Cheng-Hui Yang1, Tung-Hsin Wu2, Yi-You Chiou3, Sheng-Che Hung3, Chung-Jung Lin4, Ying-Chou Chen3, Ming-Huei Sheu3, Wan-Yuo Guo3, Chen-Fen Chiu3. 1. Department of Medical Imaging, Pojen General Hopsital, No.66, Guangfu N. Rd, Songshan Dist, Taipei City 10560, Taiwan; School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City 11221, Taiwan. 2. Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City 11221, Taiwan. 3. School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City 11221, Taiwan; Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. II, Shipai Rd, Taipei 11217, Taiwan. 4. School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City 11221, Taiwan; Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. II, Shipai Rd, Taipei 11217, Taiwan. Electronic address: bcjlin@me.com.
Abstract
BACKGROUND CONTEXT: Computed tomography (CT) scans of the lumbar spine (CTLS) have demonstrated a higher level of accuracy than plain films and have been used to assess patients with spinal disorder when magnetic resonance imaging is not available. Nevertheless, radiation exposure remains a serious safety concern. Iterative reconstruction (IR) decreases the CT radiation dose for diagnostic imaging. However, the feasibility of using IR in CTLS is unclear. PURPOSE: To evaluate the imaging quality and diagnostic reliability of CTLS with IR. STUDY DESIGN: A prospective study. PATIENT SAMPLE: All patients from outpatient departments who suffered from spinal disorders and were referred for CTLS. OUTCOME MEASURES: In acquired CT images, the signal-to-noise ratio (SNR) of the dural sac (DS), intervertebral disc (IVD), psoas muscle (PM), and L5 vertebral body, the contrast-to-noise ratio between the DS and IVD (D-D CNR), and the subjective imaging qualities were compared across groups. Interobserver agreement was evaluated with kappa values. METHODS:Patients receiving low radiation CTLS were divided into three groups. A 150 mAs tube current with 120 kVp tube voltage was used with Group A and a 230 mAs tube current with 100 kVp tube voltage with Group B. Intended end radiation exposure was 50% less than that of the control group. Tube modulation was active for all groups. The images of the two low-radiation groups were reconstructed by IR; those of the control group by filtered back-projection (FBP). RESULTS: The SNRs of the DS, IVD, PM, BM, and D-D CNR of Group A were not inferior to those of the control group. All SNRs and D-D CNRs for Group B were inferior to those of the control group. Except for that of the facet joint, all subjective imaging ratings for anatomic regions were equivalent between Groups A and B. Interobserver agreement was highest for the control group (0.72-0.88), followed by Group A (0.69-0.83) and B (0.55-0.83). CONCLUSIONS: Fifty percent tube current reduction combined with IR provides equivalent diagnostic accuracy and improved patient safety when compared with conventional CTLS. Our results support its use as a screening tool. With the tube modulation technique, further adjustments in weighting IR and FBP algorithms based on body mass index become unnecessary.
RCT Entities:
BACKGROUND CONTEXT: Computed tomography (CT) scans of the lumbar spine (CTLS) have demonstrated a higher level of accuracy than plain films and have been used to assess patients with spinal disorder when magnetic resonance imaging is not available. Nevertheless, radiation exposure remains a serious safety concern. Iterative reconstruction (IR) decreases the CT radiation dose for diagnostic imaging. However, the feasibility of using IR in CTLS is unclear. PURPOSE: To evaluate the imaging quality and diagnostic reliability of CTLS with IR. STUDY DESIGN: A prospective study. PATIENT SAMPLE: All patients from outpatient departments who suffered from spinal disorders and were referred for CTLS. OUTCOME MEASURES: In acquired CT images, the signal-to-noise ratio (SNR) of the dural sac (DS), intervertebral disc (IVD), psoas muscle (PM), and L5 vertebral body, the contrast-to-noise ratio between the DS and IVD (D-D CNR), and the subjective imaging qualities were compared across groups. Interobserver agreement was evaluated with kappa values. METHODS:Patients receiving low radiation CTLS were divided into three groups. A 150 mAs tube current with 120 kVp tube voltage was used with Group A and a 230 mAs tube current with 100 kVp tube voltage with Group B. Intended end radiation exposure was 50% less than that of the control group. Tube modulation was active for all groups. The images of the two low-radiation groups were reconstructed by IR; those of the control group by filtered back-projection (FBP). RESULTS: The SNRs of the DS, IVD, PM, BM, and D-D CNR of Group A were not inferior to those of the control group. All SNRs and D-D CNRs for Group B were inferior to those of the control group. Except for that of the facet joint, all subjective imaging ratings for anatomic regions were equivalent between Groups A and B. Interobserver agreement was highest for the control group (0.72-0.88), followed by Group A (0.69-0.83) and B (0.55-0.83). CONCLUSIONS: Fifty percent tube current reduction combined with IR provides equivalent diagnostic accuracy and improved patient safety when compared with conventional CTLS. Our results support its use as a screening tool. With the tube modulation technique, further adjustments in weighting IR and FBP algorithms based on body mass index become unnecessary.
Authors: Malte Lennart Warncke; Nis Jesper Wiese; Enver Tahir; Susanne Sehner; Axel Heinemann; Marc Regier; Klaus Püschel; Gerhard Adam; Julius Matthias Weinrich; Azien Laqmani Journal: PLoS One Date: 2020-10-08 Impact factor: 3.240