title: Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging.
abstract: OBJECTIVE
  To investigate the detection rate of pulmonary nodules in ultralow-dose CT acquisitions.
  
  
  METHODS
  In this lung phantom study, 232 nodules (115 solid, 117 ground-glass) of different sizes were randomly distributed in a lung phantom in 60 different arrangements. Every arrangement was acquired once with standard radiation dose (100 kVp, 100 references mAs) and once with ultralow radiation dose (80 kVp, 6 mAs). Iterative reconstruction was used with optimized kernels: I30 for ultralow-dose, I70 for standard dose and I50 for CAD. Six radiologists examined the axial 1-mm stack for solid and ground-glass nodules. During a second and third step, three radiologists used maximum intensity projection (MIPs), finally checking with computer-assisted detection (CAD), while the others first used CAD, finally checking with the MIPs.
  
  
  RESULTS
  The detection rate was 95.5 % with standard dose (DLP 126 mGy*cm) and 93.3 % with ultralow-dose (DLP: 9 mGy*cm). The additional use of either MIP reconstructions or CAD software could compensate for this difference. A combination of both MIP reconstructions and CAD software resulted in a maximum detection rate of 97.5 % with ultralow-dose.
  
  
  CONCLUSIONS
  Lung cancer screening with ultralow-dose CT using the same radiation dose as a conventional chest X-ray is feasible.
  
  
  CONCLUSIONS
  • 93.3 % of all lung nodules were detected with ultralow-dose CT. • A sensitivity of 97.5 % is possible with additional image post-processing. • The radiation dose is comparable to a standard radiography in two planes. • Lung cancer screening with ultralow-dose CT is feasible.
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland. adrian.huber@insel.ch.|Department of Polyvalent and Oncological Radiology, University Hospital Pitié-Salpêtrière, Paris, France. adrian.huber@insel.ch.
authors.forename: Adrian
authors.initials: A
authors.lastname: Huber
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Landau
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland.|Department of Radiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Lukas
authors.initials: L
authors.lastname: Ebner
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland.
authors.forename: Yanik
authors.initials: Y
authors.lastname: Bütikofer
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland.
authors.forename: Lars
authors.initials: L
authors.lastname: Leidolt
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Brela
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland.
authors.forename: Michelle
authors.initials: M
authors.lastname: May
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Heverhagen
authors.affiliation: Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Inselspital Bern, CH-3010, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Christe
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D013902:Radiography, Thoracic / Q000379:methods; D011897:Random Allocation; D012680:Sensitivity and Specificity; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Computed tomography; Diagnostic performance with low radiation dosage; Lung adenocarcinoma; Pulmonary nodule detection; Ultralow-dose acquisition
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