CT Pulmonary Angiography Using Automatic Tube Current Modulation Combination with Different Noise Index with Iterative Reconstruction Algorithm in Different Body Mass Index: Image Quality and Radiation Dose

Rationale and Objectives: This study aimed to determine the appropriate body mass index (BMI)-dependent noise index (NI) setting in computed tomography pulmonary angiography (CTPA) with automatic tube current modulation with adaptive statistical iterative reconstruction (ASiR). Materials and Methods: A total of 480 patients who had a CTPA were divided into group A (18.5 kg/m(2) <= BMI < 25 kg/m(2)), group B (25 kg/m(2) <= BMI < 30 kg/m(2)), and group C (BMI >= 30 kg/m(2)), according to their BMI values; each group had 160 patients. The three groups were further randomly divided into four subgroups: A1, A2, A3, A4; B1, B2, B3, B4; and Cl, C2, C3, C4, with corresponding NI values of 26, 36, 40, and 46, respectively. All images were restructured with the ASiR algorithm, and the images with the lowest NI (26 Hounsfield units) in each group were used as reference standard. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for the pulmonary artery of each group were calculated. Subjective image quality was evaluated using a five-score method by two independent radiologists. The CT dose index of volume and dose-length product were recorded and were converted to effective dose (ED). SNR and CNR in the group A, B, and C subgroups were compared to repeated measures analysis of variance, and the subjective score, Volumetric CT dose index of volume, dose-length product, and ED were compared to one-way analysis of variance. Results: For groups A and B, the SNR, CNR, and subjective scores of the images in their subgroups showed no statistical differences (P >.05). The ED in subgroups A4 and B4 was significantly lower than that in subgroups Al (by 33.24%) and B1 (by 34.47%) (P <.01). For group C, there was no significant difference in the SNR, CNR, and the subjective image scores between subgroups C3 and Cl (P >.05). The ED in subgroup C3 was significantly lower than the ED in subgroup Cl (by 47.75%) (P <.01) Conclusions: Patient BMI-dependent NI settings that are higher than the recommended value may be used in CTPA with automatic tube current modulation and ASiR to effectively reduce radiation dose while maintaining diagnostic image quality.