Effect of reduced z-axis scan coverage on diagnostic performance and radiation dose of neck computed tomography in patients with suspected cervical abscess.

Jakob Weiss,Konstantin Nikolaou,Dominik Ketelsen,Ahmed E Othman,Julian L Wichmann,Mike Notohamiprodjo,Dominik Zinsser,Michael Maurer,Fabian Bamberg

doi:10.1371/journal.pone.0180671

Jakob Weiss, Konstantin Nikolaou + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0180671

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Abstract

PurposeTo evaluate the effect of reduced z-axis scan coverage on diagnostic performance and radiation dose of neck CT in patients with suspected cervical abscess.MethodsFifty-one patients with suspected cervical abscess were included and underwent contrast-enhanced neck CT on a 2nd or 3rd generation dual-source CT system. Image acquisition ranged from the aortic arch to the upper roof of the frontal sinuses (CTstd). Subsequently, series with reduced z-axis coverage (CTred) were reconstructed starting at the aortic arch up to the orbital floor. CTstd and CTred were independently assessed by two radiologists for the presence/absence of cervical abscesses and for incidental and alternative findings. In addition, diagnostic accuracy for the depiction of the cervical abscesses was calculated for both readers. Furthermore, DLP (dose-length-product), effective dose (ED) and organ doses were calculated and compared for CTred and CTstd, using a commercially available dose management platform.ResultsA total of 41 abscesses and 3 incidental/alternative findings were identified in CTstd. All abscesses and incidental/alternative findings could also be detected on CTred resulting in a sensitivity and specificity of 1.0 for both readers. DLP, ED and organ doses of the brain, the eye lenses, the red bone marrow and the salivary glands of CTred were significantly lower than for CTstd (p<0.001).ConclusionsReducing z-axis coverage of neck CT allows for a significant reduction of effective dose and organ doses at similar diagnostic performance as compared to CTstd.

Highlights

Cervical abscesses can arise as a complication from various infectious and neoplastic diseases of the naso-pharyngeal area [1,2]
A total of 41 abscesses and 3 incidental/alternative findings were identified in CTstd
All abscesses and incidental/alternative findings could be detected on CTred resulting in a sensitivity and specificity of 1.0 for both readers

Summary

Introduction

Cervical abscesses can arise as a complication from various infectious and neoplastic diseases of the naso-pharyngeal area [1,2]. Current approaches for dose reduction focus on examination protocols with automated tube current modulation and automated tube voltage adaption, reduced kVp settings and different iterative reconstruction algorithms [10,11,12]. Another possibility to effectively reduce dose exposure of CT examinations is to shorten the z-axis scan coverage by excluding those areas, in which the suspected diagnosis is unlikely to occur [13]. Reduced z-axis scan coverage in the cranial direction might be a possible approach to reduce radiation dose of neck CT without compromising its diagnostic performance for this clinical indication

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