Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Combined Use of Automatic Tube Voltage Selection and Current Modulation with Iterative Reconstruction for CT Evaluation of Small Hypervascular Hepatocellular Carcinomas: Effect on Lesion Conspicuity and Image Quality

  • Lv, Peijie (Department of Radiology, The First Affiliated Hospital of Zhengzhou University) ;
  • Liu, Jie (Department of Radiology, The First Affiliated Hospital of Zhengzhou University) ;
  • Zhang, Rui (Department of Radiology, The First Affiliated Hospital of Zhengzhou University) ;
  • Jia, Yan (Siemens Healthcare China) ;
  • Gao, Jianbo (Department of Radiology, The First Affiliated Hospital of Zhengzhou University)
  • Received : 2014.06.07
  • Accepted : 2015.01.15
  • Published : 2015.06.01
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Abstract

Objective: To assess the lesion conspicuity and image quality in CT evaluation of small (${\leq}3cm$) hepatocellular carcinomas (HCCs) using automatic tube voltage selection (ATVS) and automatic tube current modulation (ATCM) with or without iterative reconstruction. Materials and Methods: One hundred and five patients with 123 HCC lesions were included. Fifty-seven patients were scanned using both ATVS and ATCM and images were reconstructed using either filtered back-projection (FBP) (group A1) or sinogram-affirmed iterative reconstruction (SAFIRE) (group A2). Forty-eight patients were imaged using only ATCM, with a fixed tube potential of 120 kVp and FBP reconstruction (group B). Quantitative parameters (image noise in Hounsfield unit and contrast-to-noise ratio of the aorta, the liver, and the hepatic tumors) and qualitative visual parameters (image noise, overall image quality, and lesion conspicuity as graded on a 5-point scale) were compared among the groups. Results: Group A2 scanned with the automatically chosen 80 kVp and 100 kVp tube voltages ranked the best in lesion conspicuity and subjective and objective image quality (p values ranging from < 0.001 to 0.004) among the three groups, except for overall image quality between group A2 and group B (p = 0.022). Group A1 showed higher image noise (p = 0.005) but similar lesion conspicuity and overall image quality as compared with group B. The radiation dose in group A was 19% lower than that in group B (p = 0.022). Conclusion: CT scanning with combined use of ATVS and ATCM and image reconstruction with SAFIRE algorithm provides higher lesion conspicuity and better image quality for evaluating small hepatic HCCs with radiation dose reduction.

Keywords

References

  1. Amis ES Jr, Butler PF, Applegate KE, Birnbaum SB, Brateman LF, Hevezi JM, et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 2007;4:272-284 https://doi.org/10.1016/j.jacr.2007.03.002
  2. Strzelczyk JJ, Damilakis J, Marx MV, Macura KJ. Facts and controversies about radiation exposure, part 2: low-level exposures and cancer risk. J Am Coll Radiol 2007;4:32-39 https://doi.org/10.1016/j.jacr.2006.07.010
  3. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 2007;298:317-323 https://doi.org/10.1001/jama.298.3.317
  4. Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol 2008;81:362-378 https://doi.org/10.1259/bjr/01948454
  5. Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology: the impact of new epidemiological data. Br J Radiol 2012;85:e1316-e1317 https://doi.org/10.1259/bjr/13739950
  6. Kramer R, Khoury HJ, Vieira JW. CALDose_X-a software tool for the assessment of organ and tissue absorbed doses, effective dose and cancer risks in diagnostic radiology. Phys Med Biol 2008;53:6437-6459 https://doi.org/10.1088/0031-9155/53/22/011
  7. Ball CG, Correa-Gallego C, Howard TJ, Zyromski NJ, House MG, Pitt HA, et al. Radiation dose from computed tomography in patients with necrotizing pancreatitis: how much is too much? J Gastrointest Surg 2010;14:1529-1535 https://doi.org/10.1007/s11605-010-1314-8
  8. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009;169:2078-2086 https://doi.org/10.1001/archinternmed.2009.427
  9. Schindera ST, Nelson RC, Yoshizumi T, Toncheva G, Nguyen G, DeLong DM, et al. Effect of automatic tube current modulation on radiation dose and image quality for low tube voltage multidetector row CT angiography: phantom study. Acad Radiol 2009;16:997-1002 https://doi.org/10.1016/j.acra.2009.02.021
  10. Vardhanabhuti V, Loader R, Roobottom CA. Assessment of image quality on effects of varying tube voltage and automatic tube current modulation with hybrid and pure iterative reconstruction techniques in abdominal/pelvic CT: a phantom study. Invest Radiol 2013;48:167-174 https://doi.org/10.1097/RLI.0b013e31827b8f61
  11. Siegel MJ, Schmidt B, Bradley D, Suess C, Hildebolt C. Radiation dose and image quality in pediatric CT: effect of technical factors and phantom size and shape. Radiology 2004;233:515-522 https://doi.org/10.1148/radiol.2332032107
  12. Tamm EP, Rong XJ, Cody DD, Ernst RD, Fitzgerald NE, Kundra V. Quality initiatives: CT radiation dose reduction: how to implement change without sacrificing diagnostic quality. Radiographics 2011;31:1823-1832 https://doi.org/10.1148/rg.317115027
  13. Reid J, Gamberoni J, Dong F, Davros W. Optimization of kVp and mAs for pediatric low-dose simulated abdominal CT: is it best to base parameter selection on object circumference? AJR Am J Roentgenol 2010;195:1015-1020 https://doi.org/10.2214/AJR.09.3862
  14. Schindera ST, Winklehner A, Alkadhi H, Goetti R, Fischer M, Gnannt R, et al. Effect of automatic tube voltage selection on image quality and radiation dose in abdominal CT angiography of various body sizes: a phantom study. Clin Radiol 2013;68:e79-e86 https://doi.org/10.1016/j.crad.2012.10.007
  15. Niemann T, Henry S, Faivre JB, Yasunaga K, Bendaoud S, Simeone A, et al. Clinical evaluation of automatic tube voltage selection in chest CT angiography. Eur Radiol 2013;23:2643-2651 https://doi.org/10.1007/s00330-013-2887-x
  16. Husarik DB, Schindera ST, Morsbach F, Chuck N, Seifert B, Szucs-Farkas Z, et al. Combining automated attenuationbased tube voltage selection and iterative reconstruction: a liver phantom study. Eur Radiol 2014;24:657-667 https://doi.org/10.1007/s00330-013-3049-x
  17. Lee KH, Lee JM, Moon SK, Baek JH, Park JH, Flohr TG, et al. Attenuation-based automatic tube voltage selection and tube current modulation for dose reduction at contrast-enhanced liver CT. Radiology 2012;265:437-447 https://doi.org/10.1148/radiol.12112434
  18. Suh YJ, Kim YJ, Hong SR, Hong YJ, Lee HJ, Hur J, et al. Combined use of automatic tube potential selection with tube current modulation and iterative reconstruction technique in coronary CT angiography. Radiology 2013;269:722-729 https://doi.org/10.1148/radiol.13130408
  19. Siegel MJ, Hildebolt C, Bradley D. Effects of automated kilovoltage selection technology on contrast-enhanced pediatric CT and CT angiography. Radiology 2013;268:538-547 https://doi.org/10.1148/radiol.13122438
  20. Siegel MJ, Ramirez-Giraldo JC, Hildebolt C, Bradley D, Schmidt B. Automated low-kilovoltage selection in pediatric computed tomography angiography: phantom study evaluating effects on radiation dose and image quality. Invest Radiol 2013;48:584-589 https://doi.org/10.1097/RLI.0b013e318289f918
  21. Katsura M, Matsuda I, Akahane M, Yasaka K, Hanaoka S, Akai H, et al. Model-based iterative reconstruction technique for ultralow-dose chest CT: comparison of pulmonary nodule detectability with the adaptive statistical iterative reconstruction technique. Invest Radiol 2013;48:206-212
