed at SR image voxel size showed 25.3% lower image noise compared to SR PCD acquisitions (P < 0.001). High-resolution iodine and gadolinium maps, as well as virtual monoenergetic images, were calculated from the PCD data and enabled estimation of contrast agent concentration in the lumen without interference from the coronary stent. CONCLUSION: HR spectral PCD imaging significantly improves coronary stent lumen visibility over dual-energy EID. When the PCD-HR data was reconstructed into standard voxel sizes (0.5 mm isotropic) the image noise decreased by 25% compared to SR acquisition of PCD. Both dual-energy systems were consistent in estimating contrast agent concentrations.

Dual-contrast agent photon-counting computed tomography of the heart: initial experience.

To determine the feasibility of dual-contrast agent imaging of the heart using photon-counting detector (PCD) computed tomography (CT) to simultaneously assess both first-pass and late enhancement of the myocardium. An occlusion-reperfusion canine model of myocardial infarction was used. Gadolinium-based contrast was injected 10 min prior to PCD CT. Iodinated contrast was infused immediately prior to PCD CT, thus capturing late gadolinium enhancement as well as first-pass iodine enhancement. Gadolinium and iodine maps were calculated using a linear material decomposition technique and compared to single-energy (conventional) images. PCD images were compared to in vivo and ex vivo magnetic resonance imaging (MRI) and histology. For infarct versus remote myocardium, contrast-to-noise ratio (CNR) was maximal on late enhancement gadolinium maps (CNR 9.0 ± 0.8, 6.6 ± 0.7, and 0.4 ± 0.4, p < 0.001 for gadolinium maps, single-energy images, and iodine maps, respectively). For infarct versus blood pool, CNR was maximum for iodine maps (CNR 11.8 ± 1.3, 3.8 ± 1.0, and 1.3 ± 0.4, p < 0.001 for iodine maps, gadolinium maps, and single-energy images, respectively). Combined first-pass iodine and late gadolinium maps allowed quantitative separation of blood pool, scar, and remote myocardium. MRI and histology analysis confirmed accurate PCD CT delineation of scar. Simultaneous multi-contrast agent cardiac imaging is feasible with photon-counting detector CT. These initial proof-of-concept results may provide incentives to develop new k-edge contrast agents, to investigate possible interactions between multiple simultaneously administered contrast agents, and to ultimately bring them to clinical practice.

Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction.

BACKGROUND: We analyzed the accuracy of multi-detector row spiral computed tomography (MDCT) using a 16-slice CT scanner with improved spatial and temporal resolution, as well as routine premedication with beta-blockers for detection of coronary stenoses. METHODS AND RESULTS: Seventy-seven patients with suspected coronary disease were studied by MDCT (12x0.75-mm cross-sections, 420 ms rotation, 100 mL contrast agent IV at 5 mL/s). Patients with a heart rate above 60/min received 50 mg atenolol before the scan. In axial MDCT images and multiplanar reconstructions, all coronary arteries and side branches with a diameter of 1.5 mm or more were assessed for the presence of stenoses exceeding 50% diameter reduction. In comparison to invasive coronary angiography, MDCT correctly classified 35 of 41 patients (85%) as having at least 1 coronary stenosis and correctly detected 57 of 78 coronary lesions (73%). After excluding 38 of 308 coronary arteries (left main, left anterior descending, left circumflex, and right coronary artery in 77 patients) classified as unevaluable by MDCT (12%), 57 of 62 lesions were detected, and absence of stenosis was correctly identified in 194 of 208 arteries (sensitivity: 92%; specificity: 93%; accuracy: 93%; positive and negative predictive values: 79% and 97%). CONCLUSIONS: MDCT coronary angiography with improved spatial resolution and premedication with oral beta-blockade permits detection of coronary artery stenoses with high accuracy and a low rate of unevaluable arteries.

Comparison of image quality in contrast-enhanced coronary-artery visualization by electron beam tomography and retrospectively electrocardiogram-gated multislice spiral computed tomography.

RATIONALE AND OBJECTIVES: To compare the image quality of electron beam tomography (EBT) and multislice spiral CT (MSCT) for coronary artery visualization. MATERIALS AND METHODS: Two groups of 30 patients without coronary stenoses were studied by MSCT (4 x 1 mm collimation) or EBT (3 mm slice thickness). Contrast-to-noise ratio (CNR), overall length of the visualized arteries and vessel length free of motion artifacts were measured. RESULTS: Length of visualized arteries was equal in MSCT and EBT. In EBT, longer segments were depicted free of motion artifacts (MSCT: 73%, EBT: 92% of visualized length, P< 0.001) and CNR was significantly higher than in MSCT (15.4 vs. 9.0; P< 0.001). In both modalities, vessel diameters correlated closely to quantitative coronary angiography. CONCLUSIONS: EBT and MSCT permit reliable coronary artery visualization and measurement of vessel diameters. For the used scan protocol, MSCT images had a lower CNR and were more frequently affected by motion.

Accuracy of prospectively ECG-triggered very low-dose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization.

OBJECTIVE: To evaluate the image quality and diagnostic accuracy of very low-dose computed tomography (CT) angiography (CTA) for the evaluation of coronary artery stenosis. BACKGROUND: Iterative reconstruction (IR) has shown to substantially reduce image noise and hence permit the use of very low-dose data acquisition protocols in coronary CTA. METHODS: Fifty symptomatic patients with an intermediate likelihood for coronary artery disease underwent coronary CTA (heart rate: 59 ± 5 bpm, prospectively ECG-triggered axial acquisition, 100 kV, 160 mAs, 2 × 128 × 0.6 mm collimation, 60 mL contrast, 6 mL/s) prior to invasive coronary angiography. CTA images were reconstructed using both standard filtered back projection (FBP) and a raw data-based IR algorithm [Sinogram Affirmed Iterative Reconstruction (SAFIRE), Siemens Healthcare]. Subjective image quality (four-point Likert scale from 0 = non-diagnostic to 3 = excellent image quality), image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), as well as the presence of coronary stenosis >50% were independently determined by two observers. RESULTS: The mean dose-length product was 46.8 ± 3.5 mGy cm (estimated effective dose 0.66 ± 0.05 mSv). IR led to significantly improved objective image quality compared with FBP (image noise: 41 ± 12 vs. 49 ± 11 HU, P < 0.0001; CNR: 16 ± 8 vs. 12 ± 4, P < 0.0001; SNR: 13 ± 7 vs. 10 ± 3, P < 0.0001). Four coronary segments were not evaluable on FBP data, whereas all segments showed diagnostic image quality with IR. To detect significant coronary stenosis, sensitivity, specificity, positive predictive value, and negative predictive value were 69% (11/16), 97% (175/180), 69% (11/16), and 97% (175/180) per vessel with FBP data sets, respectively. With IR data sets, the corresponding values were 81% (13/16), 97% (178/184), 68% (13/19), and 98% (178/181). These differences were not statistically significant (P = 0.617). CONCLUSIONS: Raw data-based IR significantly improves image quality in very low-dose prospectively ECG-triggered coronary dual-source CTA when compared with standard reconstruction using FBP.

CT dose and image quality in the last three scanner generations.

AIM: To compare the computed tomography (CT) dose and image quality with the filtered back projection against the iterative reconstruction and CT with a minimal electronic noise detector. METHODS: A lung phantom (Chest Phantom N1 by Kyoto Kagaku) was scanned with 3 different CT scanners: the Somatom Sensation, the Definition Flash and the Definition Edge (all from Siemens, Erlangen, Germany). The scan parameters were identical to the Siemens presetting for THORAX ROUTINE (scan length 35 cm and FOV 33 cm). Nine different exposition levels were examined (reference mAs/peek voltage): 100/120, 100/100, 100/80, 50/120, 50/100, 50/80, 25/120, 25/100 and 25 mAs/80 kVp. Images from the SOMATOM Sensation were reconstructed using classic filtered back projection. Iterative reconstruction (SAFIRE, level 3) was performed for the two other scanners. A Stellar detector was used with the Somatom Definition Edge. The CT doses were represented by the dose length products (DLPs) (mGycm) provided by the scanners. Signal, contrast, noise and subjective image quality were recorded by two different radiologists with 10 and 3 years of experience in chest CT radiology. To determine the average dose reduction between two scanners, the integral of the dose difference was calculated from the lowest to the highest noise level. RESULTS: When using iterative reconstruction (IR) instead of filtered back projection (FBP), the average dose reduction was 30%, 52% and 80% for bone, soft tissue and air, respectively, for the same image quality (P < 0.0001). The recently introduced Stellar detector (Sd) lowered the radiation dose by an additional 27%, 54% and 70% for bone, soft tissue and air, respectively (P < 0.0001). The benefit of dose reduction was larger at lower dose levels. With the same radiation dose, an average of 34% (22%-37%) and 25% (13%-46%) more contrast to noise was achieved by changing from FBP to IR and from IR to Sd, respectively. For the same contrast to noise level, an average of 59% (46%-71%) and 51% (38%-68%) dose reduction was produced for IR and Sd, respectively. For the same subjective image quality, the dose could be reduced by 25% (2%-42%) and 44% (33%-54%) using IR and Sd, respectively. CONCLUSION: This study showed an average dose reduction between 27% and 70% for the new Stellar detector, which is equivalent to using IR instead of FBP.

Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation.

OBJECTIVES: The purpose of this study was to evaluate the image quality and diagnostic accuracy of very low-dose, dual-source computed tomography (DSCT) angiography for the evaluation of coronary stents. BACKGROUND: Iterative reconstruction (IR) leads to substantial reduction of image noise and hence permits the use of very low-dose data acquisition protocols in coronary computed tomography angiography. METHODS: Fifty symptomatic patients with 87 coronary stents (diameter 3.0 ± 0.4 mm) underwent coronary DSCT angiography (heart rate, 60 ± 6 beats/min; prospectively electrocardiography-triggered axial acquisition; 80 kV, 165 mA, 2 × 128 × 0.6-mm collimation; 60 ml of contrast at 6 ml/s) before invasive coronary angiography. DSCT images were reconstructed using both standard filtered back projection and a raw data-based IR algorithm (SAFIRE, Siemens Healthcare, Forchheim, Germany). Subjective image quality (4-point scale from 0 [nondiagnostic] to 3 [excellent image quality]), image noise, contrast-to-noise ratio as well as the presence of in-stent stenosis >50% were independently determined by 2 observers. RESULTS: The median dose-length product was 23.0 (22.0; 23.0) mGy · cm (median estimated effective dose of 0.32 [0.31; 0.32] mSv). IR led to significantly improved image quality compared with filtered back projection (image quality score, 1.8 ± 0.6 vs. 1.5 ± 0.5, p < 0.05; image noise, 70 Hounsfield units [62; 80 Hounsfield units] vs. 96 Hounsfield units [82; 113 Hounsfield units], p < 0.001; contrast-to-noise ratio, 11.0 [9.6; 12.4] vs. 8.0 [6.2; 9.3], p < 0.001). To detect significant coronary stenosis in filtered back projection reconstructions, the sensitivity, specificity, positive predictive value, and negative predictive value were 97% (32 of 33), 53% (9 of 17), 80% (32 of 40), and 90% (9 of 10) per patient, respectively; 89% (43 of 48), 79% (120 of 152), 57% (42 of 74), and 96% (121 of 126) per vessel, respectively; and 85% (12 of 14), 69% (51 of 73), 32% (11 of 34), and 96% (51 of 53) per stent, respectively. In reconstructions obtained by IR, the corresponding values were 100% (33 of 33), 65% (11 of 17), 85% (33 of 39), and 100% (11 of 11) per patient, respectively; 96% (46 of 48), 84% (129 of 152), 66% (47 of 71), and 98% (127 of 129) per vessel, respectively; and 100% (14 of 14), 75% (55 of 73), 44% (14 of 32), and 100% (55 of 55) per stent, respectively. These differences were not significant. CONCLUSIONS: In selected patients, prospectively electrocardiography-triggered image acquisition with 80-kV tube voltage and low current in combination with IR permits the evaluation of patients with implanted coronary artery stents with reasonable diagnostic accuracy at very low radiation exposure.

Radiation exposure and image quality of normal computed tomography brain images acquired with automated and organ-based tube current modulation multiband filtering and iterative reconstruction.

OBJECTIVES: We sought to determine whether radiation dose can be reduced and image quality improved in computed tomography (CT) images of the brain that were acquired with automated exposure control (AEC), organ-based tube current modulation (TCM), multiband filtration (MBF), and iterative reconstruction in image space (IRIS). METHODS: An Alderson-Rando-phantom, equipped with thermoluminescent dosimeters, was used to determine the radiation exposure of organs within the head and neck by different CT brain scan modes. We measured the noise and signal-to-noise ratios and subjectively graded quality criteria in different territories of the brain in spiral CT images of 150 patients. We also derived the radiation exposure from the patient protocols. RESULTS: In the phantom, AEC and TCM reduced the radiation exposure of the lenses, cerebrum, cerebellum, and thyroid gland by 41.9%, 34.5%, 30.5%, and 34.9%, respectively. Brain CT scans from patients investigated with AEC, TCM, MBF, and IRIS were found to have significantly better image quality than with conventional filtered back projection. In addition, the CT dose index and dose-length product were significantly lower with AEC, TCM, MBF, and IRIS by 24.1% and 20.2%, respectively. CONCLUSION: The combination of AEC, TCM, MBF, and IRIS improves image quality while radiation exposure can be reduced, particularly in dose-sensitive organs, such as the lenses and thyroid gland.

Coronary artery calcium: a multi-institutional, multimanufacturer international standard for quantification at cardiac CT.

PURPOSE: To develop a consensus standard for quantification of coronary artery calcium (CAC). MATERIALS AND METHODS: A standard for CAC quantification was developed by a multi-institutional, multimanufacturer international consortium of cardiac radiologists, medical physicists, and industry representatives. This report specifically describes the standardization of scan acquisition and reconstruction parameters, the use of patient size-specific tube current values to achieve a prescribed image noise, and the use of the calcium mass score to eliminate scanner- and patient size-based variations. An anthropomorphic phantom containing calibration inserts and additional phantom rings were used to simulate small, medium-size, and large patients. The three phantoms were scanned by using the recommended protocols for various computed tomography (CT) systems to determine the calibration factors that relate measured CT numbers to calcium hydroxyapatite density and to determine the tube current values that yield comparable noise values. Calculation of the calcium mass score was standardized, and the variance in Agatston, volume, and mass scores was compared among CT systems. RESULTS: Use of the recommended scanning parameters resulted in similar noise for small, medium-size, and large phantoms with all multi-detector row CT scanners. Volume scores had greater interscanner variance than did Agatston and calcium mass scores. Use of a fixed calcium hydroxyapatite density threshold (100 mg/cm(3)), as compared with use of a fixed CT number threshold (130 HU), reduced interscanner variability in Agatston and calcium mass scores. With use of a density segmentation threshold, the calcium mass score had the smallest variance as a function of patient size. CONCLUSION: Standardized quantification of CAC yielded comparable image noise, spatial resolution, and mass scores among different patient sizes and different CT systems and facilitated reduced radiation dose for small and medium-size patients.