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04.01.2023 | Original Article

Pilot study to determine whether reduced-dose photon-counting detector chest computed tomography can reliably display Brody II score imaging findings for children with cystic fibrosis at radiation doses that approximate radiographs

verfasst von: Kelly K. Horst, Nathan C. Hull, Paul G. Thacker, Nadir Demirel, Lifeng Yu, Jennifer S. McDonald, Nicholas B. Larson, Cynthia H. McCollough, Joel G. Fletcher

Erschienen in: Pediatric Radiology | Ausgabe 6/2023

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Abstract

Background

The Brody II score uses chest CT to guide therapeutic changes in children with cystic fibrosis; however, patients and providers are often reticent to undergo chest CT given concerns about radiation.

Objective

We sought to determine the ability of a reduced-dose photon-counting detector (PCD) chest CT protocol to reproducibly display pulmonary disease severity using the Brody II score for children with cystic fibrosis (CF) scanned at radiation doses similar to those of a chest radiograph.

Materials and methods

Pediatric patients with CF underwent non-contrast reduced-dose chest PCD-CT. Volumetric inspiratory and expiratory scans were obtained without sedation or anesthesia. Three pediatric radiologists with Certificates of Added Qualification scored each scan on an ordinal scale and assigned a Brody II score to grade bronchiectasis, peribronchial thickening, parenchymal opacity, air trapping and mucus plugging. We report image-quality metrics using descriptive statistics. To calculate inter-rater agreement for Brody II scoring, we used the Krippendorff alpha and intraclass correlation coefficient (ICC).

Results

Fifteen children with CF underwent reduced-dose PCD chest CT in both inspiration and expiration (mean age 8.9 years, range, 2.5–17.5 years; 4 girls). Mean volumetric CT dose index (CTDI_vol) was 0.07 ± 0.03 mGy per scan. Mean effective dose was 0.12 ± 0.04 mSv for the total examination. All three readers graded spatial resolution and noise as interpretable on lung windows. The average Brody II score was 12.5 (range 4–19), with moderate inter-reader reliability (ICC of 0.61 [95% CI=0.27, 0.84]). Inter-rater reliability was moderate to substantial for bronchiectasis (0.52), peribronchial thickening (0.55), presence of opacity (0.62) and air trapping (0.70) and poor for mucus plugging (0.09).

Conclusion

Reduced-dose PCD-CT permits diagnostic image quality and reproducible identification of Brody II scoring imaging findings at radiation doses similar to those for chest radiography.

Brody AS, Klein JS, Molina PL et al (2004) High-resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests. J Pediatr 145:32–38PubMedCrossRef

de Jong PA, Lindblad A, Rubin L et al (2006) Progression of lung disease on computed tomography and pulmonary function tests in children and adults with cystic fibrosis. Thorax 61:80–85PubMedCrossRef

Tiddens HA, de Jong PA (2006) Update on the application of chest computed tomography scanning to cystic fibrosis. Curr Opin Pulm Med 12:433–439PubMedCrossRef

Levy H, Kalish LA, Huntington I et al (2007) Inflammatory markers of lung disease in adult patients with cystic fibrosis. Pediatr Pulmonol 42:256–262PubMedPubMedCentralCrossRef

Robinson TE, Goris ML, Moss RB et al (2020) Mucus plugging, air trapping, and bronchiectasis are important outcome measures in assessing progressive childhood cystic fibrosis lung disease. Pediatr Pulmonol 55:929–938PubMedCrossRef

Tiddens H, Andrinopoulou ER, McIntosh J et al (2020) Chest computed tomography outcomes in a randomized clinical trial in cystic fibrosis: lessons learned from the first ataluren phase 3 study. PLoS One 15:e0240898PubMedPubMedCentralCrossRef

Ramsey KA, Rosenow T, Turkovic L et al (2016) Lung clearance index and structural lung disease on computed tomography in early cystic fibrosis. Am J Respir Crit Care Med 193:60–67PubMedCrossRef

Ellemunter H, Fuchs SI, Unsinn KM et al (2010) Sensitivity of lung clearance index and chest computed tomography in early CF lung disease. Respir Med 104:1834–1842PubMedCrossRef

Joyce S, Carey BW, Moore N et al (2021) Computed tomography in cystic fibrosis lung disease: a focus on radiation exposure. Pediatr Radiol 51:544–553PubMedCrossRef

10.

O’Connor OJ, Vandeleur M, McGarrigle AM et al (2010) Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients. Radiology 257:820–829PubMedCrossRef

11.

Loeve M, Lequin MH, de Bruijne M et al (2009) Cystic fibrosis: are volumetric ultra-low-dose expiratory CT scans sufficient for monitoring related lung disease? Radiology 253:223–229PubMedCrossRef

12.

Crowley C, Connor OJO, Ciet P et al (2021) The evolving role of radiological imaging in cystic fibrosis. Curr Opin Pulm Med 27:575–585PubMedCrossRef

13.

Zhou W, Bartlett DJ, Diehn FE et al (2019) Reduction of metal artifacts and improvement in dose efficiency using photon-counting detector computed tomography and tin filtration. Invest Radiol 54:204–211PubMedPubMedCentralCrossRef

14.

Rajendran K, Voss BA, Zhou W et al (2020) Dose reduction for sinus and temporal bone imaging using photon-counting detector CT with an additional tin filter. Invest Radiol 55:91–100PubMedPubMedCentralCrossRef

15.

Baffour FI, Rajendran K, Glazebrook KN et al (2022) Ultra-high-resolution imaging of the shoulder and pelvis using photon-counting-detector CT: a feasibility study in patients. Eur Radiol 32:7079–7086PubMedCrossRef

16.

Benson JC, Rajendran K, Lane JI et al (2022) A new frontier in temporal bone imaging: photon-counting detector CT demonstrates superior visualization of critical anatomic structures at reduced radiation dose. AJNR Am J Neuroradiol 43:579–584PubMedPubMedCentralCrossRef

17.

Grunz JP, Heidenreich JF, Lennartz S et al (2022) Spectral shaping via tin prefiltration in ultra-high-resolution photon-counting and energy-integrating detector CT of the temporal bone. Invest Radiol 57:819–825PubMedCrossRef

18.

Leng S, Rajendran K, Gong H et al (2018) 150-mum spatial resolution using photon-counting detector computed tomography technology: technical performance and first patient images. Invest Radiol 53:655–662PubMedPubMedCentralCrossRef

19.

Zhou W, Lane JI, Carlson ML et al (2018) Comparison of a photon-counting-detector CT with an energy-integrating-detector CT for temporal bone imaging: a cadaveric study. AJNR Am J Neuroradiol 39:1733–1738PubMedPubMedCentralCrossRef

20.

Bartlett DJ, Koo CW, Bartholmai BJ et al (2019) High-resolution chest computed tomography imaging of the lungs: impact of 1,024 matrix reconstruction and photon-counting detector computed tomography. Invest Radiol 54:129–137PubMedPubMedCentralCrossRef

21.

Rajendran K, Petersilka M, Henning A et al (2022) First clinical photon-counting detector CT system: technical evaluation. Radiology 303:130–138PubMedCrossRef

22.

Rajendran K, Petersilka M, Henning A et al (2021) Full field-of-view, high-resolution, photon-counting detector CT: technical assessment and initial patient experience. Phys Med Biol 66(20)

23.

Rajendran K, Marsh J, Petersilka M et al (2021) High resolution, full field-of-view, whole body photon-counting detector CT: system assessment and initial experience. Proc SPIE Int Soc Opt Eng 11595:115950DPubMedPubMedCentral

24.

Leng S, Bruesewitz M, Tao S et al (2019) Photon-counting detector CT: system design and clinical applications of an emerging technology. Radiographics 39:729–743PubMedCrossRef

25.

Kawashima H, Ichikawa K, Takata T, Seto I (2022) Comparative assessment of noise properties for two deep learning CT image reconstruction techniques and filtered back projection. Med Phys 49:6359–6367PubMedCrossRef

26.

Flohr T, Petersilka M, Henning A et al (2020) Photon-counting CT review. Phys Med 79:126–136PubMedCrossRef

27.

Gutjahr R, Halaweish AF, Yu Z et al (2016) Human imaging with photon counting-based computed tomography at clinical dose levels: contrast-to-noise ratio and cadaver studies. Invest Radiol 51:421–429PubMedPubMedCentralCrossRef

28.

Symons R, Pourmorteza A, Sandfort V et al (2017) Feasibility of dose-reduced chest CT with photon-counting detectors: initial results in humans. Radiology 285:980–989PubMedCrossRef

29.

Jungblut L, Euler A, von Spiczak J et al (2022) Potential of photon-counting detector CT for radiation dose reduction for the assessment of interstitial lung disease in patients with systemic sclerosis. Invest Radiol 57:773–779PubMedPubMedCentralCrossRef

30.

Graafen D, Emrich T, Halfmann MC et al (2022) Dose reduction and image quality in photon-counting detector high-resolution computed tomography of the chest: routine clinical data. J Thorac Imaging 37:315–322PubMedCrossRef

31.

Brody AS, Kosorok MR, Li Z et al (2006) Reproducibility of a scoring system for computed tomography scanning in cystic fibrosis. J Thorac Imaging 21:14–21PubMedCrossRef

32.

Goralski JL, Stewart NJ, Woods JC (2021) Novel imaging techniques for cystic fibrosis lung disease. Pediatr Pulmonol 56:S40–S54PubMedPubMedCentralCrossRef

33.

Zorzo C, Caballero P, Diab L et al (2020) Predictive value of computed tomography scoring systems evolution in adults with cystic fibrosis. Eur Radiol 30:3634–3640PubMedCrossRef

34.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRef

35.

Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163PubMedPubMedCentralCrossRef

36.