  22. Gonzalez-Guindalini FD, Ferreira Botelho MP, Tore HG, Ahn RW, Gordon LI, Yaghmai V. MDCT of chest, abdomen, and pelvis using attenuation-based automated tube voltage selection in combination with iterative reconstruction: an intrapatient study of radiation dose and image quality. AJR Am J Roentgenol 2013;201:1075-1082 https://doi.org/10.2214/AJR.12.10354
  23. Korn A, Bender B, Fenchel M, Spira D, Schabel C, Thomas C, et al. Sinogram affirmed iterative reconstruction in head CT: improvement of objective and subjective image quality with concomitant radiation dose reduction. Eur J Radiol 2013;82:1431-1435 https://doi.org/10.1016/j.ejrad.2013.03.011
  24. Shin HJ, Chung YE, Lee YH, Choi JY, Park MS, Kim MJ, et al. Radiation dose reduction via sinogram affirmed iterative reconstruction and automatic tube voltage modulation (CARE kV) in abdominal CT. Korean J Radiol 2013;14:886-893 https://doi.org/10.3348/kjr.2013.14.6.886
  25. Lv P, Lin XZ, Li J, Li W, Chen K. Differentiation of small hepatic hemangioma from small hepatocellular carcinoma: recently introduced spectral CT method. Radiology 2011;259:720-729 https://doi.org/10.1148/radiol.11101425
  26. Kalra MK, Maher MM, Toth TL, Schmidt B, Westerman BL, Morgan HT, et al. Techniques and applications of automatic tube current modulation for CT. Radiology 2004;233:649-657 https://doi.org/10.1148/radiol.2333031150
  27. Baker ME, Dong F, Primak A, Obuchowski NA, Einstein D, Gandhi N, et al. Contrast-to-noise ratio and low-contrast object resolution on full- and low-dose MDCT: SAFIRE versus filtered back projection in a low-contrast object phantom and in the liver. AJR Am J Roentgenol 2012;199:8-18 https://doi.org/10.2214/AJR.11.7421
  28. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-163 https://doi.org/10.1016/S0140-6736(03)15268-3
  29. Rizzo S, Kalra M, Schmidt B, Dalal T, Suess C, Flohr T, et al. Comparison of angular and combined automatic tube current modulation techniques with constant tube current CT of the abdomen and pelvis. AJR Am J Roentgenol 2006;186:673-679 https://doi.org/10.2214/AJR.04.1513
  30. Lv P, Liu J, Wu R, Hou P, Hu L, Gao J. Use of non-linear image blending with dual-energy CT improves vascular visualization in abdominal angiography. Clin Radiol 2014;69:e93-e99 https://doi.org/10.1016/j.crad.2013.09.019
  31. Nakaura T, Awai K, Oda S, Funama Y, Harada K, Uemura S, et al. Low-kilovoltage, high-tube-current MDCT of liver in thin adults: pilot study evaluating radiation dose, image quality, and display settings. AJR Am J Roentgenol 2011;196:1332-1338 https://doi.org/10.2214/AJR.10.5698
  32. Sagara Y, Hara AK, Pavlicek W, Silva AC, Paden RG, Wu Q. Abdominal CT: comparison of low-dose CT with adaptive statistical iterative reconstruction and routine-dose CT with filtered back projection in 53 patients. AJR Am J Roentgenol 2010;195:713-719 https://doi.org/10.2214/AJR.09.2989
  33. Winklehner A, Goetti R, Baumueller S, Karlo C, Schmidt B, Raupach R, et al. Automated attenuation-based tube potential selection for thoracoabdominal computed tomography angiography: improved dose effectiveness. Invest Radiol 2011;46:767-773 https://doi.org/10.1097/RLI.0b013e3182266448
  34. Yang WJ, Yan FH, Liu B, Pang LF, Hou L, Zhang H, et al. Can sinogram-affirmed iterative (SAFIRE) reconstruction improve imaging quality on low-dose lung CT screening compared with traditional filtered back projection (FBP) reconstruction? J Comput Assist Tomogr 2013;37:301-305 https://doi.org/10.1097/RCT.0b013e31827b8c66
  35. Kalra MK, Woisetschlager M, Dahlstrom N, Singh S, Lindblom M, Choy G, et al. Radiation dose reduction with Sinogram Affirmed Iterative Reconstruction technique for abdominal computed tomography. J Comput Assist Tomogr 2012;36:339-346 https://doi.org/10.1097/RCT.0b013e31825586c0
  36. Schabel C, Fenchel M, Schmidt B, Flohr TG, Wuerslin C, Thomas C, et al. Clinical evaluation and potential radiation dose reduction of the novel sinogram-affirmed iterative reconstruction technique (SAFIRE) in abdominal computed tomography angiography. Acad Radiol 2013;20:165-172 https://doi.org/10.1016/j.acra.2012.08.015
  37. Yu MH, Lee JM, Yoon JH, Baek JH, Han JK, Choi BI, et al. Low tube voltage intermediate tube current liver MDCT: sinogramaffirmed iterative reconstruction algorithm for detection of hypervascular hepatocellular carcinoma. AJR Am J Roentgenol 2013;201:23-32 https://doi.org/10.2214/AJR.12.10000
  38. Hoang JK, Yoshizumi TT, Nguyen G, Toncheva G, Choudhury KR, Gafton AR, et al. Variation in tube voltage for adult neck MDCT: effect on radiation dose and image quality. AJR Am J Roentgenol 2012;198:621-627 https://doi.org/10.2214/AJR.11.6831

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