Novel Deep Learning Denoising Enhances Image Quality and Lowers Radiation Exposure in Interventional Bronchial Artery Embolization Cone Beam CT

Abstract

In interventional bronchial artery embolization (BAE), periprocedural cone beam CT (CBCT) improves guiding and localization. However, a trade-off exists between 6-second runs (high radiation dose and motion artifacts, but low noise) and 3-second runs (vice versa). This study aimed to determine the efficacy of an advanced deep learning denoising (DLD) technique in mitigating the trade-offs related to radiation dose and image quality during interventional BAE CBCT. This study included BMI-matched patients undergoing 6-second and 3-second BAE CBCT scans. The dose-area product values (DAP) were obtained. All datasets were reconstructed using standard weighted filtered back projection (OR) and a novel DLD software. Objective image metrics were derived from place-consistent regions of interest, including CT numbers of the Aorta and lung, noise, and contrast-to-noise ratio. Three blinded radiologists performed subjective assessments regarding image quality, sharpness, contrast, and motion artifacts on all dataset combinations in a forced-choice setup (-1=inferior, 0=equal; 1=superior). The points were averaged per item for a total score. Statistical analysis ensued using a properly corrected mixed-effects model with post hoc pairwise comparisons. Sixty patients were assessed in 30 matched pairs (age 64±15 years; 10 female). The mean DAP for the 6s and 3s runs was 2199±185 µGym² and 1227±90 µGym², respectively. Neither low-dose imaging nor the reconstruction method introduced a significant HU shift (p≥0.127). The 3s-DLD presented the least noise and superior contrast-to-noise ratio (CNR) (p<0.001). While subjective evaluation revealed no noticeable distinction between 6s-DLD and 3s-DLD in terms of quality (p≥0.996), both outperformed the OR variants (p<0.001). The 3s datasets exhibited fewer motion artifacts than the 6s datasets (p<0.001). DLD effectively mitigates the trade-off between radiation dose, image noise, and motion artifact burden in regular reconstructed BAE CBCT by enabling diagnostic scans with low radiation exposure and inherently low motion artifact burden at short examination times.