Evaluation of CT Angiography Image Quality Acquired with Single-Energy Metal Artifact Reduction (SEMAR) Algorithm in Patients After Complex Endovascular Aortic Repair.

PURPOSE: To evaluate the value of single-energy metal artifact reduction (SEMAR) algorithm on image quality in patients after complex endovascular aortic repair (EVAR) with fenestrated and branched devices. METHODS: Routine follow-up computed tomography angiography (CTA) examinations were performed between February 2016 and May 2017 in 18 patients who underwent a complex EVAR procedure at our institution. Objective analysis was performed by measuring the standard deviation (SD) of attenuation (Hounsfield Units), and the contrast-to-noise ratio (CNR) in regions of interests in the stented visceral arteries. Subjective analysis of the degree of artifacts and stent visualization was performed independently by two interventional radiologists, blinded to the image reconstruction. RESULTS: The SD of attenuation was significantly lower in all target visceral arteries (p < .001), the celiac artery (p = .002), the superior mesenteric artery (SMA; p = .043), and renal arteries (p < .001) in the CT images with SEMAR reconstruction. The CNR significantly increased in all SEMAR-reconstructed target visceral arteries (overall: p < .001, celiac artery: p = .009; SMA: p = .003; renal arteries: p < .001). The reviewers rated a significantly lower artifact degree in all target vessels (overall: p < .001, celiac artery: p = .001; SMA: p = .008; renal arteries: p < .001) and a significantly improved visualization of the stent patency in all target vessels (overall: p < .001, celiac artery: p = .031; SMA: p = .047; renal arteries: p < .001) in the SEMAR images. Overall preference of both reviewers was in favor of the SEMAR reconstruction in 15/18 cases (83%). CONCLUSION: Reconstruction with SEMAR algorithm significantly improves CTA image quality in patients after complex EVAR. LEVEL OF EVIDENCE: Level 4, Case series.

Monte Carlo simulation of the dose distribution of ICRP adult reference computational phantoms for acquisitions with a 320 detector-row cone-beam CT scanner.

PURPOSE: The purpose of this study was to develop and validate a Monte Carlo (MC) simulation tool for patient dose assessment for a 320 detector-row CT scanner, based on the recommendations of International Commission on Radiological Protection (ICRP). Additionally, the simulation was applied on four clinical acquisition protocols, with and without automatic tube current modulation (TCM). METHODS: The MC simulation was based on EGS4 code and was developed specifically for a 320 detector-row cone-beam CT scanner. The ICRP adult reference phantoms were used as patient models. Dose measurements were performed free-in-air and also in four CTDI phantoms: 150 mm and 350 mm long CT head and CT body phantoms. The MC program was validated by comparing simulations results with these actual measurements acquired under the same conditions. The measurements agreed with the simulations across all conditions within 5%. Patient dose assessment was performed for four clinical axial acquisitions using the ICRP adult reference phantoms, one of them using TCM. RESULTS: The results were nearly always lower than those obtained from other dose calculator tools or published in other studies, which were obtained using mathematical phantoms in different CT systems. For the protocol with TCM organ doses were reduced by between 28 and 36%, compared to the results obtained using a fixed mA value. CONCLUSIONS: The developed simulation program provides a useful tool for assessing doses in a 320 detector-row cone-beam CT scanner using ICRP adult reference computational phantoms and is ready to be applied to more complex protocols.

Low contrast detectability performance of model observers based on CT phantom images: kVp influence.

This paper studies low contrast detectability (LCD) performance of two model observers in CT phantom images acquired at different kVp levels and compares the results with humans in a 2-alternative forced choice experiment (2-AFC). Images of the Catphan phantom with objects of different contrasts (0.5 and 1%) and diameters (2-15 mm) were acquired in an Aquilion ONE 320-detector row CT (Toshiba Medical Systems, Tokyo, Japan), in two experiments, selecting (80-100-120-135 kV) with fixed mAs and varying the mAs to keep the dose constant, respectively. Four human observers evaluated the objects visibility obtaining a proportion correct (PC) for each case. LCD was also analyzed with two model observers (non-prewhitening matched filter with an eye filter, NPWE, and channelized Hotelling observer with Gabor channels, CHO). Object contrast was affected by kV, with differences up to 17% between the lowest and highest kV. Both models overestimated human performance and were corrected by efficiency and internal noise factors. The NPWE model reproduced better the human PC values trends showing Pearson's correlation coefficients ≥0.976 (0.954-0.987, 95% CI) for both experiments, whereas for CHO they were ≥0.706 (0.493-0.839). Bland-Altman plots showed better agreement between NPWE and humans being the average difference Δ and the range of the differences Δ±2σ (σ, standard deviation) of Δ=-0.3%, Δ±2σ = [-4.0%,4.5%]. For CHO, Δ=-1.2%, Δ± 2σ= [-10.7%,8.3%]. The NPWE model can be a useful tool to predict human performance in CT low contrast detection tasks in a standard phantom and be potentially used in protocol optimization based on kV selection.

