Low Tube Voltage Research Articles

Quantitative CT imaging and radiation-absorbed dose estimations of 166Ho microspheres: paving the way for clinical application

BackgroundMicrobrachytherapy enables high local tumor doses sparing surrounding tissues by intratumoral injection of radioactive holmium-166 microspheres (166Ho-MS). Magnetic resonance imaging (MRI) cannot properly detect high local Ho-MS concentrations and single-photon emission computed tomography has insufficient resolution. Computed tomography (CT) is quicker and cheaper with high resolution and previously enabled Ho quantification. We aimed to optimize Ho quantification on CT and to implement corresponding dosimetry.MethodsTwo scanners were calibrated for Ho detection using phantoms and multiple settings. Quantification was evaluated in five phantoms and seven canine patients using subtraction and thresholding including influences of the target tissue, injected amounts, acquisition parameters, and quantification volumes. Radiation-absorbed dose estimation was implemented using a three-dimensional 166Ho specific dose point kernel generated with Monte Carlo simulations.ResultsCT calibration showed a near-perfect linear relation between radiodensity (HU) and Ho concentrations for all conditions, with differences between scanners. Ho detection during calibration was higher using lower tube voltages, soft-tissue kernels, and without a scanner detection limit. The most accurate Ho recovery in phantoms was 102 ± 11% using a threshold of mean tissue HU + (2 × standard deviation) and in patients 98 ± 31% using a 100 HU threshold. Thresholding allowed better recovery with less variation and dependency on the volume of interest compared to the subtraction of a single HU reference value. Corresponding doses and histograms were successfully generated.ConclusionCT quantification and dosimetry of 166Ho should be considered for further clinical application with on-site validation using radioactive measurements and intra-operative Ho-MS and dose visualizations.Relevance statementImage-guided holmium-166 microbrachytherapy currently lacks reliable quantification and dosimetry on CT to ensure treatment safety and efficacy, while it is the only imaging modality capable of quantifying high in vivo holmium concentrations.Key PointsLocal injection of 166Ho-MS enables high local tumor doses while sparing surrounding tissue.CT enables imaging-based quantification and radiation-absorbed dose estimation of concentrated Ho in vivo, essential for treatment safety and efficacy.Two different CT scanners and multiple acquisition and reconstruction parameters showed near-perfect linearity between radiodensity and Ho concentration.The most accurate Ho recoveries on CT were 102 ± 11% in five phantoms and 98 ± 31% in seven canine patients using thresholding methods.Dose estimations and volume histograms were successfully implemented for clinical application using a dose point kernel based on Monte Carlo simulations.Graphical

154 - Reducing radiation doses and improving image quality in myocardial delayed enhancement CT with low tube voltage and deep learning image reconstruction

154 - Reducing radiation doses and improving image quality in myocardial delayed enhancement CT with low tube voltage and deep learning image reconstruction

Application value of individualized tube voltage, contrast injection, and adaptive statistical iterative reconstruction V algorithm based on body mass index in renal computed tomography angiography for radiation and iodinated contrast dose reduction.

To explore the application value of body mass index (BMI)-based kilovoltage peak (kVp) selection and contrast injection protocol combined with different adaptive statistical iterative reconstruction V (ASIR-V) strengths in renal computed tomography angiography (CTA) in reducing radiation and contrast medium (CM) doses. One-hundred renal CTA patients were prospectively enrolled and were divided into individualized kVp group (group A, n = 50) and conventional 100kVp group (group B, n = 50), both with automatic tube current modulation and CM of Iohexol at 350mgI/mL concentration. Group A: 70kVp, noise index (NI) of 18 and CM dose rate of 17mgI/kg/s for 10 s for BMI <25kg/m2 patients; 80kVp, NI = 17, and CM dose rate of 19mgI/kg/s for 10 s for 25 kg/m2≤BMI≤30kg/m2 patients. Group B: 100kVp, 50 mL of CM at the flow rate of 4.5 mL/s. The objective image quality, effective radiation dose, CM dose, injection rate, and image quality were compared between the 2 groups. There was no significant difference in patient characteristics between the 2 groups (P > .05). Compared to group B, group A significantly reduced effective radiation dose by 28.4%, CM dose by 27.2%, and injection rate by 22.7% (all P < .001). The 2 groups had similar SD values in erector spine (P > .05). Group A had significantly higher CT values, SNR, and CNR values of the renal arteries than group B (all P < .001). The 2 radiologists had excellent agreement (Kappa value > 0.8) in the subjective scores of renal CTA images and showed no statistically significant difference between the 2 groups (4.57 ± 0.42 vs 4.41 ± 0.49) (P > .05). BMI-based scan and reconstruction protocol in renal CTA significantly reduces radiation and contrast doses while maintaining diagnostic image quality. (i) BMI-based individualized tube voltage selection and contrast injection protocol in renal CTA reduces both radiation and contrast doses over conventional protocol. (ii) The combination of lower kVp and higher weight ASIR-V maybe used to improve image quality in terms of contrast enhancement and image noise under lower radiation and contrast dose conditions. (iii) Renal CTA of normal size (BMI ≤ 30kg/m2) patients acquired at low radiation dosage and low iodine contrast dose through the combination of low tube voltage and ASIR-V algorithm achieves excellent diagnostic image quality with a good inter-rater agreement.

The Feasibility of a Model-Based Iterative Reconstruction Technique Tuned for the Myocardium on Myocardial Computed Tomography Late Enhancement.

This study evaluated the feasibility of a model-based iterative reconstruction technique (MBIR) tuned for the myocardium on myocardial computed tomography late enhancement (CT-LE). Twenty-eight patients who underwent myocardial CT-LE and late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) within 1 year were retrospectively enrolled. Myocardial CT-LE was performed using a 320-row CT with low tube voltage (80 kVp). Myocardial CT-LE images were scanned 7 min after CT angiography (CTA) without additional contrast medium. All myocardial CT-LE images were reconstructed with hybrid iterative reconstruction (HIR), conventional MBIR (MBIR_cardiac), and new MBIR tuned for the myocardium (MBIR_myo). Qualitative (5-grade scale) scores and quantitative parameters (signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]) were assessed as image quality. The sensitivity, specificity, and accuracy of myocardial CT-LE were evaluated at the segment level using an American Heart Association (AHA) 16-segment model, with LGE-MRI as a reference standard. These results were compared among the different CT image reconstructions. In 28 patients with 448 segments, 160 segments were diagnosed with positive by LGE-MRI. In the qualitative assessment of myocardial CT-LE, the mean image quality scores were 2.9 ± 1.2 for HIR, 3.0 ± 1.1 for MBIR_cardiac, and 4.0 ± 1.0 for MBIR_myo. MBIR_myo showed a significantly higher score than HIR (P < 0.001) and MBIR_cardiac (P = 0.018). In the quantitative image quality assessment of myocardial CT-LE, the median image SNR was 10.3 (9.1-11.1) for HIR, 10.8 (9.8-12.1) for MBIR_cardiac, and 16.8 (15.7-18.4) for MBIR_myo. The median image CNR was 3.7 (3.0-4.6) for HIR, 3.8 (3.2-5.1) for MBIR_cardiac, and 6.4 (5.0-7.7) for MBIR_myo. MBIR_myo significantly improved the SNR and CNR of CT-LE compared to HIR and MBIR_cardiac (P < 0.001). The sensitivity, specificity, and accuracy for the detection of myocardial CT-LE were 70%, 92%, and 84% for HIR; 71%, 92%, and 85% for MBIR_cardiac; and 84%, 92%, and 89% for MBIR_myo, respectively. MBIR_myo showed significantly higher image quality, sensitivity, and accuracy than the others (P < 0.05). MBIR tuned for myocardium improved image quality and diagnostic performance for myocardial CT-LE assessment.

Evaluation of X-ray radiation shielding performance of Bi2O3 and BaTiO3 embedded in PVP and PEG polymer nanocomposite

This study addressed the limitations of lead-based radiation shields by developing lead-free, non-toxic, lightweight, and flexible shielding materials with high attenuation efficiency. To achieve this, single and triple layers of Bi2O3-BaTiO3/PVP-PEG nanocomposite films were synthesized. Polyvinylpyrrolidone (PVP) and polyethylene glycol (PEG) polymers (2:1 ratio) were used as the polymeric matrix in which fillers of Bi2O3 and BaTiO3 nanoparticles (NPs) with particle sizes ranging from 90 to 210 nm and <100 nm, respectively, were embedded. Four single-layer samples with 20%, 30%, 40%, and 50% NP concentrations were prepared; the samples were 1.05, 1.09, 1.27, and 1.42 mm thick, respectively. Two samples of triple-layered films were prepared with 30% and 50% NPs, measuring 3.78 and 4.23 mm in thickness, respectively. The attenuation efficiency of these films was investigated using X-ray tube voltages from 10 to 120 kVp. Further, the flexibility of the synthesized films was tested by manual handling. All single- and triple-layer nanocomposites exhibited effective radiation attenuation and desirable flexibility. Specifically, at the lowest tube voltage, all samples exhibited 100% attenuation, while at the highest tube voltage, the attenuation ranged from 27% to 84%, depending on the NP concentration and number of layers of the sample. The highest attenuation ratio, observed in the 50% triple-layer sample, reached 100% up to approximately 60 kVp and 84% at 120 kVp. Consequently, the most optimal film synthesized in this study had a triple-layer configuration with 50% Bi2O3-BaTiO3 NPs embedded in a PVP-PEG polymer with an average attenuation of 95.5% for all tube voltages (10–120 kVp). Therefore, this shielding is suitable for various diagnostic applications, such as mammography, dental X-rays, computerized tomography, and fluoroscopy. Highlights Single- and triple-layered nanocomposite Bi2O3-BaTiO3/PVP-PEG films were synthesized The attenuation efficiency of the films against X-rays was investigated A triple-layer configuration with 50% Bi2O3-BaTiO3/PVP-PEG was suitable for various diagnostic applications

B-MAR: bidirectional artifact representations learning framework for metal artifact reduction in dental CBCT

Objective. Metal artifacts in computed tomography (CT) images hinder diagnosis and treatment significantly. Specifically, dental cone-beam computed tomography (Dental CBCT) images are seriously contaminated by metal artifacts due to the widespread use of low tube voltages and the presence of various high-attenuation materials in dental structures. Existing supervised metal artifact reduction (MAR) methods mainly learn the mapping of artifact-affected images to clean images, while ignoring the modeling of the metal artifact generation process. Therefore, we propose the bidirectional artifact representations learning framework to adaptively encode metal artifacts caused by various dental implants and model the generation and elimination of metal artifacts, thereby improving MAR performance. Approach. Specifically, we introduce an efficient artifact encoder to extract multi-scale representations of metal artifacts from artifact-affected images. These extracted metal artifact representations are then bidirectionally embedded into both the metal artifact generator and the metal artifact eliminator, which can simultaneously improve the performance of artifact removal and artifact generation. The artifact eliminator learns artifact removal in a supervised manner, while the artifact generator learns artifact generation in an adversarial manner. To further improve the performance of the bidirectional task networks, we propose artifact consistency loss to align the consistency of images generated by the eliminator and the generator with or without embedding artifact representations. Main results. To validate the effectiveness of our algorithm, experiments are conducted on simulated and clinical datasets containing various dental metal morphologies. Quantitative metrics are calculated to evaluate the results of the simulation tests, which demonstrate b-MAR improvements of >1.4131 dB in PSNR, >0.3473 HU decrements in RMSE, and >0.0025 promotion in structural similarity index measurement over the current state-of-the-art MAR methods. All results indicate that the proposed b-MAR method can remove artifacts caused by various metal morphologies and restore the structural integrity of dental tissues effectively. Significance. The proposed b-MAR method strengthens the joint learning of the artifact removal process and the artifact generation process by bidirectionally embedding artifact representations, thereby improving the model’s artifact removal performance. Compared with other comparison methods, b-MAR can robustly and effectively correct metal artifacts in dental CBCT images caused by different dental metals.

Optimization of contrast and dose in x-ray phase-contrast tomography with a Talbot-Lau interferometer

X-ray phase-contrast imaging has become a valuable tool for biomedical research due to its improved contrast abilities over regular attenuation-based imaging. The recently emerged Talbot-Lau interferometer can provide quantitative attenuation, phase-contrast and dark-field image data, even with low-brilliance x-ray tube sources. Thus, it has become a valid option for clinical environments. In this study, we analyze the effects of x-ray tube voltage and total number of images on the contrast-to-noise ratio (CNR) and dose-weighted CNR (CNRD) calculated from tomographic transmission and phase-contrast data of a phantom sample. Constant counting statistics regardless of the voltage was ensured by adjusting the image exposure time for each voltage setting. The results indicate that the x-ray tube voltage has a clear effect on both image contrast and noise. This effect is amplified in the case of phase-contrast images, which is explained by the polychromatic x-ray spectrum and the dependence of interferometer visibility on the spectrum. CNRD is additionally affected by the total imaging time. While submerging the sample into a water container effectively reduces image artefacts and improves the CNR, the additional attenuation of the water must be compensated with a longer exposure time. This reduces dose efficiency. Both the CNR and CNRD are higher in the phase-contrast images compared to transmission images. For transmission images, and phase-contrast images without the water container, CNRD can be increased by using higher tube voltages (in combination with a lower exposure time). For phase-contrast images with the water container, CNRD is increased with lower tube voltages. In general, the CNRD does not strongly depend on the number of tomographic angles or phase steps used.

Clinical audit of the image quality and customised contrast volume using P3T contrast injection software versus standard injection protocol in CT coronary angiography

IntroductionThe implications of shorter scan time and lower tube voltage in the dual-source CT coronary angiography (CTCA) scan protocol necessitate the adaptation of contrast media (CM) injection parameters. This audit evaluates the coronary arteries' vascular attenuation and image quality by comparing the personalised patient protocol technology (P3T) contrast injection software with standard injection protocol. The secondary aim is to determine the relationship between CM volume and the patient's weight. MethodologyA Siemens Somatom Definition Force CT Unit was used to scan 30 sets of patients between August 2020 and October 2020. Patients were selected retrospectively and separated into Standard Injection and P3T injection protocols. An experienced radiologist blinded to the groups reviewed the coronary vessels' contrast enhancement and image quality. ResultsOverall, the mean HU of all the main coronary artery vessels obtained from P3T injection software reached above 350 HU and was diagnostically sufficient. The mean attenuation at the proximal region of RCA in the 80–99 kg weight category was significantly higher in the P3T injection software than the standard injection protocol (p < 0.001). The CM volume proposed by P3T injection software for 40–59 kg was approximately 57 ± 5 mls, while 75 ml was used for the standard injection protocol. ConclusionP3T injection software in CTCA resulted in an adequate diagnostic attenuation of coronary arteries (>350HU) in all weight groups, most effectively in the higher weight group, while maintaining diagnostic image quality. Further, the P3T software reduces CM volumes in lower-weight patients. ImplicationsP3T software enables reducing CM volume in lower-weight patients while improving vascular enhancement in CTCA scans in higher-weight patients.

Low tube voltage and deep-learning reconstruction for reducing radiation and contrast medium doses in thin-slice abdominal CT: a prospective clinical trial.

To investigate the feasibility of low-radiation dose and low iodinated contrast medium (ICM) dose protocol combining low-tube voltage and deep-learning reconstruction (DLR) algorithm in thin-slice abdominal CT. This prospective study included 148 patients who underwent contrast-enhanced abdominal CT with either 120-kVp (600 mgL/kg, n = 74) or 80-kVp protocol (360 mgL/kg, n = 74). The 120-kVp images were reconstructed using hybrid iterative reconstruction (HIR) (120-kVp-HIR), while 80-kVp images were reconstructed using HIR (80-kVp-HIR) and DLR (80-kVp-DLR) with 0.5 mm thickness. Size-specific dose estimate (SSDE) and iodine dose were compared between protocols. Image noise, CT attenuation, and contrast-to-noise ratio (CNR) were quantified. Noise power spectrum (NPS) and edge rise slope (ERS) were used to evaluate noise texture and edge sharpness, respectively. The subjective image quality was rated on a 4-point scale. SSDE and iodine doses of 80-kVp were 40.4% (8.1 ± 0.9 vs. 13.6 ± 2.7 mGy) and 36.3% (21.2 ± 3.9 vs. 33.3 ± 4.3 gL) lower, respectively, than those of 120-kVp (both, p < 0.001). CT attenuation of vessels and solid organs was higher in 80-kVp than in 120-kVp images (all, p < 0.001). Image noise of 80-kVp-HIR and 80-kVp-DLR was higher and lower, respectively than that of 120-kVp-HIR (both p < 0.001). The highest CNR and subjective scores were attained in 80-kVp-DLR (all, p < 0.001). There were no significant differences in average NPS frequency and ERS between 120-kVp-HIR and 80-kVp-DLR (p ≥ 0.38). Compared with the 120-kVp-HIR protocol, the combined use of 80-kVp and DLR techniques yielded superior subjective and objective image quality with reduced radiation and ICM doses at thin-section abdominal CT. Scanning at low-tube voltage (80-kVp) combined with the deep-learning reconstruction algorithm may enhance diagnostic efficiency and patient safety by improving image quality and reducing radiation and contrast doses of thin-slice abdominal CT. Reducing radiation and iodine doses is desirable; however, contrast and noise degradation can be detrimental. The 80-kVp scan with the deep-learning reconstruction technique provided better images with lower radiation and contrast doses. This technique may be efficient for improving diagnostic confidence and patient safety in thin-slice abdominal CT.

Evaluation of image quality on low contrast media with deep learning image reconstruction algorithm in prospective ECG-triggering coronary CT angiography.

To assess the impact of low-dose contrast media (CM) injection protocol with deep learning image reconstruction (DLIR) algorithm on image quality in coronary CT angiography (CCTA). In this prospective study, patients underwent CCTA were prospectively and randomly assigned to three groups with different contrast volume protocols (at 320mgI/mL concentration and constant flow rate of 5ml/s). After pairing basic information, 210 patients were enrolled in this study: Group A, 0.7mL/kg (n = 70); Group B, 0.6mL/kg (n = 70); Group C, 0.5mL/kg (n = 70). All patients were examined via a prospective ECG-triggered scan protocol within one heartbeat. A high level DLIR (DLIR-H) algorithm was used for image reconstruction with a thickness and interval of 0.625mm. The CT values of ascending aorta (AA), descending aorta (DA), three main coronary arteries, pulmonary artery (PA), and superior vena cava (SVC) were measured and analyzed for objective assessment. Two radiologists assessed the image quality and diagnostic confidence using a 5-point Likert scale. The CM doses were 46.81 ± 6.41mL, 41.96 ± 7.51mL and 34.65 ± 5.38mL for Group A, B and C, respectively. The objective assessments on AA, DA and the three main coronary arteries and the overall subjective scoring showed no significant difference among the three groups (all p > 0.05). The subjective assessment proved that excellent CCTA images can be obtained from the three different contrast media protocols. There were no significant differences in intracoronary attenuation values between the higher HR subgroup and the lower HR subgroup among three groups. CCTA reconstructed with DLIR could be realized with adequate enhancement in coronary arteries, excellent image quality and diagnostic confidence at low contrast dose of a 0.5mL/kg. The use of lower tube voltages may further reduce the contrast dose requirement.

Feasibility Analysis of Individualized Low Flow Rate Abdominal Contrast-Enhanced Computed Tomography in Chemotherapy Patients: Dual-Source Computed Tomography With Low Tube Voltage.

The aim of the study is to investigate the feasibility of using dual-source computed tomography (CT) combined with low flow rate and low tube voltage for postchemotherapy image assessment in cancer patients. Ninety patients undergoing contrast-enhanced CT scans of the upper abdomen were prospectively enrolled and randomly assigned to groups A, B, and C (n = 30 each). In group A, patients underwent scans at 120 kVp with 448 mgI/kg. Patients in group B underwent scans at 100 kVp with 336 mgI/kg. Patient in group C underwent scans at 70 kVp with of 224 mgI/kg. Quantitative measurements including the CT number, standard deviation of CT number, signal-to-noise ratio, contrast-to-noise ratio, subjective reader scores, and the volume and flow rate of contrast agent were evaluated for each group. There was no statistically significant difference in the subjective image scores within the three groups except for the kidney (all P > 0.05). Group C showed significantly higher CT values, lower noise levels, and higher signal-to-noise ratio and contrast-to-noise ratio values in the majority of the regions of interest compared to the other groups (P < 0.05). In group C, the contrast agent dose was decreased by 46% compared to group A (79.48 ± 12.24 vs 42.7 ± 8.6, P < 0.01), and the contrast agent injection rate was reduced by 22% (2.7 ± 0.41 vs 2.1 ± 0.4, P < 0.01). The use of 70 kVp tube voltage combined with low iodine flow rates prove to be a more effective approach in solving the challenge of compromised blood vessels in postchemotherapy tumor patients, without reducing image quality and diagnostic confidence.

관상동맥 CT와 심근관류 CT 검사를 이용한 고농도 조영제와 저농도 조영제 간 비교 평가

With the advancement of CT technology, the use of low tube voltages, and the clinical efficacy of low-concentration contrast media are gradually being demonstrated. In this study, we compared the differences between high- and low-concentration contrast media using Coronary Computed Tomography Angiography (CCTA) and Computed Tomography-Myocardial Perfusion Imaging (CT-MPI). These imaging techniques can simultaneously evaluate the patient's hemodynamic distribution and myocardium. The study results indicated that the quantitative analysis of tissues and blood vessels in CCTA showed that high-concentration contrast media led to a 5 to 10% increase in Hounsfield Units (HU), but the probability of significance was greater than 0.05. As a result of myocardial evaluation using CCTA and CT-MPI, the difference between the two contrast agents was within 5%, and the probability of significance was greater than 0.05. Qualitative analysis utilized nominal measurements in five categories and did not reveal significant differences between low- and high-concentration contrast media with a significance probability greater than 0.05. This study differed from existing studies by utilizing high- and low-concentration contrast media for CCTA and CT-MPI examinations. Analysis using CCTA and CT-MPI shows that low-concentration images are not inferior to images obtained using high-concentration contrast media.

Effects of low-tube voltage coronary CT angiography on plaque and pericoronary fat assessment: intraindividual comparison.

To investigate the effects of low tube voltage on coronary plaques and pericoronary fat assessment, and to compare their extent among various levels of low voltage. Patients were recommended for high-pitch low-tube voltage coronary computed tomography angiography (CCTA), and they were included if they had poor image quality and were referred to a conventional CCTA. The patients were classified into a low-voltage group (with 70-kV, 80-kV, and 90-kV subgroups) and a conventional group (100/120 kV). Their total plaque and subcomponent volumes and pericoronary fat attenuation index (FAI) were measured. A total of 1002 image slices (from 65 patients and 74 plaques) were included, including 21, 31, 13, 4, and 61 patients in the 70-kV, 80-kV, 90-kV, 100-kV, and 120-kV groups respectively. The CT values of noncalcified plaques in the conventional and low-voltage groups were 54.6 ± 21.3 HU and 31.5 ± 22.6 HU, respectively (p < 0.05). Compared with the conventional group, the necrotic core and calcification volume were increased, and the fibrolipid volume, periplaque, and right coronary artery FAI were decreased in the low-voltage group and its subgroups (p < 0.001). The magnitude of changes in fibrous and calcification volumes increased in the 70-kV subgroup compared with that in the 90-kV subgroup (p < 0.05). Low tube voltages, particularly of 70 kV, have a significant effect on coronary plaque and FAI. The effect of low voltage on plaque composition is characterized by a polarization pattern, i.e., a decrease in fibrolipid (medium density) and an increase in necrotic core (low density) and calcification (high density). Our results highlight the comparability and repeatability of plaque and pericoronary fat assessments facilitated by the same or a similar tube voltage. It is necessary to carry out studies on the specificity threshold of low tube voltage at each level. • Low tube voltage had a significant effect on coronary plaque and pericoronary fat, particularly 70 kV. • The effect of low tube voltage on plaque composition shows the shift from medium-density mixed components to low- and high-density components. • It is necessary to correct the specificity threshold or attenuation difference for low tube voltage at each level.

The effect of a pre-reconstruction process in a filtered backprojection reconstruction on an image quality of a low tube voltage computed tomography.

This study aims to evaluate the effect of pre-reconstruction process for low tube voltage computed tomography (CT) on image quality of filtered backprojection (FBP) reconstruction. Small and large quality assurance water phantoms (19 and 33cm diameter) were scanned on a third-generation dual-source CT with 70 kVp and 120 kVp at various dose levels. Image quality was assessed in terms of the noise power spectrum (NPS) and task-based transfer function (TTF). NPSs and TTFs in the small phantom were comparable between 70 and 120 kVp protocols. In the large phantom, the curves of the NPS changed and the TTF decreased even at the high-dose levels for 70 kVp protocol compared to 120 kVp protocol. Our results indicated that the pre-reconstruction process is performed in low tube voltage CT for large objects even for the FBP reconstruction and has an effect on the image quality.

Effectiveness of low tube voltage scan in the exposure dose for lenses during paediatric thoracic CT examination: anthropomorphic phantoms study.

To determine whether using lower-tube voltage reduces the scattered dose for the lens during paediatric thoracic computed tomography (CT). Two paediatric anthropomorphic phantoms (ATOM Phantom, CIRS, Norfolk, Virginia, USA) representing a newborn and 5-year-old were placed on the gantry of CT scanner, and optically stimulated luminescence dosemeters were placed on the left and right lenses, in front of the left and right thyroid glands, in front of the left and right mammary glands, and in front of and behind the mammary gland level and we measured scattered dose of the optically stimulated luminescence dosemeter was compared for each phantom between 80 and 120kVp. Significant differences were observed in the scatter doses for the lens between 80 and 120kVp (p<0.01). Compared with the 120kVp scan, the scatter doses for the lens were ~15-40% lower in newborn and 5-year-olds using the 80kVp scan during paediatric CT.

