title: Effect of altering automatic exposure control settings and quality reference mAs on radiation dose, image quality, and diagnostic efficacy in MDCT enterography of active inflammatory Crohn's disease.
abstract: OBJECTIVE
  The purpose of our study was to determine whether the MDCT enterography dose can be reduced by changing automatic exposure control (AEC) setting and quality reference milliampere-seconds (mAs) without altering subjective image quality or efficacy in active inflammatory Crohn's disease.
  
  
  METHODS
  This is a prospective study of 2,310 MDCT enterography procedures performed using 16- and 64-MDCT in three cohorts (original, intermediate, and final dose levels). For 16-MDCT, the original and intermediate dose level quality reference mAs was 200, and weight-based (1 pound [0.45 kg] = 1 mAs) for the final dose level. For 64-MDCT, the original dose level quality reference mAs was 260; the mAs was 220 for intermediate and weight-based for the final dose level. For the intermediate and final dose levels, AEC was changed from strong to weak increase for obese and weak to strong decrease for slim patients. Demographic data and volume CT dose index (CTDI(vol)) were analyzed. Three readers evaluated the cases for image quality and efficacy differentiating normal from active inflammatory Crohn's disease.
  
  
  RESULTS
  For 16-MDCT, CTDI(vol) decreased from 12.82 to 10.14 mGy and 10.14 to 8.7 mGy between original to intermediate and intermediate to final dose levels. For 64-MDCT, the CTDI(vol) decreased from 15.72 to 11.42 mGy and 11.42 to 9.25 mGy between original to intermediate and intermediate to final dose levels. Images were rated suboptimal or nondiagnostic more often in the intermediate dose level (p < 0.05) but not in the final. There was no reduction in diagnostic efficacy as measured by area under the ROC curve (p > 0.1443 except for one comparison with one reader).
  
  
  CONCLUSIONS
  Substantial dose reduction can be achieved using weight-based quality reference mAs and altering AEC settings without affecting diagnostic efficacy in active inflammatory Crohn's disease of the terminal ileum. However, subjective image quality can be compromised at these dose settings, depending on radiologist preference.
authors.affiliation: Imaging Institute, Cleveland Clinic, OH 44195, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Allen
authors.forename: Mark E
authors.initials: ME
authors.lastname: Baker
authors.forename: David M
authors.initials: DM
authors.lastname: Einstein
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.forename: Brian R
authors.initials: BR
authors.lastname: Herts
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Achkar
authors.forename: William J
authors.initials: WJ
authors.lastname: Davros
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Obuchowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012372:ROC Curve; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide