Feasibility of radiation dose reduction with iterative reconstruction in abdominopelvic CT for patients with inappropriate arm positioning

Background The arms-down position increases computed tomography (CT) radiation dose. Iterative reconstruction (IR) could enhance image quality without increasing radiation dose in patients with arms-down position. Aim To investigate the feasibility of reduced-dose CT with IR for patients with inappropriate arm positioning Methods Twenty patients who underwent two-phase abdominopelvic CT including standard-dose and reduced-dose CT (performed with 80% of the radiation dose of the standard protocol) with their arms positioned in the abdominal area were included in this study. Reduced-dose CT images were reconstructed using filtered back projection (FBP), hybrid IR, and iterative model reconstruction (IMR). These images were compared with standard-dose CT images reconstructed with FBP. Objective image noise in the liver and subcutaneous fat was measured by standard deviation for the quantitative analysis. Then, two radiologists qualitatively assessed beam hardening artifacts, artificial texture, noise, sharpness, and overall image quality in consensus. Results Reduced-dose CT with all IR levels had lower objective image noise compared to standard-dose CT with FBP reconstruction (P < 0.05). Quantitatively measured beam hardening artifacts were similar in reduced-dose CT with iDose levels 5-6 and fewer with IMR compared to standard-dose CT. In the qualitative analysis, beam hardening artifacts and noise decreased as the IR levels increased. However, artificial texture was significantly aggravated with iDose 5-6 and IMR, and overall image quality significantly worsened with IMR. Conclusions IR algorithms can reduce beam hardening artifacts in a reduced-dose CT setting in patients with arms-down position, and an intermediate level of hybrid IR allows radiologists to obtain the best image quality. Because the retrospective and single-center nature of our study limited the number of patients, multicenter prospective clinical studies are required to validate our results.