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European Radiology
Published in: European Radiology 5/2021

Open Access 01-05-2021 | Computed Tomography | Computed Tomography

Task-based assessment of neck CT protocols using patient-mimicking phantoms—effects of protocol parameters on dose and diagnostic performance

Authors: Paul Jahnke, Juliane Conzelmann, Ulrich Genske, Maximilian Nunninger, Michael Scheel, Bernd Hamm, Torsten Diekhoff

Published in: European Radiology | Issue 5/2021

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Abstract

Objectives

To assess how modifying multiple protocol parameters affects the dose and diagnostic performance of a neck CT protocol using patient-mimicking phantoms and task-based methods.

Methods

Six patient-mimicking neck phantoms containing hypodense lesions of 1 cm diameter and 30 HU contrast and one non-lesion phantom were examined with 36 CT protocols. All possible combinations of the following parameters were investigated: 100- and 120-kVp tube voltage; tube current modulation (TCM) noise levels of SD 7.5, 10, and 14; pitches of 0.637, 0.813, and 1.388; filtered back projection (FBP); and iterative reconstruction (AIDR 3D). Dose-length products (DLPs) and lesion detectability (assessed by 14 radiologists) were compared with the clinical standard protocol (120 kVp, TCM SD 7.5, 0.813 pitch, AIDR 3D).

Results

The DLP of the standard protocol was 25 mGy•cm; the area under the curve (AUC) was 0.839 (95%CI: 0.790–0.888). Combined effects of tube voltage reduction to 100 kVp and TCM noise level increase to SD 10 optimized protocol performance by improving dose (7.3 mGy•cm) and detectability (AUC 0.884, 95%CI: 0.844–0.924). Diagnostic performance was significantly affected by the TCM noise level at 120 kVp (AUC 0.821 at TCM SD 7.5 vs. 0.776 at TCM SD 14, p = 0.003), but not at 100-kVp tube voltage (AUC 0.839 at TCM SD 7.5 vs. 0.819 at TCM SD 14, p = 0.354), the reconstruction method at 100 kVp (AUC 0.854 for AIDR 3D vs. 0.806 for FBP, p < 0.001), but not at 120-kVp tube voltage (AUC 0.795 for AIDR 3D vs. 0.793 for FBP, p = 0.822), and the tube voltage for AIDR 3D reconstruction (p < 0.001), but not for FBP (p = 0.226).

Conclusions

Combined effects of 100-kVp tube voltage, TCM noise level of SD 10, a pitch of 0.813, and AIDR 3D resulted in an optimal neck protocol in terms of dose and diagnostic performance. Protocol parameters were subject to complex interactions, which created opportunities for protocol improvement.

Key Points

• A task-based approach using patient-mimicking phantoms was employed to optimize a CT system for neck imaging through systematic testing of protocol parameters.
• Combined effects of 100-kVp tube voltage, TCM noise level of SD 10, a pitch of 0.813, and AIDR 3D reconstruction resulted in an optimal protocol in terms of dose and diagnostic performance.
• Interactions of protocol parameters affect diagnostic performance and should be considered when optimizing CT techniques.
Appendix
Available only for authorised users
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Metadata
Title
Task-based assessment of neck CT protocols using patient-mimicking phantoms—effects of protocol parameters on dose and diagnostic performance
Authors
Paul Jahnke
Juliane Conzelmann
Ulrich Genske
Maximilian Nunninger
Michael Scheel
Bernd Hamm
Torsten Diekhoff
Publication date
01-05-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07374-8

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