Optimization of Radiation Dose and Image Quality in Musculoskeletal CT: Emphasis on Iterative Reconstruction Techniques (Part 1)

Abstract

Computed tomography (CT) is a modality of choice for the study of the musculoskeletal system for various indications including the study of bone, calcifications, internal derangements of joints (with CT arthrography), as well as periprosthetic complications. However, CT remains intrinsically limited by the fact that it exposes patients to ionizing radiation. Scanning protocols need to be optimized to achieve diagnostic image quality at the lowest radiation dose possible. In this optimization process, the radiologist needs to be familiar with the parameters used to quantify radiation dose and image quality. CT imaging of the musculoskeletal system has certain specificities including the focus on high-contrast objects (i.e., in CT of bone or CT arthrography). These characteristics need to be taken into account when defining a strategy to optimize dose and when choosing the best combination of scanning parameters. In the first part of this review, we present the parameters used for the evaluation and quantification of radiation dose and image quality. In the second part, we discuss different strategies to optimize radiation dose and image quality at CT, with a focus on the musculoskeletal system and the use of novel iterative reconstruction techniques.

Keywords

computed tomography - image quality - radiation dose - iterative reconstruction techniques - musculoskeletal imaging

^* F. Becce and F.R. Verdun contributed equally to this work.

• References

• 1 Roth TD, Buckwalter KA, Choplin RH. Musculoskeletal computed tomography: current technology and clinical applications. Semin Roentgenol 2013; 48 (2) 126-139
• 2 Larbi A, Viala P, Omoumi P , et al. Cartilaginous tumours and calcified lesions of the hand: a pictorial review. Diagn Interv Imaging 2013; 94 (4) 395-409
• 3 Lepage-Saucier M, Thiéry C, Larbi A, Lecouvet FE, Vande Berg BC, Omoumi P. Femoroacetabular impingement: normal values of the quantitative morphometric parameters in asymptomatic hips. Eur Radiol 2014; 24 (7) 1707-1714
• 4 Rydberg J, Buckwalter KA, Caldemeyer KS , et al. Multisection CT: scanning techniques and clinical applications. Radiographics 2000; 20 (6) 1787-1806
• 5 Omoumi P, Bae WC, Du J , et al. Meniscal calcifications: morphologic and quantitative evaluation by using 2D inversion-recovery ultrashort echo time and 3D ultrashort echo time 3.0-T MR imaging techniques—feasibility study. Radiology 2012; 264 (1) 260-268
• 6 Freire V, Becce F, Feydy A , et al. MDCT imaging of calcinosis in systemic sclerosis. Clin Radiol 2013; 68 (3) 302-309
• 7 Omoumi P, Vande Berg B, Simoni P, Lecouvet F. Value of CT arthrography in the assessment of cartilage pathology. In: Link TM, ed. Cartilage Imaging: Significance, Techniques, and New Developments. New York, NY: Springer; 2011: 37-49
• 8 Omoumi P, Rubini A, Dubuc JE, Vande Berg BC, Lecouvet FE. Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation. Eur Radiol 2015; 25 (4) 961-969
• 9 Omoumi P, Mercier GA, Lecouvet F, Simoni P, Vande Berg BC. CT arthrography, MR arthrography, PET, and scintigraphy in osteoarthritis. Radiol Clin North Am 2009; 47 (4) 595-615
• 10 Omoumi P, Michoux N, Roemer FW, Thienpont E, Vande Berg BC. Cartilage thickness at the posterior medial femoral condyle is increased in femorotibial knee osteoarthritis: a cross-sectional CT arthrography study (Part 2). Osteoarthritis Cartilage 2015; 23 (2) 224-231
• 11 Omoumi P, Michoux N, Thienpont E, Roemer FW, Vande Berg BC. Anatomical distribution of areas of preserved cartilage in advanced femorotibial osteoarthritis using CT arthrography (Part 1). Osteoarthritis Cartilage 2015; 23 (1) 83-87
• 12 Omoumi P, Bafort AC, Dubuc JE, Malghem J, Vande Berg BC, Lecouvet FE. Evaluation of rotator cuff tendon tears: comparison of multidetector CT arthrography and 1.5-T MR arthrography. Radiology 2012; 264 (3) 812-822
• 13 Omoumi P, de Gheldere A, Leemrijse T , et al. Value of computed tomography arthrography with delayed acquisitions in the work-up of ganglion cysts of the tarsal tunnel: report of three cases. Skeletal Radiol 2010; 39 (4) 381-386
• 14 McCollough CH, Primak AN, Braun N, Kofler J, Yu L, Christner J. Strategies for reducing radiation dose in CT. Radiol Clin North Am 2009; 47 (1) 27-40
• 15 Prabhu V, Rosenkrantz AB. Imbalance of opinions expressed on Twitter relating to CT radiation risk: an opportunity for increased radiologist representation. AJR Am J Roentgenol 2015; 204 (1) W48-W51
• 16 Brody AS, Guillerman RP. Don't let radiation scare trump patient care: 10 ways you can harm your patients by fear of radiation-induced cancer from diagnostic imaging. Thorax 2014; 69 (8) 782-784
• 17 Doss M. COUNTERPOINT: should radiation dose from CT scans be a factor in patient care? No. Chest 2015; 147 (4) 874-877
• 18 McCunney RJ. POINT: should radiation dose from CT scans be a factor in patient care? Yes. Chest 2015; 147 (4) 872-874
• 19 Omoumi P, Verdun F, Becce F. Optimization of radiation dose and image quality in musculoskeletal CT: emphasis on iterative reconstruction techniques (part 2). Semin Musculoskelet Radiol 2015; 19 (5) 422-430
• 20 McCollough CH, Leng S, Yu L, Cody DD, Boone JM, McNitt-Gray MF. CT dose index and patient dose: they are not the same thing. Radiology 2011; 259 (2) 311-316
• 21 American Association of Physicists in Medicine. Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations: report of AAPM Task Group 204 . Available at: https://www.aapm.org/pubs/reports/RPT_204.pdf . Accessed December 11, 2015
• 22 Saltybaeva N, Jafari ME, Hupfer M, Kalender WA. Estimates of effective dose for CT scans of the lower extremities. Radiology 2014; 273 (1) 153-159
• 23 Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am 2009; 91 (8) 1882-1889
• 24 Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A. CT dose optimisation and reduction in osteoarticular disease. Diagn Interv Imaging 2013; 94 (4) 371-388
• 25 Deak PD, Smal Y, Kalender WA. Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 2010; 257 (1) 158-166
• 26 Bongartz G, Golding SJ, Jurik AG , et al. European Guidelines for Multislice Computed Tomography. Luxembourg: European Commission; 2004
• 27 Omoumi P, Verdun FR, Ben Salah Y , et al. Low-dose multidetector computed tomography of the cervical spine: optimization of iterative reconstruction strength levels. Acta Radiol 2014; 55 (3) 335-344
• 28 Becce F, Ben Salah Y, Verdun FR , et al. Computed tomography of the cervical spine: comparison of image quality between a standard-dose and a low-dose protocol using filtered back-projection and iterative reconstruction. Skeletal Radiol 2013; 42 (7) 937-945
• 29 Tobalem F, Dugert E, Verdun FR , et al. MDCT arthrography of the hip: value of the adaptive statistical iterative reconstruction technique and potential for radiation dose reduction. AJR Am J Roentgenol 2014; 203 (6) W665-W73
• 30 Christianson O, Chen JJS, Yang Z , et al. An improved index of image quality for task-based performance of CT iterative reconstruction across three commercial implementations. Radiology 2015; 275 (3) 725-734
• 31 Schindera ST, Odedra D, Raza SA , et al. Iterative reconstruction algorithm for CT: can radiation dose be decreased while low-contrast detectability is preserved?. Radiology 2013; 269 (2) 511-518
• 32 Ott JG, Becce F, Monnin P, Schmidt S, Bochud FO, Verdun FR. Update on the non-prewhitening model observer in computed tomography for the assessment of the adaptive statistical and model-based iterative reconstruction algorithms. Phys Med Biol 2014; 59 (15) 4047-4064