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Ultralow dose CT for pulmonary nodule detection with chest x-ray equivalent dose - a prospective intra-individual comparative study


Messerli, Michael; Kluckert, Thomas; Knitel, Meinhard; Wälti, Stephan; Desbiolles, Lotus; Rengier, Fabian; Warschkow, René; Bauer, Ralf W; Alkadhi, Hatem; Leschka, Sebastian; Wildermuth, Simon (2017). Ultralow dose CT for pulmonary nodule detection with chest x-ray equivalent dose - a prospective intra-individual comparative study. European Radiology, 27(8):3290-3299.

Abstract

PURPOSE To prospectively evaluate the accuracy of ultralow radiation dose CT of the chest with tin filtration at 100 kV for pulmonary nodule detection. MATERIALS AND METHODS 202 consecutive patients undergoing clinically indicated chest CT (standard dose, 1.8 ± 0.7 mSv) were prospectively included and additionally scanned with an ultralow dose protocol (0.13 ± 0.01 mSv). Standard dose CT was read in consensus by two board-certified radiologists to determine the presence of lung nodules and served as standard of reference (SOR). Two radiologists assessed the presence of lung nodules and their locations on ultralow dose CT. Sensitivity and specificity of the ultralow dose protocol was compared against the SOR, including subgroup analyses of different nodule sizes and types. A mixed effects logistic regression was used to test for independent predictors for sensitivity of pulmonary nodule detection. RESULTS 425 nodules (mean diameter 3.7 ± 2.9 mm) were found on SOR. Overall sensitivity for nodule detection by ultralow dose CT was 91%. In multivariate analysis, nodule type, size and patients BMI were independent predictors for sensitivity (p < 0.001). CONCLUSIONS Ultralow dose chest CT at 100 kV with spectral shaping enables a high sensitivity for the detection of pulmonary nodules at exposure levels comparable to plain film chest X-ray. KEYPOINTS • 91% of all lung nodules were detected with ultralow dose CT • Sensitivity for subsolid nodule detection is lower in ultralow dose CT (77.5%) • The mean effective radiation dose in 202 patients was 0.13 mSv • Ultralow dose CT seems to be feasible for lung cancer screening.

Abstract

PURPOSE To prospectively evaluate the accuracy of ultralow radiation dose CT of the chest with tin filtration at 100 kV for pulmonary nodule detection. MATERIALS AND METHODS 202 consecutive patients undergoing clinically indicated chest CT (standard dose, 1.8 ± 0.7 mSv) were prospectively included and additionally scanned with an ultralow dose protocol (0.13 ± 0.01 mSv). Standard dose CT was read in consensus by two board-certified radiologists to determine the presence of lung nodules and served as standard of reference (SOR). Two radiologists assessed the presence of lung nodules and their locations on ultralow dose CT. Sensitivity and specificity of the ultralow dose protocol was compared against the SOR, including subgroup analyses of different nodule sizes and types. A mixed effects logistic regression was used to test for independent predictors for sensitivity of pulmonary nodule detection. RESULTS 425 nodules (mean diameter 3.7 ± 2.9 mm) were found on SOR. Overall sensitivity for nodule detection by ultralow dose CT was 91%. In multivariate analysis, nodule type, size and patients BMI were independent predictors for sensitivity (p < 0.001). CONCLUSIONS Ultralow dose chest CT at 100 kV with spectral shaping enables a high sensitivity for the detection of pulmonary nodules at exposure levels comparable to plain film chest X-ray. KEYPOINTS • 91% of all lung nodules were detected with ultralow dose CT • Sensitivity for subsolid nodule detection is lower in ultralow dose CT (77.5%) • The mean effective radiation dose in 202 patients was 0.13 mSv • Ultralow dose CT seems to be feasible for lung cancer screening.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:16 January 2017
Deposited On:20 Jan 2017 08:07
Last Modified:30 Jun 2017 01:01
Publisher:Springer
ISSN:0938-7994
Publisher DOI:https://doi.org/10.1007/s00330-017-4739-6
PubMed ID:28093625

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