Comparison between human and model observer performance in low-contrast detection tasks in CT images: application to images reconstructed with filtered back projection and iterative algorithms.

OBJECTIVE: To compare low-contrast detectability (LCDet) performance between a model [non-pre-whitening matched filter with an eye filter (NPWE)] and human observers in CT images reconstructed with filtered back projection (FBP) and iterative [adaptive iterative dose reduction three-dimensional (AIDR 3D; Toshiba Medical Systems, Zoetermeer, Netherlands)] algorithms. METHODS: Images of the Catphan® phantom (Phantom Laboratories, New York, NY) were acquired with Aquilion ONE™ 320-detector row CT (Toshiba Medical Systems, Tokyo, Japan) at five tube current levels (20-500 mA range) and reconstructed with FBP and AIDR 3D. Samples containing either low-contrast objects (diameters, 2-15 mm) or background were extracted and analysed by the NPWE model and four human observers in a two-alternative forced choice detection task study. Proportion correct (PC) values were obtained for each analysed object and used to compare human and model observer performances. An efficiency factor (η) was calculated to normalize NPWE to human results. RESULTS: Human and NPWE model PC values (normalized by the efficiency, η = 0.44) were highly correlated for the whole dose range. The Pearson's product-moment correlation coefficients (95% confidence interval) between human and NPWE were 0.984 (0.972-0.991) for AIDR 3D and 0.984 (0.971-0.991) for FBP, respectively. Bland-Altman plots based on PC results showed excellent agreement between human and NPWE [mean absolute difference 0.5 ± 0.4%; range of differences (-4.7%, 5.6%)]. CONCLUSION: The NPWE model observer can predict human performance in LCDet tasks in phantom CT images reconstructed with FBP and AIDR 3D algorithms at different dose levels. ADVANCES IN KNOWLEDGE: Quantitative assessment of LCDet in CT can accurately be performed using software based on a model observer.

Development and validation of a low dose simulator for computed tomography.

PURPOSE: To develop and validate software for facilitating observer studies on the effect of radiation exposure on the diagnostic value of computed tomography (CT). METHODS: A low dose simulator was developed which adds noise to the raw CT data. For validation two phantoms were used: a cylindrical test object and an anthropomorphic phantom. Images of both were acquired at different dose levels by changing the tube current of the acquisition (500 mA to 20 mA in five steps). Additionally, low dose simulations were performed from 500 mA downwards to 20 mA in the same steps. Noise was measured within the cylindrical test object and in the anthropomorphic phantom. Finally, noise power spectra (NPS) were measured in water. RESULTS: The low dose simulator yielded similar image quality compared with actual low dose acquisitions. Mean difference in noise over all comparisons between actual and simulated images was 5.7 +/- 4.6% for the cylindrical test object and 3.3 +/- 2.6% for the anthropomorphic phantom. NPS measurements showed that the general shape and intensity are similar. CONCLUSION: The developed low dose simulator creates images that accurately represent the image quality of acquisitions at lower dose levels and is suitable for application in clinical studies.

Evaluation of 4 multisection CT systems in postoperative imaging of a cochlear implant: a human cadaver and phantom study.

BACKGROUND AND PURPOSE: Postoperative imaging of cochlear implants (CIs) needs to provide detailed information on localization of the electrode array. We evaluated visualization of a HiFocus1J array and accuracy of measurements of electrode positions for acquisitions with 64-section CT scanners of 4 major CT systems (Toshiba Aquilion-64, Philips Brilliance-64, GE LightSpeed-64, and Siemens Sensation-64). MATERIALS AND METHODS: An implanted human cadaver temporal bone, a polymethylmethacrylate (PMMA) phantom containing a CI, and a point spread function (PSF) phantom were scanned. In the human cadaver temporal bone, the visibility of cochlear structures and electrode array were assessed by using a visual analog scale (VAS). Statistical analysis was performed with a paired 2-tailed Student t test with significant level set to .008 after Bonferroni correction. Distinction of individual electrode contacts was quantitatively evaluated. Quantitative assessment of electrode contact positions was achieved with the PMMA phantom by measurement of the displacement. In addition, PSF was measured to evaluate spatial resolution performance of the CT scanners. RESULTS: VAS scores were significantly lower for Brilliance-64 and LightSpeed-64 compared with Aquilion-64 and Sensation-64. Displacement of electrode contacts ranged from 0.05 to 0.14 mm on Aquilion-64, 0.07 to 0.16 mm on Brilliance-64, 0.07 to 0.61 mm on LightSpeed-64, and 0.03 to 0.13 mm on Sensation-64. PSF measurements show an in-plane and longitudinal resolution varying from 0.48 to 0.68 mm and 0.70 to 0.98 mm, respectively, over the 4 scanners. CONCLUSION: According to PSF results, electrode contacts of the studied CI can be visualized separately on all of the studied scanners unless curvature causes intercontact spacing narrowing. Assessment of visibility of CI and electrode contact positions, however, varies between scanners.