Computed Tomography-Based Coronary Artery Calcium Score Calculation at a Reduced Tube Voltage Utilizing Iterative Reconstruction and Threshold Modification Techniques: A Feasibility Study.

The coronary artery calcium score (CACS) indicates cardiovascular health. A concern in this regard is the ionizing radiation from computed tomography (CT). Recent studies have tried to introduce low-dose CT techniques to assess CACS. We aimed to investigate the accuracy of iterative reconstruction (IR) and threshold modification while applying low tube voltage in coronary artery calcium imaging. The study population consisted of 107 patients. Each subject underwent an electrocardiogram-gated CT twice, once with a standard voltage of 120 kVp and then a reduced voltage of 80 kVp. The standard filtered back projection (FBP) reconstruction was applied in both voltages. Considering Hounsfield unit (HU) thresholds other than 130 (150, 170, and 190), CACS was calculated using the FBP-reconstructed 80 kVp images. Moreover, the 80 kVp images were reconstructed utilizing IR at different strength levels. CACS was measured in each set of images. The intraclass correlation coefficient (ICC) was used to compare the CACSs. A 64% reduction in the effective dose was observed in the 80 kVp protocol compared to the 120 kVp protocol. Excellent agreement existed between CACS at high-level (strength level = 5) IR in low-kVp images and the standard CACS protocol in scores ≥ 11 (ICC > 0.9 and p < 0.05). Increasing the threshold density to 190 HU in FBP-reconstructed low-kVp images yielded excellent agreement with the standard protocol in scores ≥ 11 (ICC > 0.9 and p < 0.05) and good agreement in score zero (ICC = 0.84 and p = 0.02). The modification of the density threshold and IR provides an accurate calculation of CACS in low-voltage CT with the potential to decrease patient radiation exposure.

Screening for osteoporosis based on IQon spectral CT virtual low monoenergetic images: Comparison with conventional 120 kVp images

ObjectivesTo explore the differences between low kiloelectron volt (keV) virtual monoenergetic images (VMIs) using IQon spectral CT and conventional CT (120 kVp) in the diagnosis of osteoporosis. MethodsThis retrospective study included 317 patients who underwent IQon spectral CT and dual-energy X-ray absorptiometry (DXA) examination. Commercial deep learning–based software was used for the fully automated extraction of the CT values of the first to fourth lumbar vertebrae (L1–L4) from two different low-keV levels (including 40/70 keV) VMIs and conventional 120 kVp images. The DXA examination results served as the standard of reference (normal [T-score ≥ −1], osteopenia [-2.5 < T-score < −1], and osteoporosis [T-score < −2.5]). Osteoporosis diagnosis models were constructed using machine learning classifiers (logistic regression, support vector machine, random forest, XGBoost, and multilayer perceptron) based on the average CT values of L1–L4. The area under the receiver operating characteristic curve (AUC) and DeLong test were performed to compare differences in the performance of the osteoporosis diagnosis model between virtual low-keV VMIs and standard 120 kVp images. ResultsRandom forest-based prediction model obtained good overall performance among all classifiers, and macro/micro average AUC values of 0.820/840, 0.834/853, and 0.831/852 were obtained based on 40/70 keV and 120 kVp images, respectively. The model presented no significant difference between low-keV VMIs and standard 120 kVp images for the diagnosis of osteoporosis (p > 0.05). ConclusionsThe performance of the osteoporosis diagnosis model using IQon spectral CT simulating the low tube voltage scanning condition (less than 120 kVp) was also satisfactory. Bone density screening evaluation can be performed with a combination of low-dose lung scanning CT, greatly reducing the radiation dose without affecting the diagnosis.

