title: Computational and human observer image quality evaluation of low dose, knowledge-based CT iterative reconstruction.
abstract: OBJECTIVE
  Aims in this study are to (1) develop a computational model observer which reliably tracks the detectability of human observers in low dose computed tomography (CT) images reconstructed with knowledge-based iterative reconstruction (IMR™, Philips Healthcare) and filtered back projection (FBP) across a range of independent variables, (2) use the model to evaluate detectability trends across reconstructions and make predictions of human observer detectability, and (3) perform human observer studies based on model predictions to demonstrate applications of the model in CT imaging.
  
  
  METHODS
  Detectability (d') was evaluated in phantom studies across a range of conditions. Images were generated using a numerical CT simulator. Trained observers performed 4-alternative forced choice (4-AFC) experiments across dose (1.3, 2.7, 4.0 mGy), pin size (4, 6, 8 mm), contrast (0.3%, 0.5%, 1.0%), and reconstruction (FBP, IMR), at fixed display window. A five-channel Laguerre-Gauss channelized Hotelling observer (CHO) was developed with internal noise added to the decision variable and/or to channel outputs, creating six different internal noise models. Semianalytic internal noise computation was tested against Monte Carlo and used to accelerate internal noise parameter optimization. Model parameters were estimated from all experiments at once using maximum likelihood on the probability correct, PC. Akaike information criterion (AIC) was used to compare models of different orders. The best model was selected according to AIC and used to predict detectability in blended FBP-IMR images, analyze trends in IMR detectability improvements, and predict dose savings with IMR. Predicted dose savings were compared against 4-AFC study results using physical CT phantom images.
  
  
  RESULTS
  Detection in IMR was greater than FBP in all tested conditions. The CHO with internal noise proportional to channel output standard deviations, Model-k4, showed the best trade-off between fit and model complexity according to AICc. With parameters fixed, the model reasonably predicted detectability of human observers in blended FBP-IMR images. Semianalytic internal noise computation gave results equivalent to Monte Carlo, greatly speeding parameter estimation. Using Model-k4, the authors found an average detectability improvement of 2.7 ± 0.4 times that of FBP. IMR showed greater improvements in detectability with larger signals and relatively consistent improvements across signal contrast and x-ray dose. In the phantom tested, Model-k4 predicted an 82% dose reduction compared to FBP, verified with physical CT scans at 80% reduced dose.
  
  
  CONCLUSIONS
  IMR improves detectability over FBP and may enable significant dose reductions. A channelized Hotelling observer with internal noise proportional to channel output standard deviation agreed well with human observers across a wide range of variables, even across reconstructions with drastically different image characteristics. Utility of the model observer was demonstrated by predicting the effect of image processing (blending), analyzing detectability improvements with IMR across dose, size, and contrast, and in guiding real CT scan dose reduction experiments. Such a model observer can be applied in optimizing parameters in advanced iterative reconstruction algorithms as well as guiding dose reduction protocols in physical CT experiments.
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106.
authors.forename: Brendan L
authors.initials: BL
authors.lastname: Eck
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106.
authors.forename: Rachid
authors.initials: R
authors.lastname: Fahmi
authors.affiliation: Philips Healthcare, Cleveland, Ohio 44143.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Brown
authors.affiliation: Philips Healthcare, Cleveland, Ohio 44143.
authors.forename: Stanislav
authors.initials: S
authors.lastname: Zabic
authors.affiliation: Philips Healthcare, Cleveland, Ohio 44143.
authors.forename: Nilgoun
authors.initials: N
authors.lastname: Raihani
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106.
authors.forename: Jun
authors.initials: J
authors.lastname: Miao
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106 and Department of Radiology, Case Western Reserve University, Cleveland, Ohio 44106.
authors.forename: David L
authors.initials: DL
authors.lastname: Wilson
mesh_terms: D003198:Computer Simulation; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D000069550:Machine Learning; D015588:Observer Variation; D019047:Phantoms, Imaging; D011786:Quality Control; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed