ObjectivesThe aim of this study was to investigate the extent of dose reduction and comparability of standard dose CT vs Ultra low dose CT in evaluating pulmonary emphysema. MethodsForty-nine patients with emphysema were recruited from a tertiary referral respiratory clinic. Each patient had a non-contrast Standard Dose (SD) and Ultra Low Dose (ULD) thoracic CT. The images were reconstructed using contemporary iterative reconstruction with a standard lung kernel. Lung volumes and emphysema severity was calculated using a commercially available automated densitometry segmentation package. The effective dose was calculated for both CT protocols. ResultsAutomated densitometry calculated the total lung volume and percentage lung area of emphysema. The findings were highly comparable between ULD and SD protocols. A strong correlation was seen between ULD and SD images in measurement of total lung volume (R = 0.925, p < 0.001) and percentage lung involvement by densitometry (R = 0.940, p < 0.001). There is a 95% dose reduction with the ULD protocol, the mean effective dose is 0.12 ± 0.09 mSv versus 2.33 ± 1.54 mSv for the SD protocol. ConclusionsULD thoracic CT is a comparable protocol for the assessment of emphysema severity relative to standard dose CT. ULD CT is performed at a 95% dose reduction compared to SD CT.