A Study on the Comparison of VNCa and VMI+ Image Quality and Optimized Method according to kV Modulation of DECT: A Porcine Ankle Ligament Model

This study conducted a quantitative and qualitative assessment of the effectiveness of Single-Energy and Dual-Energy Virtual non-calcium imaging, as well as Virtual Monoenergetic Imaging at 55, 65, and 75 keV, for diagnosing ligament conditions with regard to tube voltage modulation. A porcine hindlimb ankle ligament model was utilized for this evaluation. The two widest regions within the ligament model were designated as regions of interest, and measurements of Hounsfield Units, Signal-to-Noise Ratios, and Contrast-to-Noise Ratios were obtained. Quantitative evaluation was then conducted based on the average values. Furthermore, qualitative assessments of ligament diagnosis were carried out by five musculoskeletal radiologists and five radiological technologists, each with over five years of experience in Computed Tomography laboratory work. Following both quantitative and qualitative evaluations, it was observed that the Dual-Energy Virtual non-calcium image obtained at 70/Sn150 kVp and the Virtual Monoenergetic Imaging Plus 65 keV image exhibited superior image quality compared to the Single-Energy CT image. These differences were statistically significant (p&lt;0.05). Moreover, the highest image quality was noted at 65 keV within the Virtual Monoenergetic Imaging Plus energy range. The Dual-Energy Virtual non-calcium image was found to be more suitable for imaging ligaments than the Virtual Monoenergetic Imaging Plus 65 keV image.(p&lt;0.05) Notably, lower tube voltages were associated with improved image quality across all images. Consequently, it was determined that 70/Sn150 kVp Dual-Energy Virtual non-calcium images are more optimized than Single-Energy CT and Virtual Monoenergetic Imaging Plus 65 keV images for diagnosing ligament diseases in patients who present challenges for Magnetic Resonance Imaging and in emergency cases. Additionally, employing Virtual non-calcium Color Coding images for accurately describing ligament thickness or length may enhance the diagnostic value of the images.

Early detection of hypervascularization in hepatocellular carcinoma (≤2 cm) on hepatic arterial phase with virtual monochromatic imaging: Comparison with low-tube voltage CT.

This study aims to assess the diagnostic value of virtual monochromatic image (VMI) at low keV energy for early detection of small hepatocellular carcinoma (HCC) in hepatic arterial phase compared with low-tube voltage (80 kVp) CT generated from dual-energy CT (DE-CT). A total of 107 patients with 114 hypervascular HCCs (≤2 cm) underwent DE-CT, 140 kVp, blended 120 kVp, and 80 kVp images were generated, as well as 40 and 50 keV. CT numbers of HCCs and the standard deviation as image noise on psoas muscle were measured. The contrast-to-noise ratios (CNR) of HCC were compared among all techniques. Overall image quality and sensitivity for detecting HCC hypervascularity were qualitatively assessed by three readers. The mean CT numbers, CNR, and image noise were highest at 40 keV followed by 50 keV, 80 kVp, blended 120 kVp, and 140 kVp. Significant differences were found in all evaluating endpoints except for mean image noise of 50 keV and 80 kVp. Image quality of 40 keV was the lowest, but still it was considered acceptable for diagnostic purposes. The mean sensitivity for detecting lesion hypervascularity with 40 keV (92%) and 50 keV (84%) was higher than those with 80 kVp (56%). Low keV energy images were superior to 80 kVp in detecting hypervascularization of early HCC.

“Triple-low” radiation dose bronchial artery CT angiography before bronchial artery embolisation: a feasibility study

To explore the feasibility of a "triple-low" dose (low tube voltage, low tube current, and low contrast agent volume) bronchial artery computed tomography (CT) angiography (CTA) to replace routine dose bronchial artery CTA before bronchial artery embolisation (BAE). CTA was obtained from 60 patients with body mass index (BMI)<30 kg/m2 using a 256 multi-section iCT system, and they were divided into two groups: (1) group A: 100 kVp, 100 mAs, 50 ml contrast medium (CM); (2) group B: 120 kVp, automatic tube current modulation (ACTM), 80 ml CM. CT attenuation of the thoracic aorta, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated, and subjective image quality scores and traceability scores assessed. The effective radiation dose was calculated. The radiation dose was reduced by 79.7% in group A compared to group B (p<0.05). The CT attenuation of the thoracic aorta was increased by approximately 13% in group A compared to group B (p<0.05). Higher image noise, lower SNR, and CNR were obtained in group A compared to group B (all p<0.05). Both subjective image quality scores and traceability scores did not differ between groups A and B (both p>0.05). It is feasible to use the "triple-low" dose CTA protocol for patients with a body mass index (BMI)<30 kg/m2. The radiation dose was reduced by 79.7%, and the dose of contrast medium was reduced by 37.5% to ensure the diagnostic value.