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Preliminary Results: Prospective Clinical Study to Assess Image-Based Iterative Reconstruction for Abdominal Computed Tomography Acquired at 2 Radiation Dose Levels

Pourjabbar, Sarvenaz MD; Singh, Sarabjeet MD; Singh, Anand K. MD; Johnston, Rocio P. MD; Shenoy-Bhangle, Anuradha S. MD; Do, Synho PhD; Padole, Atul MD; Blake, Michael A. MD; Persson, Anders MD; Kalra, Mannudeep K. MD

Journal of Computer Assisted Tomography: January/February 2014 - Volume 38 - Issue 1 - p 117–122
doi: 10.1097/RCT.0b013e3182a17629
Abdominal Imaging

Objective The objective of this study was to compare image quality for abdominal computed tomographic (CT) images acquired at 200 and 50 mA s and reconstructed with image-based iterative reconstruction.

Materials and Methods In this institutional review board–approved prospective study, 22 patients (mean [SD] age, 64.3 [14.4] years; male-female ratio, 12:10) gave informed consent for acquisition of additional abdominal CT images on 64-slice multi-detector CT (MDCT) (Siemens Definition Flash). Standard-dose images were acquired at 200 quality reference mA s, whereas low-dose images were acquired at 50 mA s (all series: 120 kV; 5-mm section thickness; pitch, 0.9:1). The low-dose images were reconstructed with a nonlinear 3-dimensional iterative image reconstruction (3D-IIR) (SafeCT; MedicVision, Tirat Carmel, Israel) (4 settings, namely, A1, A2, A3, and A4) and were assessed by 3 abdominal radiologists for lesion detection, image noise, and visibility of small structures. CATPHAN 500 was scanned at the respective doses to obtain noise spectral density and modulation transfer function.

Results Subjective image noise was unacceptable at 50-mA s filtered back projection and improved to average in 50-mA s A1 and minimal or no noise in 50-mA s A4. However, the visibility of small structures was similar to standard-dose filtered back projection images on 50-mA s A2. Objective image noise was reduced to 66% for the 50-mA s 3D-IIR images (9.08 [2.3]/26.75 [6.8]). The modulation transfer function curve demonstrated resolution improvement in the low-dose images with the 3D-IIR technique, whereas the noise spectral density curve confirmed noise suppression in the 50-mA s 3D-IIR images.

Conclusions Three-dimensional iterative image reconstruction helps to lower image noise without affecting the visibility of small structures at “moderate” settings. Diagnostically acceptable abdominal CT examinations can be acquired at 75% lower-radiation dose with the help of the image-based iterative reconstruction technique.

From the *Department of Radiology, Massachusetts General Hospital, Boston, MA; and †Center for Medical Image Science and Visualization, Linköpings universitet/US, Linköping, Sweden.

Received for publication April 25, 2013; accepted June 19, 2013.

Reprints: Sarvenaz Pourjabbar, MD, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (e-mail:

None of the coauthors have any pertinent financial disclosures.

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.