CT Automated Exposure Control Using A Generalized Detectability Index

Purpose Identifying an appropriate tube current setting can be challenging when using iterative reconstruction due to the varying relationship between spatial resolution, contrast, noise, and dose across different algorithms. This study developed and investigated the application of a generalized detectability index (d\u27gen) to determine the noise parameter to input to existing automated exposure control (AEC) systems to provide consistent image quality (IQ) across different reconstruction approaches. Methods This study proposes a task‐based automated exposure control (AEC) method using a generalized detectability index (d\u27gen). The proposed method leverages existing AEC methods that are based on a prescribed noise level. The generalized d\u27gen metric is calculated using lookup tables of task‐based modulation transfer function (MTF) and noise power spectrum (NPS). To generate the lookup tables, the American College of Radiology CT accreditation phantom was scanned on a multidetector CT scanner (Revolution CT, GE Healthcare) at 120 kV and tube current varied manually from 20 to 240 mAs. Images were reconstructed using a reference reconstruction algorithm and four levels of an in‐house iterative reconstruction algorithm with different regularization strengths (IR1–IR4). The task‐based MTF and NPS were estimated from the measured images to create lookup tables of scaling factors that convert between d\u27gen and noise standard deviation. The performance of the proposed d\u27gen‐AEC method in providing a desired IQ level over a range of iterative reconstruction algorithms was evaluated using the American College of Radiology (ACR) phantom with elliptical shell and using a human reader evaluation on anthropomorphic phantom images. Results The study of the ACR phantom with elliptical shell demonstrated reasonable agreement between the d\u27gen predicted by the lookup table and d\u27 measured in the images, with a mean absolute error of 15% across all dose levels and maximum error of 45% at the lowest dose level with the elliptical shell. For the anthropomorphic phantom study, the mean reader scores for images resulting from the d\u27gen‐AEC method were 3.3 (reference image), 3.5 (IR1), 3.6 (IR2), 3.5 (IR3), and 2.2 (IR4). When using the d\u27gen‐AEC method, the observers’ IQ scores for the reference reconstruction were statistical equivalent to the scores for IR1, IR2, and IR3 iterative reconstructions (P \u3e 0.35). The d\u27gen‐AEC method achieved this equivalent IQ at lower dose for the IR scans compared to the reference scans. Conclusions A novel AEC method, based on a generalized detectability index, was investigated. The proposed method can be used with some existing AEC systems to derive the tube current profile for iterative reconstruction algorithms. The results provide preliminary evidence that the proposed d\u27gen‐AEC can produce similar IQ across different iterative reconstruction approaches at different dose levels

Reduced Chest Computed Tomography Scan Length for Patients Positive for Coronavirus Disease 2019: Dose Reduction and Impact on Diagnostic Utility

Objective This work aimed to retrospectively evaluate the potential of dose reduction on chest computed tomography (CT) examinations by reducing the longitudinal scan length for patients positive for coronavirus disease 2019 (COVID-19). Methods This study used the Personalized Rapid Estimation of Dose in CT (PREDICT) tool to estimate patient-specific organ doses from CT image data. The PREDICT is a research tool that combines a linear Boltzmann transport equation solver for radiation dose map generation with deep learning algorithms for organ contouring. Computed tomography images from 74 subjects in the Medical Imaging Data Resource Center–RSNA International COVID-19 Open Radiology Database data set (chest CT of adult patients positive for COVID-19), which included expert annotations including “infectious opacities,” were analyzed. First, the full z-scan length of the CT image data set was evaluated. Next, the z-scan length was reduced from the left hemidiaphragm to the top of the aortic arch. Generic dose reduction based on dose length product (DLP) and patient-specific organ dose reductions were calculated. The percentage of infectious opacities excluded from the reduced z-scan length was used to quantify the effect on diagnostic utility. Results Generic dose reduction, based on DLP, was 69%. The organ dose reduction ranged from approximately equal to 18% (breasts) to approximately equal to 64% (bone surface and bone marrow). On average, 12.4% of the infectious opacities were not included in the reduced z-coverage, per patient, of which 5.1% were above the top of the arch and 7.5% below the left hemidiaphragm. Conclusions Limiting z-scan length of chest CTs reduced radiation dose without significantly compromising diagnostic utility in COVID-19 patients. The PREDICT demonstrated that patient-specific organ dose reductions varied from generic dose reduction based on DLP