title: Detection of urinary tract stones at low-radiation-dose CT with z-axis automatic tube current modulation: phantom and clinical studies.
abstract: OBJECTIVE
  To evaluate depiction of urinary tract calculi at computed tomography (CT) with a z-axis modulation technique at various noise indexes to reduce radiation dose and preserve image quality.
  
  
  METHODS
  Sixteen radiopaque kidney stones (2.5-19.2 mm in diameter) were embedded in the collecting systems of two bovine kidneys immersed in a water bath. A kidney phantom was made by placing the kidneys in an elliptical Plexiglas phantom (32 x 20 x 20 cm) filled with physiologic saline. The phantom was scanned at 16-detector row CT with a fixed tube current (300 mA) and z-axis modulation at noise indexes of 14, 20, 25, 35, and 50; remaining imaging parameters were held constant. Two abdominal radiologists reviewed images from most to least noisy. Images were evaluated for presence of stones and size, site, and attenuation value of each stone. Readers also graded conspicuity and margins of each stone on a five-point scale. In addition, follow-up studies of 22 patients (mean age, 46 years; range, 26-57 years; male-female ratio, 14:8) with kidney and ureteral stones who underwent CT with z-axis modulation (noise index, 14 and 20) were evaluated in the same manner. Statistical analysis was performed with the Student t test, Wilcoxon signed rank test, and kappa test of interobserver agreement. Institutional review board approval was obtained, and informed consent was not needed.
  
  
  RESULTS
  In the phantom study, all 16 stones were identified on images obtained with a fixed tube current and z-axis modulation at noise indexes of 14, 20, and 25 (with a reduction in radiation dose of up to 77% compared with that of fixed tube current scanning). Three stones (<5 mm) were not visualized with z-axis modulation at noise indexes of 35 and 50. No significant difference was shown for conspicuity of kidney stones in 22 patients who underwent CT with z-axis modulation (with a 43%-66% reduction in radiation dose) when compared with results of previous fixed tube current studies (P > .05).
  
  
  CONCLUSIONS
  Kidney stones (< or =2.5 mm) can be adequately depicted with the z-axis modulation technique, with a 56%-77% reduction in radiation dose. In patients with urinary tract stones, the technique results in a 43%-66% reduction in radiation dose at noise indexes of 14 and 20 without compromising stone depiction.
authors.affiliation: Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 270-E, 55 Fruit Street, Boston, MA 02114, USA. mannudeep_k_kalra@yahoo.com
authors.forename: Mannudeep K
authors.initials: MK
authors.lastname: Kalra
authors.forename: Michael M
authors.initials: MM
authors.lastname: Maher
authors.forename: Roy V
authors.initials: RV
authors.lastname: D'Souza
authors.forename: Stefania
authors.initials: S
authors.lastname: Rizzo
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.forename: Michael A
authors.initials: MA
authors.lastname: Blake
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saini
mesh_terms: D000328:Adult; D000465:Algorithms; D016477:Artifacts; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007669:Kidney Calculi / Q000000981:diagnostic imaging*; D007682:Kidney Pelvis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011874:Radiometry; D015203:Reproducibility of Results; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods*; D014514:Ureteral Calculi / Q000000981:diagnostic imaging*