Learning effects in visual grading assessment of model-based reconstruction algorithms in abdominal Computed Tomography

Objectives: Images reconstructed with higher strengths of iterative reconstruction algorithms may impair radi-ologists' subjective perception and diagnostic performance due to changes in the amplitude of different spatial frequencies of noise. The aim of the present study was to ascertain if radiologists can learn to adapt to the unusual appearance of images produced by higher strengths of Advanced modeled iterative reconstruction al-gorithm (ADMIRE). Methods: Two previously published studies evaluated the performance of ADMIRE in non-contrast and contrast -enhanced abdominal CT. Images from 25 (first material) and 50 (second material) patients, were reconstructed with ADMIRE strengths 3, 5 (AD3, AD5) and filtered back projection (FBP). Radiologists assessed the images using image criteria from the European guidelines for quality criteria in CT. To ascertain if there was a learning effect, new analyses of data from the two studies was performed by introducing a time variable in the mixed -effects ordinal logistic regression model. Results: In both materials, a significant negative attitude to ADMIRE 5 at the beginning of the viewing was strengthened during the progress of the reviews for both liver parenchyma (first material:-0.70, p < 0.01, second material:-0.96, p < 0.001) and overall image quality (first material:-0.59, p < 0.05, second materi-al::-1.26, p < 0.001). For ADMIRE 3, an early positive attitude for the algorithm was noted, with no significant change over time for all criteria except one (overall image quality), where a significant negative trend over time (-1.08, p < 0.001) was seen in the second material.Conclusions: With progression of reviews in both materials, an increasing dislike for ADMIRE 5 images was apparent for two image criteria. In this time perspective (weeks or months), no learning effect towards accepting the algorithm could be demonstrated.