Ultra-low radiation dose CT angiography of the lower extremity using the iterative model reconstruction (IMR) algorithm

AIM: To investigate the image quality of lower-extremity computed tomography (CT) angiography (CTA) with ultra-low radiation dose using the iterative model reconstruction (IMR) algorithm. MATERIALS AND METHODS: Lower-extremity CTA was acquired using a 256-multidetector CT system from 90 patients assigned into three groups: (1) the routine dose (RD) group: 120 kVp, automatic tube current modulation (ACTM) with an image quality index of 12, and filtered back projection (FBP); (2) the low-dose (LD) group: 80 kVp, ACTM with an image quality index of 1, and IMR; and (3) the ultra-low dose (ULD) group: 80 kVp, 20 mAs, and IMR. CT attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the lower-extremity arteries were calculated. Subjective image quality of lower-extremity segments was assessed. Effective radiation dose was recorded. RESULTS: The radiation dose was reduced by 91.4% and 67.3% in the ULD group (0.15 +/- 0.02 mSv) compared to the RD group (1.86 +/- 0.51 mSv) and the LD group (0.49 +/- 0.08 mSv; both p<0.05). Higher CT attenuation, SNR, CNR, and lower image noise were obtained in the ULD group and the LD group compared to the RD group (all p<0.05). Better subjective image quality in lower leg segments was obtained in the ULD group and the LD group compared to the RD group (all p<0.05). No difference was found between the ULD and LD groups in both objective and subjective image quality (all p>0.05). CONCLUSION: By using IMR during lower-extremity CTA, the radiation dose is reduced by up to 91.4% without compromising image quality. (C) 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.