Diagnostic Performance and Dose Comparison of Filtered Back Projection and Adaptive Iterative Dose Reduction Three-dimensional CT Enterography in Children and Young Adults

Wallihan, Daniel B.; Podberesky, Daniel J.; Sullivan, John; Denson, Lee A.; Zhang, Bin; Salisbury, Shelia; Towbin, Alexander J.

doi:10.1148/radiol.14140468

Cited by 22 publications

(13 citation statements)

References 32 publications

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“…necessarily correlate with subjective image quality, as also shown in previous studies (6,9,33,34). IR in CT enterography reduces noise versus FBP at similar radiation exposures (17,32,33,35), which can alter the perceived subjective image sharpness (32). However, as was shown in our study, even half-dose images in patients with specific diagnoses such as active inflammatory terminal ileal Crohn disease have enough information to allow readers to formulate an accurate diagnosis.…”

Section: Discussionsupporting

confidence: 83%

“…The original CT enterographic protocol at our institution (in 2006) included scanning with a fixed 120 kVp and fixed quality reference milliampere second (200 for 16-section multidetector CT and 260 for 64-section multidetector CT), with automatic exposure control at strong increase for obese patients and weak decrease for slim patients (5). By changing to a weightbased reference milliampere second (1 pound [0.45 kg] = 1 mAs) and changing the automatic exposure control settings to a weak increase for obese patients and a strong decrease for slim patients, we were able to achieve a substantial dose reduction of about 32% (16-section multidetector CT) to 41% (64-section multidetector CT) (to date, the main strategies for reducing radiation dose in CT enterography have included using appropriate automatic exposure control, lowering kilovolt peak, using weight-based protocols, and applying IR techniques) (6,31,32). In our study, we evaluated whether dose reductions with IR could result in lower doses without affecting diagnostic accuracy in this patient population.…”

Section: Discussionmentioning

confidence: 94%

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Diagnostic Accuracy of CT Enterography for Active Inflammatory Terminal Ileal Crohn Disease: Comparison of Full-Dose and Half-Dose Images Reconstructed with FBP and Half-Dose Images with SAFIRE

Gandhi¹,

Baker²,

Goenka³

et al. 2016

Radiology

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Purpose To compare the diagnostic accuracy and image quality of computed tomographic (CT) enterographic images obtained at half dose and reconstructed with filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) with those of full-dose CT enterographic images reconstructed with FBP for active inflammatory terminal or neoterminal ileal Crohn disease. Materials and Methods This retrospective study was compliant with HIPAA and approved by the institutional review board. The requirement to obtain informed consent was waived. Ninety subjects (45 with active terminal ileal Crohn disease and 45 without Crohn disease) underwent CT enterography with a dual-source CT unit. The reference standard for confirmation of active Crohn disease was active terminal ileal Crohn disease based on ileocolonoscopy or established Crohn disease and imaging features of active terminal ileal Crohn disease. Data from both tubes were reconstructed with FBP (100% exposure); data from the primary tube (50% exposure) were reconstructed with FBP and SAFIRE strengths 3 and 4, yielding four datasets per CT enterographic examination. The mean volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) at full dose were 13.1 mGy (median, 7.36 mGy) and 15.9 mGy (median, 13.06 mGy), respectively, and those at half dose were 6.55 mGy (median, 3.68 mGy) and 7.95 mGy (median, 6.5 mGy). Images were subjectively evaluated by eight radiologists for quality and diagnostic confidence for Crohn disease. Areas under the receiver operating characteristic curves (AUCs) were estimated, and the multireader, multicase analysis of variance method was used to compare reconstruction methods on the basis of a noninferiority margin of 0.05. Results The mean AUCs with half-dose scans (FBP, 0.908; SAFIRE 3, 0.935; SAFIRE 4, 0.924) were noninferior to the mean AUC with full-dose FBP scans (0.908; P < .003). The proportion of images with inferior quality was significantly higher with all half-dose reconstructions than with full-dose FBP (mean proportion: 0.117 for half-dose FBP, 0.054 for half-dose SAFIRE 3, 0.054 for half-dose SAFIRE 4, and 0.017 for full-dose FBP; P < .001). Conclusion The diagnostic accuracy of half-dose CT enterography with FBP and SAFIRE is statistically noninferior to that of full-dose CT enterography for active inflammatory terminal ileal Crohn disease, despite an inferior subjective image quality. (©) RSNA, 2016 Online supplemental material is available for this article.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 94%

Diagnostic Accuracy of CT Enterography for Active Inflammatory Terminal Ileal Crohn Disease: Comparison of Full-Dose and Half-Dose Images Reconstructed with FBP and Half-Dose Images with SAFIRE

Gandhi¹,

Baker²,

Goenka³

et al. 2016

Radiology

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“…In the pediatric population, estimated effective doses as low as 2.94 mSv have been reported for abdominal CT using multiple detector computed tomography [6] and varied 64320 detector CT scanners [17] . Newer adaptive iterative dose reduction techniques have been described that greatly reduce the radiation exposure among pediatric patients undergoing CTE from 16.7 milligray (mGy) to 6.1 mGy, with minimal reduction in diagnostic sensitivity and specificity [18] . Similarly, newly proposed CTE imaging techniques using lowdose radiation and noise reduction techniques among adults can reduce effective dose radiation exposure by 53%60% from 1520 mSv to 57 mSv [19] .…”

Section: Ctementioning

confidence: 99%

Role of imaging in the evaluation of inflammatory bowel disease: How much is too much?

Haas¹,

Rubesova²,

Bass³

2016

WJR

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Inflammatory bowel disease (IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient's lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient's lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD. Core tip: Imaging plays a key role in the diagnosis and lifelong evaluation of a patient with inflammatory bowel disease (IBD). Several imaging modalities are available, each with a unique set of risks and benefits when considering cost, anesthesia risk in the pediatric population, ionizing radiation, image quality, and availability. In this article, we review the imaging techniques

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“…These improvements, whatever the anatomical region examined, make it possible to reduce exposure parameters, hence decreasing patient radiation dose. Many authors therefore consider that they are a suitable alternative to FBP [1][2][3][4][5][6][7][8].In this issue of Diagnostic and Interventional Imaging, Pontana et al reported a novel approach for assessing the impact of IR on CT pulmonary angiography [9]. In their article, the authors evaluated CT angiograms obtained with a dual-source CT unit.…”

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confidence: 99%

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confidence: 99%

Iterative reconstruction: Why, how and when?

Blum¹,

Gervaise

Teixeira³

2015

Diagnostic and Interventional Imaging

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Radiation exposure during CT imaging has become a major concern for imaging device manufacturers, radiologists, patients and radiation safety organizations, such as the French Radioprotection and Nuclear Safety Institute (IRSN). Using the iterative reconstruction (IR) algorithms offered by device manufacturers is one of the approaches implemented to reduce radiation exposure. Numerous investigations have been carried out to assess the impact of IR algorithms, usually by testing their results against filtered back projection (FBP). The majority of these studies have used both algorithms to reconstruct the same raw data and then made a head-to-head comparison. In other studies, successive acquisitions of the same patients were compared, but with different exposure parameters. Finally, IR algorithms have also been evaluated using phantom studies. Even if some variability is observed depending on the methodology used, the region examined, the image quality required and the algorithm itself, the results of these studies are consistent. The latest IR algorithms significantly enhance the signal/noise ratio while maintaining image quality and, more importantly, spatial resolution. These improvements, whatever the anatomical region examined, make it possible to reduce exposure parameters, hence decreasing patient radiation dose. Many authors therefore consider that they are a suitable alternative to FBP [1][2][3][4][5][6][7][8].In this issue of Diagnostic and Interventional Imaging, Pontana et al. reported a novel approach for assessing the impact of IR on CT pulmonary angiography [9]. In their article, the authors evaluated CT angiograms obtained with a dual-source CT unit. They compared the image quality achieved when both X-ray sources are used together and the images reconstructed using FBP with data from a single source at 40% of the total effective dose and IR. This approach allowed the authors to directly compare low-dose acquisition with IR and classic acquisition with FBP in the same patients. Their results demonstrate that the images obtained with IR and a dose reduced by 60% are of better quality than those obtained with FBP and the full dose.This issue of Diagnostic and Interventional Imaging also includes a phantom study (Catphan ® 500 and anthropomorphic phantom) by Greffier et al. [10]. These researchers intended to help radiologists find the optimal combination of parameters that should be used with IR algorithms. They reported 4032 possible combinations of acquisition parameters depending on the kVp, mAs, reconstruction kernel, slice thickness, and reconstruction type. This study also quantified the reduction of the noise power spectrum for each algorithm and revealed the limitations of such algorithms. They found that excessive power levels amplify the image smoothing effect and are reflected by a leftwards shift of the peaks towards lower frequencies.

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Diagnostic Performance and Dose Comparison of Filtered Back Projection and Adaptive Iterative Dose Reduction Three-dimensional CT Enterography in Children and Young Adults

Cited by 22 publications

References 32 publications

Diagnostic Accuracy of CT Enterography for Active Inflammatory Terminal Ileal Crohn Disease: Comparison of Full-Dose and Half-Dose Images Reconstructed with FBP and Half-Dose Images with SAFIRE

Diagnostic Accuracy of CT Enterography for Active Inflammatory Terminal Ileal Crohn Disease: Comparison of Full-Dose and Half-Dose Images Reconstructed with FBP and Half-Dose Images with SAFIRE

Role of imaging in the evaluation of inflammatory bowel disease: How much is too much?

Iterative reconstruction: Why, how and when?

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