Application of CARE kv and SAFIRE in Contrast-Enhanced CT Examination on Thorax

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1 Application of CARE kv and SAFIRE in Contrast-Enhanced CT Examination on Thorax Poster No.: C-0013 Congress: ECR 2013 Type: Authors: Scientific Exhibit Z. Dejian 1, X. Zhuodong 2, J. Hui 2, L. Xiao 3 ; 1 Ji'nan/CN, 2 Ji'nan/CN, 3 Jinan/CN Keywords: DOI: Quality assurance, Technical aspects, CT, Thorax /ecr2013/C-0013 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Purpose To evaluate the potential of automated tube potential selection algorithm (CARE kv) and Sinogram Affirmed Iterative Reconstruction (SAFIRE) to improve image quality while reduce the radiation dose of patients. Methods and Materials 60 consecutive patients were enrolled and divided into 2 groups#group 1#group 2#with 30 patients per group. Group 1 underwent 128-slice DSCT with routine scan, and images were reconstructed with FBP; group 2 underwent 128-slice DSCT using an automated tube potential selection algorithm (CARE kv), images were reconstructed with FBP(group 2a) and SAFIRE(group 2b) separately. Two observers rated image quality using a 5- point score (5: excellent to 1: non-diagnostic) independently. Image attenuation and noise were measured,the image attenuation values (in HU) were measured with circular ROIs placed in the locations as follows: (1) the ascending aorta at the level of the pulmonary trunk (ROI1), (2) the descending aorta at the level of the pulmonary trunk ( (ROI2), (3) the left subscapularis muscle and the the air on the edge of the muscle at the level of the middle of the aortic arch(away from the clothing) (ROI3and 4, respectively), (4) intrapulmonary lesions (ROI5 ). contrast-to-noise-ratio (CNR)was calculated as CT value ROI2 -CT value ROI3 #/SD ROI3, and the basic information of patients were recorded as well as operational radiation dose. Results The effective radiation dose of group 2b (2.26±0.77mSv) was significantly lower than that of group 1 (2.82±1.15mSv), corresponding to an overall dose reduction of 19.7%#t=3.370#P=0.001#,as Fig.1&2. All the images were diagnostic. The interobserver agreement for image quality rating was good (k = 0.749#P=0.003). The image quality of group 2b is better than that of group 1, and the CNR of group 2b was increased to 61.2%#t=6.312#P<0.001# compared with that of group 1,as Fig.3. Page 2 of 8

3 Fig. 4: As shown by Fig.4: All the images were got from two patients who had almost the same BMI. And Ima.A1&B1 came from group 1,while Ima.A2a,A2b,&B2 came from group 2.The nosie level of Ima 2b(SAFIRE) was lowest.as depicted by Ima.B1&2 that CARE kv had the advantages in radiac dose control. References: - Ji'nan/CN Images for this section: Page 3 of 8

4 Fig. 1: CDTIvol of group 2 were significantly decreased compared to that of group 1 by 18.1%#P=0.003# Fig. 2: DLP of group 2 were lower than that of group 1 by 19.7%(P=0.001). Page 4 of 8

5 Fig. 3: Contrast-to-noise-ratio (CNR) of group 2a and 2b was higher than that of group 1 by 16.7%,61.4%#respectively, with a significant difference. Page 5 of 8

6 Conclusion The combined application of both CARE kv and SAFIRE can improve image quality while reduce the radiation dose of patients. Images for this section: Fig. 5 Page 6 of 8

7 References 1.McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26: Bevelacqua JJ. Practical and effective ALARA. Health Phys 2010;98(Suppl.2):S Alkadhi H, Schindera ST (2011) State of the art low-dose CT angiography of the body. Eur J Radiol. doi: /j. ejrad McCollough CH, Bruesewitz MR, Kofler JM Jr. CT dose reduction and dose management tools: overview of available options.radiographics Mar- Apr;26(2): Amacker NA, Mader C, Alkadhi H, et al chest and abdominal high-pitch CT: An alternative low dose protocol with preserved image quality. Eur J Radiol Mar;81(3):e Flicek KT, Hara AK, Silva AC, et al. Reducing the radiation dose for CT colonography using adaptive statistical iterative reconstruction: A pilot study. AJR Am J Roentgenol Jul;195(1): Hara AK, Paden RG, Silva AC, et al. Iterative reconstruction technique for reducing body radiation dose at CT: feasibility study. AJR Am J Roentgenol Sep;193(3): Manousaki E, Perisinakis K, Karantanas A, et al. MDCT angiography assessment of renal artery in-stent restenosis: can we reduce the radiation exposure burden? A feasibility study. Eur J Radiol Aug;79(2): CARE kv [computer program]. Version syngo CT 2011 A (VA40). Forchheim,Germany: Siemens Healthcare; SAFIRE [computer program]. Version syngo CT 2011 A (VA40). Forchheim,Germany: Siemens Healthcare; Winklehner A, Goetti R, Baumueller S, et al. Automated Attenuation- Based Tube Potential Selection for Thoracoabdominal Computed Tomography Angiography;Improved Dose Effectiveness. Invest Radiol Dec;46(12): Winklehner A, Karlo C, Puippe G, et al. Raw data-based iterative reconstruction in body CTA: evaluationof radiation dose saving potential ; Eur Radiol Dec;21(12): Page 7 of 8

8 13. Ulzheimer S, Endt H, and Leidecker C. CARE kv - How to Optimize Individualized Dose. SOMATOM Sessions.2011 Jun;28: Wintersperger B, Jakobs T, Herzog P, et al. Aorto-iliac multidetector-row CT angiography with low kv settings: improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol. 2005;15: ### ### ###. ####CT################ ####### (4) Pontana F, Pagniez J, Flohr T, et al, Remy-Jardin M. Chest computed tomography using iterative reconstruction vs filtered back projection (Part 1): Evaluation of image noise reduction in 32 patients.eur Radiol Mar;21(3): Prakash P, Kalra MK, Kambadakone AK et al (2010). Reducing abdominal CT radiation dose with adaptive statistical iterative reconstruction technique. Invest Radiol 45: Moscariello A, Takx RA, Schoepf UJ, et al. Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection. Eur Radiol Oct;21(10): Personal Information Page 8 of 8