Ultra-low dose chest computed tomography: Effect of iterative reconstruction levels on image quality

Purpose: To optimize image quality and radiation dose of chest CT with respect to various iterative reconstruction levels, detector collimations and body sizes. Method: A Kyoto Kagaku Lungman with and without extensions was scanned using fixed ultra-low doses of 0.25, 0.49 and 0.74 mGy CTDIvol, and collimations of 40 and 80 mm. Images were reconstructed with the lung kernel, filtered back projection (FBP) and different ASIR-V levels (10-100%). Contrast-to-noise ratios (CNR) were calculated for 12 mm simulated lesions of different densities in the lung. Image noise, signal-to-noise ratios (SNR), variations in Hounsfield units (HU), noise power spectrum (NPS) and noise texture deviations (NTD) were evaluated for all reconstructions. NTD was calculated as percentage of pixels outside 3 standard deviations to evaluate IR-specific artefacts. Results: Compared to the FBP, image noise reduced (5-55%) with ASIR-V levels irrespective of dose or collimation. SNR correlated positively (r >= 0.925, p <= 0.001) with ASIR-V levels at all doses, collimations, and phantom sizes. ASIR-V enhanced the CNR of the lesion with the lowest contrast from 12.7-42.1 (0-100% ASIRV) at 0.74 mGy with 40 mm collimation. As expected, higher SNR and CNR were measured in the smaller phantom than the bigger phantom. Uniform HU were observed between FBP and ASIR-V levels at all doses, collimations, and phantom sizes. NPS curves left-shifted towards lower frequencies at increasing levels of ASIR-V irrespective of collimation. A positive correlation (r >= 0.946, p >= 0.001) was observed between NTD and ASIR-V levels. NTD of the FBP was not significantly (p <= 0.087) different from NTD of ASIR-V <= 20%. The data from the NPS and NTD indicates a blotchier and coarser noise texture at higher levels of ASIR-V, especially at 100% ASIR-V. Conclusion: In comparison with the FBP technique, ASIR-V enhanced quantitative image quality parameters at all ultra-low doses tested. Moreover, the use of ASIR-V showed consistency with body size and collimation. Hence, ASIR-V may be useful for improving image quality of chest CT at ultra-low doses.