CT colonography at different radiation dose levels: feasibility of dose reduction.
OBJECTIVE
To investigate the sensitivity and specificity of polyp detection and the image quality of computed tomographic (CT) colonography at different radiation dose levels and to study effective doses reported in literature on CT colonography.


METHODS
CT colonography and colonoscopy were performed with 100 mAs in 50 consecutive patients at high risk for colorectal cancer; 50- and 30-mAs CT colonographic examinations were simulated with controlled addition of noise to raw transmission measurements. One radiologist randomly evaluated all original and simulated images for the presence of polyps and scored image quality. Differences in image quality were assessed with the Wilcoxon rank test. Scan protocols from the literature and recent (unpublished) updates were collected.


RESULTS
In nine of 10 patients with polyps 5 mm in diameter or larger (sensitivity, 90%) and in seven of 17 patients with polyps smaller than 5 mm, polyps were correctly identified with CT colonography at all dose levels. Specificity for patients without polyps 5 mm or larger was 53%-60% at all dose levels and for patients without any polyps was 26% (at 100 and 50 mAs) and 48% (at 30 mAs). Image quality decreased significantly as the dose level decreased. The median effective doses (supine and prone positions) calculated from protocols reported in the literature and updates were 7.8 and 8.8 mSv, respectively.


CONCLUSIONS
Although image quality decreases significantly at 30 mAs (3.6 mSv), polyp detection remains unimpaired. The median dose for CT colonography at institutions that perform CT colonographic research is currently 8.8 mSv.
van Gelder
Rogier E
RE
Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. r.e.vangelder@amc.uva.nl
Venema
Henk W
HW
Serlie
Iwo W O
IW
Nio
C Yung
CY
Determann
Rogier M
RM
Tipker
Corinne A
CA
Vos
Frans M
FM
Glas
Afina S
AS
Bartelsman
Joep F W
JF
Bossuyt
Patrick M M
PM
Laméris
Johan S
JS
Stoker
Jaap
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003113:Colonoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging*; D007417:Intestinal Polyps / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D012680:Sensitivity and Specificity