Low-dose CT enterography

This article pretty well confirms what many have felt: model-based iterative reconstruction (MBIR) lowers radiation dose by 70-80% compared to adaptive statistical iterative reconstruction (ASIR), without loss of diagnostic power/information. While the images do indeed look different because there is much less noise and because of a slightly different pattern in the remaining noise, all the findings are there. Further, the anatomy and the findings are displayed as well or better.

So, in a young patient (under age 45) – especially if they are likely to be getting multiple exams – use of model-based iterative reconstruction is well worth the longer reconstruction time.

(To read more about CT enterography, Radiologyinfo.org is a great resource for patients.)

Low dose CT Revolution scanner

Seattle King5 TV’s Jean Enerson reported recently on UW Medical Center’s installation of the GE Revolution CT scanner.

Revolution CT scanner

The new technology of the Revolution features the following:

  • Much longer and wider detector
    • (16 cm vs. 4 cm)
  • Much faster rotation speed and scanning
    • (0.28 seconds – 70 G’s centrifugal force)
  • Much better radiation dose lowering technology
    • ASIR-V, auto kVp, density modulated auto mA

16 cm wide-detector array: Whole organ scanning on one 0.2 second rotation

Currently, the Revolution CT scanner is being used at UW Medicine for scans of the heart, blood vessels, and organs that involve more than one pass and the evaluation of transplanted organs. In the future, we intend to expand further into:

    • TAVR
    • All aortograms
    • Cardiac
      • coronaries, perfusion, congen., ablation
    • All misc. vascular studies
      • Renal arteries, HA, runoffs, carotids, COW, grafts/stents, venograms
    • Non-Dual-Energy multi-pass exams
      • Liver, pancreas, IVP
    • Perfusion (brain, transplants, tumor)
    • Workhorse (CAP, KUB, brain, spine)


Low radiation dose without compromise of image quality

This article illustrates that Radiologists’ perceptions of image quality and content change as they become accustomed – over time –  to the different noise pattern of the various types of iterative reconstruction.

In fact, no spatial resolution or low contrast resolution is lost with iterative reconstruction techniques – and diagnostic power is maintained.

Our work here at UW Medicine agrees with this report.

And it is important to know this because iterative reconstruction can result in 30%-60% dose reduction for all types of CT, without loss of diagnostic power.

A thoughtwise approach to CT iterative reconstruction

This very wise philosophy for implementing iterative dose reduction in any CT program was well presented at the recent MDCT meeting of the ISCT in San Francisco in June. A key component is to have regular and measurable ways for radiologists to regularly grade or score image quality as dose is ramped down slowly with increasing amounts of iterative reconstruction. With Model Based Iterative Reconstruction (MBIR), it may be possible to drop dose up to 60% compared to otherwise low dose adaptive statistical iterative reconstruction methods (ASIR) – but not in one jump. It takes time to get accustomed to the slightly different look of images with iterative reconstruction.

At least a month’s worth of experience should accrue before passing judgment on image quality. It is also important to guard against anecdotal cases used to render judgments, so experience over time is important. But with a methodical approach, a lot of progress can be achieved in overall dose reduction.

Significant radiation dose reduction without sacrificing image quality

At the 2014 ISCT-sponsored MDCT meeting in San Francisco – dose reduction was a key theme during all four days.

Iterative reconstruction was a common theme of an overall dose reduction program. While adaptive statistical iterative reconstruction (ASIR) now has been well-shown to reduce average doses by up to 40% without impact on image quality, the hot topic was model-based iterative reconstruction (MBIR) in its various forms.

Consensus is now developing around MBIR being capable of 50-70% dose reductions incremental to adaptive statistical iterations. While image appearance may be somewhat different from that of filtered back projection, it is now pretty clear that such different appearance does not compromise diagnostic power. Indeed, with experience, some radiologists have developed a preference for the image appearance of MBIR.

Striving towards ALARA

This direction of combining a higher noise index (NI) to get lower dose images and then correcting for the resultant noise by using an increased percent of iterative reconstruction (ASIR) is exactly the way to go when striving towards “as low as reasonably achievable” (ALARA) – in my opinion.

At UWMC, we have for a couple of years now gone even further – we use NI in the 30-36 range and routine 70 percent ASIR as a standard for all our CT imaging except high resolution lung (which is NI 25 and ASIR 30%). According to the ACR CT Dose Registry, we are in the bottom 10% of their data base for CT dose….. but the images are very good.

Check out this article to learn more.

Study Offers Promising Benefits for Iterative Reconstruction

At UW, we are outspoken for our support of adaptive statistical iterative reconstruction (ASIR).  As a big proponent of the method, I find this write-up from Radiology to be a landmark article, and the research it highlights, very impressive work.

A team of researchers recently confirmed that iterative reconstruction allows significant CT radiation dose reductions for patients undergoing urolithiasis imaging, without unintended decreased image quality or diagnostic confidence.

Urolithiasis is a common condition, with high likelihood (estimated at 75 percent) of recurrence amongst individuals diagnosed. Therefore, imaging scans are a regularity for those patients with the disease. It is important to treat these patients with the lowest radiation dose possible, as to alleviate fear of potentially excessive radiation.

For the 25 patients involved in the study, image quality was significantly boosted by adding iterative reconstruction, while dose was reduced by about 85 percent, thanks to the ultra-low dose. While previous studies report substantial degradations in imaging quality, 80 percent of the images acquired in this study had suboptimal image quality.

This study is just further evidence of the promising benefit of ASIR. I firmly believe that every imaging site with access to the protocol should use it regularly as to lower dose by 80 percent in frequently performed exams.

To learn more about iterative reconstruction, please click here!

New Algorithm Provides Lower Radiation Dose, Better Image Quality

At the recent International Society for Computed Tomography (ISCT) meeting in San Francisco, studies were presented showing that CT scanning with a new algorithm, called model-based iterative reconstruction (MBIR), could offer better image quality and lower radiation dose than scanning with an adaptive statistical iterative reconstruction (ASIR).

According to AuntMinnie.com, “researchers claim that MBIR outperforms previous efforts to maximize the utility of low-dose CT exams, with researchers reporting excellent image quality and enhanced lesion conspicuity.”

University of Washington is one of the international sites for the multi-center trial of MBIR. My colleague, Paul Kinahan, was one of the two scientists who reported on MBIR images at the ISCT meeting.

We are very impressed with the technique here – it may someday result in a further huge dose reduction for CT. At this point it is in early stages of development and assessment of its clinical impact has not yet begun. But it looks very promising!