CT is still not a low‐dose imaging modality

Rehani, Madan M.; Szczykutowicz, Timothy P.; Zaidi, Habib

doi:10.1002/mp.14000

Cited by 19 publications

(17 citation statements)

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“…Despite the controversies and heated debates around the potential haphazardous effects of low levels of ionizing radiation and the linear-no-threshold theory [ 29 ], concerns from radiation exposure are still current [ 30 ]. Since CT imaging is widely used in clinical diagnosis, prognosis, and assessment of response to treatment and follow-up of a number of diseases, it is an incremental source of radiation dose to patients in modern healthcare [ 7 , 31 ]. With respect to the current COVID-19 crisis, chest CT imaging is the fastest diagnostic approach.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study demonstrated that DNA double-strand breaks and chromosome aberrations increased in patients undergoing a standard-dose CT examination while no effect on human DNA was detected in patients undergoing low-dose CT scans [ 6 ]. Although a plethora of hardware and software technological advances in CT dose reduction have been reported, including high-sensitivity detectors, new automatic exposure control (AEC) systems, adaptive x-ray tube voltage, and new image reconstruction algorithms, CT is still not a low-dose imaging modality [ 7 ]. Therefore, the level of radiation exposure from this modality is still a matter of concern [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Ultra-low-dose chest CT imaging of COVID-19 patients using a deep residual neural network

et al. 2020

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Objectives The current study aimed to design an ultra-low-dose CT examination protocol using a deep learning approach suitable for clinical diagnosis of COVID-19 patients. Methods In this study, 800, 170, and 171 pairs of ultra-low-dose and full-dose CT images were used as input/output as training, test, and external validation set, respectively, to implement the full-dose prediction technique. A residual convolutional neural network was applied to generate full-dose from ultra-low-dose CT images. The quality of predicted CT images was assessed using root mean square error (RMSE), structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR). Scores ranging from 1 to 5 were assigned reflecting subjective assessment of image quality and related COVID-19 features, including ground glass opacities (GGO), crazy paving (CP), consolidation (CS), nodular infiltrates (NI), bronchovascular thickening (BVT), and pleural effusion (PE). Results The radiation dose in terms of CT dose index (CTDI vol ) was reduced by up to 89%. The RMSE decreased from 0.16 ± 0.05 to 0.09 ± 0.02 and from 0.16 ± 0.06 to 0.08 ± 0.02 for the predicted compared with ultra-low-dose CT images in the test and external validation set, respectively. The overall scoring assigned by radiologists showed an acceptance rate of 4.72 ± 0.57 out of 5 for reference full-dose CT images, while ultra-low-dose CT images rated 2.78 ± 0.9. The predicted CT images using the deep learning algorithm achieved a score of 4.42 ± 0.8. Conclusions The results demonstrated that the deep learning algorithm is capable of predicting standard full-dose CT images with acceptable quality for the clinical diagnosis of COVID-19 positive patients with substantial radiation dose reduction. Key Points • Ultra-low-dose CT imaging of COVID-19 patients would result in the loss of critical information about lesion types, which could potentially affect clinical diagnosis. • Deep learning–based prediction of full-dose from ultra-low-dose CT images for the diagnosis of COVID-19 could reduce the radiation dose by up to 89%. • Deep learning algorithms failed to recover the correct lesion structure/density for a number of patients considered outliers, and as such, further research and development is warranted to address these limitations. Electronic supplementary material The online version of this article (10.1007/s00330-020-07225-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultra-low-dose chest CT imaging of COVID-19 patients using a deep residual neural network

et al. 2020

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“…With the benefit of hindsight, SPECT/CT could have profited from a different paradigm, where the appropriate CT acquisition parameters are tailored according to the specific disease or diagnostic question ( Fig. 3) (16). Considerable effort will be required to harmonize clinical practice in this respect, with recent guidelines for bone SPECT/CT being a good initial attempt to define broad region-specific CT acquisition parameters (17).…”

Section: If a Little Is Great Is More Better?mentioning

confidence: 99%

SPECT/CT: Standing on the Shoulders of Giants, It Is Time to Reach for the Sky!

et al. 2020

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Twenty years ago, SPECT/CT became commercially available, combining the strengths of both techniques: the diagnostic sensitivity of SPECT and the anatomic detail of CT. Other benefits initially included attenuation correction of SPECT reconstructions, ultimately evolving to correction techniques that would enable absolute tracer uptake quantification. Recent developments in SPECT hardware include solid-state digital systems with higher sensitivity and resolution, using novel collimator designs based on tungsten. Similar advances in CT technology have been introduced in hybrid SPECT/ CT systems, replacing low-end x-ray tubes with high-end multislice CT scanners equipped with iterative reconstruction, metal artifact reduction algorithms, and dual-energy capabilities. More recently, the design of whole-body SPECT/CT systems has taken another major leap with the introduction of a ring-shaped gantry equipped with multiple movable detectors surrounding the patient. These exciting developments have fueled efforts to develop novel SPECT radiopharmaceuticals, creating new chelators and prosthetic groups for radiolabeling. Innovative SPECT radionuclide pairs have now become available for radiolabeling with the potential for use as theranostic agents. The growth of precision medicine and the associated need for accurate radionuclide treatment dosimetry will likely drive the use of SPECT/CT in the near future. In addition, expanding clinical applications of SPECT/CT in other areas such as orthopedics offer exciting opportunities. Although it is true that the SPECT/CT ecosystem has seen several challenges during its development over the past 2 decades, it is now a feature-rich and mature tool ready for clinical prime time.

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“…In addition, the MDCT's use of narrow collimation caused a decrease in geometric efficiency and thus an increase in image noise and was countered through the use of increased dose [19]. Use of higher than needed image quality, with a preference for crisp images rather than those with some noise present, has also contributed to the higher CT doses [9,20]. As such, radiologists must be willing to use images with some noise (salt and pepper appearance) [20].…”

Section: High Doses In Ctmentioning

confidence: 99%

“…However, some computed tomography (CT) and interventional procedures using fluoroscopy are associated with a relatively higher E (a few tens of mSv). This and increasing patient radiation doses are primarily due to many fold increases in diagnostic information [9]. Previously, in 1970 ′ s, the CT scan used to be 10 mm slices scan with about 10 mm inter-slice gap.…”

Section: Introductionmentioning

confidence: 99%

Higher patient doses through X-ray imaging procedures

Rehani

Nacouzi

2020

Physica Medica

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Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of Xrays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators-but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.

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CT is still not a low‐dose imaging modality

Cited by 19 publications

References 17 publications

Ultra-low-dose chest CT imaging of COVID-19 patients using a deep residual neural network

Ultra-low-dose chest CT imaging of COVID-19 patients using a deep residual neural network

SPECT/CT: Standing on the Shoulders of Giants, It Is Time to Reach for the Sky!

Higher patient doses through X-ray imaging procedures

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