Evaluation of low-contrast detectability for iterative reconstruction in pediatric abdominal computed tomography: a phantom study

Iterative reconstruction is offered by all vendors to achieve similar or better CT image quality at lower doses than images reconstructed with filtered back-projection.

The purpose of this study was to investigate the dose-reduction potential for pediatric abdominal CT imaging when using either a commercially available hybrid or a commercially available model-based iterative reconstruction algorithm from a single manufacturer.

A phantom containing four low-contrast inserts and a uniform background with total attenuation equivalent to the abdomen of an average 8-year-old child was imaged on a CT scanner (IQon; Philips Healthcare, Cleveland, OH). We reconstructed images using both hybrid iterative reconstruction (iDose⁴) and model-based iterative reconstruction (Iterative Model Reconstruction). The four low-contrast inserts had circular cross-section with diameters of 3 mm, 5 mm, 7 mm and 10 mm and contrasts of 14 Hounsfield units (HU), 7 HU, 5 HU and 3 HU, respectively. Helical scans with identical kilovoltage (kV), pitch, rotation time, and collimation were repeated on the phantom at volume CT dose index (CTDI_vol) of 2.0 milligrays (mGy), 3.0 mGy, 4.5 mGy and 6.0 mGy. We measured the contrast-to-noise ratio (CNR) in each rod across scans. Additionally, we collected sub-images containing each rod and sub-images containing the background and used them in two-alternative forced choice observer experiments with four observers (two radiologists and two physicists). We calculated the dose-reduction potential of both iterative reconstruction algorithms relative to a scan performed at 6 mGy and reconstructed with filtered back-projection.

We calculated dose-reduction potential by either matching average equal observer performance in the two-alternative forced choice experiments or matching CNR. When matching CNR, the dose-reduction potential was 34% to 45% for hybrid iterative reconstruction and 89% to 95% for model-based iterative reconstruction. When matching average observer performance, the dose-reduction potential was 9% to 30% for hybrid iterative reconstruction and 57% to 74% for model-based iterative reconstruction. The range in dose-reduction potential depended on the rod size and contrast level.

Observer performance in this phantom study indicates that the dose-reduction potential indicated by an observer study is less than that of CNR; extrapolating the results to clinical studies suggests that the dose-reduction potential would also be less.