The Use of Model-based Iterative Reconstruction to Optimize Chest CT Examinations for Diagnosing Lung Metastases in Patients with Sarcoma: A Phantom Study

Rationale and Objectives: This phantom study aimed to evaluate low-dose (LD) chest computed tomography (CT) protocols using model-based iterative reconstruction (MBIR) for diagnosing lung metastases in patients with sarcoma. Materials and Methods: An adult female anthropomorphic phantom was scanned with a 64-slice CT using four LD protocols and a standard-dose protocol. Absorbed organ doses were measured with 10 metal-oxide-semiconductor field-effect transistor dosimeters. Furthermore, Monte Carlo simulations were performed to estimate organ and effective doses. Image quality in terms of image noise, contrast, and resolution was measured from the CT images reconstructed with conventional filtered back projection, adaptive statistical iterative reconstruction, and MBIR algorithms. All the results were compared to the performance of the standard-dose protocol. Results: Mean absorbed organ and effective doses were reduced by approximately 95% with the LD protocol (100-kVp tube voltage and a fixed 10-mA tube current) compared to the standard-dose protocol (120-kVp tube voltage and tube current modulation) while yielding an acceptable image quality for diagnosing round-shaped lung metastases. The effective doses ranged from 0.16 to 2.83 mSv in the studied protocols. The image noise, contrast, and resolution were maintained or improved when comparing the image quality of LD protocols using MBIR to the performance of the standard-dose chest CT protocol using filtered back projection. The small round-shaped lung metastases were delineated at levels comparable to the used protocols. Conclusions: Radiation exposure in patients can be reduced significantly by using LD chest CT protocols and MBIR algorithm while maintaining image quality for detecting round-shaped lung metastases.