Reduction of radiation dose for coronary computed tomography angiography using prospective electrocardiography-triggered high-pitch acquisition in clinical routine

Purpose: To evaluate the image quality, radiation exposure, and means of application in a group of patients who underwent coronary computed tomography angiography (CCTA) performed with low-dose prospective electrocardiography (ECG)-triggered acquisition in which a standard sequence was added if the low-dose sequence did not allow reliable exclusion of coronary stenosis with respect to image quality. Material and methods: The present study was approved by the Ethics Committee of the Faculty of Medicine, and informed consent was obtained from all patients. The authors performed a retrospective review of 256 consecutive patients referred for CCTA using dual-source CT scanner (Definition FLASH, Siemens, Germany). CCTA was performed using prospective ECG-triggered high-pitch acquisition. In patients with higher heart rates (> 65 bpm) or in whom irregular heart rates were noted prior to the scan, a subsequent CCTA was performed immediately (double flash protocol). The effective radiation dose was calculated for each patient. All images were evaluated by two independent observers for quality on a four-point scale with 1 being non-diagnostic image quality and 4 being excellent. Results: Mean effective whole-body dose of CCTA was 1.6 ± 0.4 mSv (range, 0.4-5.4) for the entire cardiac examination and 0.9 ± 0.3 mSv (range, 0.4-2.8) for individual prospective ECG-triggered high-pitch CCTAs. In 27 of these patients with higher heart rates or occasional premature ventricular contractions or atrial fibrillation, subsequent CCTAs were performed immediately. The average image quality score was good to excellent with less than 1% unevaluable coronary segments. The double flash protocol resulted in a fully diagnostic CCTA in all cases. Conclusions: The prospective ECG-triggered high-pitch CCTA technique is feasible and promising in clinical routine with good to excellent image quality and minimal radiation dose. The double flash protocol might become a more robust tool in patients with higher heart rates or arrhythmia

State of the art: iterative CT reconstruction techniques

Owing to recent advances in computing power, iterative reconstruction (IR) algorithms have become a clinically viable option in computed tomographic (CT) imaging. Substantial evidence is accumulating about the advantages of IR algorithms over established analytical methods, such as filtered back projection. IR improves image quality through cyclic image processing. Although all available solutions share the common mechanism of artifact reduction and/or potential for radiation dose savings, chiefly due to image noise suppression, the magnitude of these effects depends on the specific IR algorithm. In the first section of this contribution, the technical bases of IR are briefly reviewed and the currently available algorithms released by the major CT manufacturers are described. In the second part, the current status of their clinical implementation is surveyed. Regardless of the applied IR algorithm, the available evidence attests to the substantial potential of IR algorithms for overcoming traditional limitations in CT imaging

A New Statistical Reconstruction Method for the Computed Tomography Using an X-Ray Tube with Flying Focal Spot

Abstract This paper presents a new image reconstruction method for spiral cone- beam tomography scanners in which an X-ray tube with a flying focal spot is used. The method is based on principles related to the statistical model-based iterative reconstruction (MBIR) methodology. The proposed approach is a continuous-to-continuous data model approach, and the forward model is formulated as a shift-invariant system. This allows for avoiding a nutating reconstruction-based approach, e.g. the advanced single slice rebinning methodology (ASSR) that is usually applied in computed tomography (CT) scanners with X-ray tubes with a flying focal spot. In turn, the proposed approach allows for significantly accelerating the reconstruction processing and, generally, for greatly simplifying the entire reconstruction procedure. Additionally, it improves the quality of the reconstructed images in comparison to the traditional algorithms, as confirmed by extensive simulations. It is worth noting that the main purpose of introducing statistical reconstruction methods to medical CT scanners is the reduction of the impact of measurement noise on the quality of tomography images and, consequently, the dose reduction of X-ray radiation absorbed by a patient. A series of computer simulations followed by doctor's assessments have been performed, which indicate how great a reduction of the absorbed dose can be achieved using the reconstruction approach presented here

High resolution computed tomography at the Ghent University: measuring, visualizing and analyzing the internal structure of objects with sub-micron precision.

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Exact Filtered Back Projection (FBP) Algorithm for Spiral Computer Tomography [US]

Reconstructing images of objects spirally scanned with two-dimensional detectors with a novel algorithm. The image reconstruction process is proven to create an exact image of the object under the ideal circumstances. The algorithm has an FBP (Filtered Back Projection) structure and works very efficiently. The algorithm uses less computer power and combines the benefits of Exact Algorithms and Approximate algorithms

Technical Note: Enhancing Soft Tissue Contrast And Radiation‐Induced Image Changes With Dual‐Energy CT For Radiation Therapy

Purpose The purpose of this work is to investigate the use of low‐energy monoenergetic decompositions obtained from dual‐energy CT (DECT) to enhance image contrast and the detection of radiation‐induced changes of CT textures in pancreatic cancer. Methods The DECT data acquired for 10 consecutive pancreatic cancer patients during routine nongated CT‐guided radiation therapy (RT) using an in‐room CT (Definition AS Open, Siemens Healthcare, Malvern, PA) were analyzed. With a sequential DE protocol, the scanner rapidly performs two helical acquisitions, the first at a tube voltage of 80 kVp and the second at a tube voltage of 140 kVp. Virtual monoenergetic images across a range of energies from 40 to 140 keV were reconstructed using an image‐based material decomposition. Intravenous (IV) bolus‐free contrast enhancement in pancreas patient tumors was measured across a spectrum of monoenergies. For treatment response assessment, the changes in CT histogram features (including mean CT number (MCTN), entropy, kurtosis) in pancreas tumors were measured during treatment. The results from the monoenergetic decompositions were compared to those obtained from the standard 120 kVp CT protocol for the same subjects. Results Data of monoenergetic decompositions of the 10 patients confirmed the expected enhancement of soft tissue contrast as the energy is decreased. The changes in the selected CT histogram features in the pancreas during RT delivery were amplified with the low‐energy monoenergetic decompositions, as compared to the changes measured from the 120 kVp CTs. For the patients studied, the average reduction in the MCTN in pancreas from the first to the last (the 28th) treatment fraction was 4.09 HU for the standard 120 kVp and 11.15 HU for the 40 keV monoenergetic decomposition. Conclusions Low‐energy monoenergetic decompositions from DECT substantially increase soft tissue contrast and increase the magnitude of radiation‐induced changes in CT histogram textures during RT delivery for pancreatic cancer. Therefore, quantitative DECT may assist the detection of early RT response