Our experience at UW Medicine Radiology mirrors that of the authors in this article. DECT image quality is very much better with the current reconstruction software. It now rivals SECT in image quality and is the same in radiation dose. But tissue characterization is better and iodine contrast is much brighter – you may need much less injected contrast (up to 70% less).
This interesting article documents both the degree of CT dose reduction from model-based iterative reconstruction and improvement in image quality when looking at lung parenchyma detail.
This study illustrates how iterative reconstruction techniques can be used to lower the radiation dose when using CT to search for urinary tract stones – without compromising accuracy significantly.
Its time has come!
This article illustrates how iterative reconstruction can be used to markedly lower CT radiation dose without significant impact on diagnostic content in CT exams.
For patients with Crohn’s disease who likely will have multiple CT exams over time, lowering dose is especially important.
Study concludes that ultralow-dose CT may substitute for standard-dose CT in some COPD patients
There are at least three different generations of iterative reconstruction, all of which enable substantial CT dose reductions without compromise of diagnostic power. While earlier versions of IR yielded 30% dose reductions, those with model-based IR or some blend thereof can result in 50-80% patient radiation dose reductions – with even better spatial and low contrast resolution. Access the full article on this study.
As this article demonstrates, iterative reconstruction is a very powerful way to reduce dose without impacting diagnostic ability. Key points of the authors include, “To reduce patient and operator radiation dose involves optimization of medical imaging equipment and best control of the equipment by the operator. … The results of our study confirm in a large patient number reflecting the routine clinical setting that the image noise reduction technology allows a significant reduction in radiation dose. … The substantially lower radiation dosage achieved in a routine clinical setting with the image noise reduction technique, provide further evidence of the substantial impact of the new technology. They indicate potential reduction in radiation dosage in invasive and interventional cardiology with more diffusion of newer radiation technology in clinical practice.”
All iterative reconstruction techniques powerfully reduce CT radiation dose in the 40-80% range – without compromising diagnostic power. And they all continue to be refined and to evolve, as this article illustrates. While the “look” of CT images may change from the noise removal, the diagnostic power is not compromised despite the substantial dose reduction. As radiologists, working with change is our future. The old days of nothing but filtered back projection are in our history but not in our future.
This interesting paper talks about the use of iterative reconstruction to help lower the radiation dose of screening CT colonography.
Of course, as with all screening exams, the first order of priorities is to do no harm – hence the motivation to keep the radiation dose especially low.
The challenge is to lower dose without compromising diagnostic power.
For about the past two years, here at UW Medicine (Seattle) we have been using Model Based Iterative Reconstruction (VEO, GE Healthcare) for all our CT colonography exams. As recommended in this article, we also keep the kVp low – 80 or 100, which also helps to reduce the dose.
The result is a very low dose exam, but with excellent image quality and low image noise. This helps to make great coronal/sagittal reconstructions plus very nice 3D fly-through on the post-processing workstation.
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.
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.
Patients with Crohn’s disease often are young and often have their disease activity assessed repeatedly with CT – though MR is used more frequently now as well.
So – they are good candidates for reducing radiation dose by means of iterative reconstruction.
This paper demonstrates that considerable reduction of dose can be achieved without damaging image quality.