title: Characterization of a commercial hybrid iterative and model-based reconstruction algorithm in radiation oncology.
abstract: OBJECTIVE
  Iterative reconstruction (IR) reduces noise, thereby allowing dose reduction in computed tomography (CT) while maintaining comparable image quality to filtered back-projection (FBP). This study sought to characterize image quality metrics, delineation, dosimetric assessment, and other aspects necessary to integrate IR into treatment planning.
  
  
  METHODS
  CT images (Brilliance Big Bore v3.6, Philips Healthcare) were acquired of several phantoms using 120 kVp and 25-800 mAs. IR was applied at levels corresponding to noise reduction of 0.89-0.55 with respect to FBP. Noise power spectrum (NPS) analysis was used to characterize noise magnitude and texture. CT to electron density (CT-ED) curves were generated over all IR levels. Uniformity as well as spatial and low contrast resolution were quantified using a CATPHAN phantom. Task specific modulation transfer functions (MTF task) were developed to characterize spatial frequency across objects of varied contrast. A prospective dose reduction study was conducted for 14 patients undergoing interfraction CT scans for high-dose rate brachytherapy. Three physicians performed image quality assessment using a six-point grading scale between the normal-dose FBP (reference), low-dose FBP, and low-dose IR scans for the following metrics: image noise, detectability of the vaginal cuff/bladder interface, spatial resolution, texture, segmentation confidence, and overall image quality. Contouring differences between FBP and IR were quantified for the bladder and rectum via overlap indices (OI) and Dice similarity coefficients (DSC). Line profile and region of interest analyses quantified noise and boundary changes. For two subjects, the impact of IR on external beam dose calculation was assessed via gamma analysis and changes in digitally reconstructed radiographs (DRRs) were quantified.
  
  
  RESULTS
  NPS showed large reduction in noise magnitude (50%), and a slight spatial frequency shift (∼ 0.1 mm(-1)) with application of IR at L6. No appreciable changes were observed for CT-ED curves between FBP and IR levels [maximum difference ∼ 13 HU for bone (∼ 1% difference)]. For uniformity, differences were ∼ 1 HU between FBP and IR. Spatial resolution was well conserved; the largest MTFtask decrease between FBP and IR levels was 0.08 A.U. No notable changes in low-contrast detectability were observed and CNR increased substantially with IR. For the patient study, qualitative image grading showed low-dose IR was equivalent to or slightly worse than normal dose FBP, and is superior to low-dose FBP (p < 0.001 for noise), although these did not translate to differences in CT number, contouring ability, or dose calculation. The largest CT number discrepancy from FBP occurred at a bone/tissue interface using the most aggressive IR level [-1.2 ± 4.9 HU (range: -17.6-12.5 HU)]. No clinically significant contour differences were found between IR and FBP, with OIs and DSCs ranging from 0.85 to 0.95. Negligible changes in dose calculation were observed. DRRs preserved anatomical detail with <2% difference in intensity from FBP combined with aggressive IRL6.
  
  
  CONCLUSIONS
  These results support integrating IR into treatment planning. While slight degradation in edges and shift in texture were observed in phantom, patient results show qualitative image grading, contouring ability, and dosimetric parameters were not adversely affected.
authors.affiliation: Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan 48202 and Wayne State University School of Medicine, Detroit, Michigan 48201.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Price
authors.affiliation: Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan 48202.
authors.forename: Sean
authors.initials: S
authors.lastname: Vance
authors.affiliation: Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan 48202.
authors.forename: Richard
authors.initials: R
authors.lastname: Cattaneo
authors.affiliation: Department of Public Health Sciences, Henry Ford Health Systems, Detroit, Michigan 48202.
authors.forename: Lonni
authors.initials: L
authors.lastname: Schultz
authors.affiliation: Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan 48202.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
authors.affiliation: Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan 48202.
authors.forename: Indrin J
authors.initials: IJ
authors.lastname: Chetty
authors.affiliation: Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan 48202.
authors.forename: Carri K
authors.initials: CK
authors.lastname: Glide-Hurst
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016477:Artifacts; D001918:Brachytherapy / Q000379:methods; D004583:Electrons; D005260:Female; D006801:Humans; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D019047:Phantoms, Imaging; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D011874:Radiometry; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult