title: CT colonography at different radiation dose levels: feasibility of dose reduction.
abstract: 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 Scan protocols from the literature and recent (unpublished) updates were collected.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.
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. r.e.vangelder@amc.uva.nl
authors.forename: Rogier E
authors.initials: RE
authors.lastname: van Gelder
authors.forename: Henk W
authors.initials: HW
authors.lastname: Venema
authors.forename: Iwo W O
authors.initials: IW
authors.lastname: Serlie
authors.forename: C Yung
authors.initials: CY
authors.lastname: Nio
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Determann
authors.forename: Corinne A
authors.initials: CA
authors.lastname: Tipker
authors.forename: Frans M
authors.initials: FM
authors.lastname: Vos
authors.forename: Afina S
authors.initials: AS
authors.lastname: Glas
authors.forename: Joep F W
authors.initials: JF
authors.lastname: Bartelsman
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Johan S
authors.initials: JS
authors.lastname: Laméris
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
mesh_terms: 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