Boone J, Strauss K, Cody D et al (2011) Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. Report of AAPM Task Group 204. American Association of Physicists in Medicine, College Park

37.

McCollough C, Bakalyar DM, Bostani M et al (2014) Use of water equivalent diameter for calculating patient size and size-specific dose estimates (SSDE) in CT: the report of AAPM Task Group 220. AAPM Rep 2014:6–23

38.

Romanyukha A, Folio L, Lamart S et al (2016) Body size-specific effective dose conversion coefficients for CT scans. Radiat Prot Dosimetry 172:428–437PubMedCrossRef

39.

Wall BF, Kendall GM, Edwards AA et al (2006) What are the risks from medical X-rays and other low dose radiation? Br J Radiol 79:285–294PubMedCrossRef

40.

McCollough C, Cody D, Edyvean S et al (2008) The measurement, reporting, and management of radiation dose in CT. Report of AAPM Task Group 23. American Association of Physicists in Medicine, College Park

41.

Lahham A, Issa A (2021) Evaluation of radiation doses in pediatric patients undergoing conventional chest X-ray examination. Health Phys 120:212–216PubMedCrossRef

42.

Shatskiy IG, Ivanov D, Reznik VA et al (2021) Doses and radiation risk of the chest X-ray examination of children with COVID-19. American Institute of Physics, St. PetersburgCrossRef

43.

American College of Radiology (2022) Radiation dose to adults from common imaging examinations. RadiologyInfo.org. https://www.acr.org/-/media/ACR/Files/Radiology-Safety/Radiation-Safety/Dose-Reference-Card.pdf. Accessed 5 Dec 2022

44.

Kuo W, Ciet P, Tiddens HA et al (2014) Monitoring cystic fibrosis lung disease by computed tomography. Radiation risk in perspective. Am J Respir Crit Care Med 189:1328–1336PubMedCrossRef

45.

Guo J, Garratt A, Hill A (2022) Worldwide rates of diagnosis and effective treatment for cystic fibrosis. J Cyst Fibros 21:456–462PubMedCrossRef

46.

Knapp EA, Fink AK, Goss CH et al (2016) The Cystic Fibrosis Foundation patient registry. Design and methods of a national observational disease registry. Ann Am Thorac Soc 13:1173–1179PubMedCrossRef

47.

Lahiri T, Hempstead SE, Brady C et al (2016) Clinical practice guidelines from the Cystic Fibrosis Foundation for preschoolers with cystic fibrosis. Pediatrics 137:e20151784PubMedCrossRef

48.

Foundation CF, Borowitz D, Robinson KA et al (2009) Cystic Fibrosis Foundation evidence-based guidelines for management of infants with cystic fibrosis. J Pediatr 155:S73–S93CrossRef

49.

Ciet P, Bertolo S, Ros M et al (2022) State-of-the-art review of lung imaging in cystic fibrosis with recommendations for pulmonologists and radiologists from the “Imaging Management of Cystic Fibrosis” (MAESTRO) consortium. Eur Respir Rev 31:21073CrossRef

50.

Ernst CW, Basten IA, Ilsen B et al (2014) Pulmonary disease in cystic fibrosis: assessment with chest CT at chest radiography dose levels. Radiol 273:597–605CrossRef

51.

Moloney F, Kavanagh RG, Ronan NJ et al (2021) Ultra-low-dose thoracic CT with model-based iterative reconstruction (MBIR) in cystic fibrosis patients undergoing treatment with cystic fibrosis transmembrane conductance regulators (CFTR). Clin Radiol 76:393.e9–393.e17PubMedCrossRef

52.

de Jong PA, Tiddens HA (2007) Cystic fibrosis specific computed tomography scoring. Proc Am Thorac Soc 4:338–342PubMedCrossRef

53.

de Jong PA, Nakano Y, Lequin MH, Tiddens HA (2006) Dose reduction for CT in children with cystic fibrosis: is it feasible to reduce the number of images per scan? Pediatr Radiol 36:50–53PubMedCrossRef

54.

Jimenez S, Jimenez JR, Crespo M et al (2006) Computed tomography in children with cystic fibrosis: a new way to reduce radiation dose. Arch Dis Child 91:388–390PubMedPubMedCentralCrossRef

Titel: Pilot study to determine whether reduced-dose photon-counting detector chest computed tomography can reliably display Brody II score imaging findings for children with cystic fibrosis at radiation doses that approximate radiographs
verfasst von: Kelly K. Horst
Nathan C. Hull
Paul G. Thacker
Nadir Demirel
Lifeng Yu
Jennifer S. McDonald
Nicholas B. Larson
Cynthia H. McCollough
Joel G. Fletcher
Publikationsdatum: 04.01.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Radiology / Ausgabe 6/2023
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-022-05574-6

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Pilot study to determine whether reduced-dose photon-counting detector chest computed tomography can reliably display Brody II score imaging findings for children with cystic fibrosis at radiation doses that approximate radiographs