How do kV and mAs affect CT lesion detection performance?

Abstract

The purpose of this study was to investigate how output (mAs) and x-ray tube voltage (kV) affect lesion detection in CT imaging. An adult Rando phantom was scanned on a GE LightSpeed CT scanner at x-ray tube voltages from 80 to 140 kV, and outputs from 90 to 360 mAs. Axial images of the abdomen were reconstructed and viewed on a high quality monitor at a soft tissue display setting. We measured detection of 2.5 to 12.5 mm sized lesions using a 2 Alternate Forced Choice (2-AFC) experimental paradigm that determined lesion contrast (I) corresponding to a 92% accuracy (I_92%) of lesion detection. Plots of log(I_92%) versus log(lesion size) were all approximately linear. The slope of the contrast detail curve was ~ -1.0 at 90 mAs, close to the value predicted by the Rose model, but monotonically decreased with increasing mAs to a value of ~ -0.7 at 360 mAs. Increasing the x-ray tube output by a factor of four improved lesion detection by a factor of 1.9 for the smallest lesion (2.5 mm), close to the value predicted by the Rose model, but only by a factor of 1.2 for largest lesion (12.5 mm). Increasing the kV monotonically decreased the contrast detail slopes from -1.02 at 80 kV to -0.71 at 140 kV. Increasing the x-ray tube voltage from 80 to 140 kV improved lesion detection by a factor of 2.8 for the smallest lesion (2.5 mm), but only by a factor of 1.7 for largest lesion (12.5 mm). We conclude that: (i) quantum mottle is an important factor for low contrast lesion detection in images of anthropomorphic phantoms; (ii) x-ray tube voltage has a much greater influence on lesion detection performance than x-ray tube output; (iii) the Rose model only predicts CT lesion detection performance at low x-ray tube outputs (90 mAs) and for small lesions (2.5 mm).