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Influence of radiation dose and reconstruction algorithm in MDCT
assessment of airway wall thickness: A phantom study
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Wall thickness (WT) is an airway feature of great interest for the assessment of
morphological changes in the lung parenchyma. Multidetector computed tomography
(MDCT) has recently been used to evaluate airway WT, but the potential risk of
radiation-induced carcinogenesis—particularly in younger patients—might limit a
wider use of this imaging method in clinical practice. The recent commercial
implementation of the statistical model-based iterative reconstruction
(MBIR) algorithm, instead of the conventional filtered back projection (FBP)
algorithm, has enabled considerable radiation
reduction in many other clinical applications of MDCT. The purpose of this work
was to study the impact of radiation
MBIR in the MDCT assessment of airway WT.
An airway phantom was scanned using a clinical MDCT system (Discovery CT750 HD,
Healthcare) at 4 kV levels and 5 mAs levels. Both FBP and a commercial
implementation of MBIR (VeoTM, GE Healthcare) were
used to reconstruct
images of the airways. For each kV–mAs combination and each
reconstruction algorithm, the contrast-to-noise
the airways was measured, and the WT of each airway was measured and compared with
the nominal value; the relative bias and the angular standard deviation in the
measured WT were calculated. For each airway and reconstruction
algorithm, the overall performance of WT quantification across all of the 20
kV–mAs combinations was quantified by the sum of squares (SSQs) of the difference
between the measured and nominal WT values. Finally, the particular kV–mAs
combination and reconstruction algorithm that minimized radiation
still achieving a reference WT quantification accuracy level was chosen as the
optimal acquisition and reconstruction settings.
The wall thicknesses of seven airways of different sizes were analyzed in the
study. Compared with FBP, MBIR improved the CNR of the airways,
particularly at low radiation
levels. For FBP, the relative bias and the angular standard deviation of the
measured WT increased steeply with decreasing radiation
Except for the smallest airway, MBIR enabled significant reduction in both the
relative bias and angular standard deviation of the WT, particularly at low
levels; the SSQ was reduced by 50%–96% by using MBIR. The optimal reconstruction
algorithm was found to be MBIR for the seven airways being assessed, and the
combined use of MBIR and optimal kV–mAs selection resulted in a radiation
reduction of 37%–83% compared with a reference scan protocol with a dose level of 1
The quantification accuracy of airway WT is strongly influenced by radiation
reconstruction algorithm. The MBIR algorithm potentially
allows the desired WT quantification accuracy to be achieved with reduced
which may enable a wider clinical use of MDCT for the assessment of airway WT,
particularly for younger patients who may be more sensitive to exposures with
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