Submillisievert Chest CT With Filtered Back Projection and Iterative Reconstruction Techniques

OBJECTIVE. The purpose of this study was to compare submillisievert chest CT images reconstructed with filtered back projection (FBP), SafeCT, adaptive statistical iterative reconstruction (ASIR), and model-based iterative reconstruction (MBIR) with standard of care FBP images. SUBJECTS AND METHODS. Fifty patients (33 men and 17 women; mean age [+/- SD], 62 +/- 10 years) undergoing routine chest CT gave written informed consent for acquisition of an additional submillisievert chest CT series with reduced tube current but identical scanning length as standard of care chest CT. Sinogram data of the submillisievert series were reconstructed with FBP, SafeCT, ASIR, and MBIR and compared with FBP images at standard-dose chest CT (n = 8 x 50 = 400 series). Two thoracic radiologists performed independent comparison for visualization of lesion margin, visibility of small structures, and diagnostic acceptability. Objective noise measurements and noise spectral density were obtained. RESULTS. Of 287 detected lesions, 162 were less than 1-cm noncalcified nodules. Lesion margins were well seen on all submillisievert reconstruction images except MBIR, on which they were poorly visualized. Likewise, only submillisievert MBIR images were suboptimal for visibility of normal structures, such as pulmonary vessels in the outer 2 cm of the lung, interlobular fissures, and subsegmental bronchial walls. MBIR had the lowest image noise compared with other techniques. CONCLUSION. FBP, SafeCT, ASIR, and MBIR can enable optimal lesion evaluation on chest CT acquired at a volume CT dose index of 2 mGy. However, all submillisievert reconstruction techniques were suboptimal for visualization of mediastinal structures. Submillisievert MBIR images were suboptimal for visibility of normal lung structures despite showing lower image noise.