title: Computer-aided detection (CAD) of solid pulmonary nodules in chest x-ray equivalent ultralow dose chest CT - first in-vivo results at dose levels of 0.13mSv.
abstract: OBJECTIVE
  To determine the value of computer-aided detection (CAD) for solid pulmonary nodules in ultralow radiation dose single-energy computed tomography (CT) of the chest using third-generation dual-source CT at 100kV and fixed tube current at 70 mAs with tin filtration.
  
  
  METHODS
  202 consecutive patients undergoing clinically indicated standard dose chest CT (1.8±0.7 mSv) were prospectively included and scanned with an additional ultralow dose CT (0.13±0.01 mSv) in the same session. Standard of reference (SOR) was established by consensus reading of standard dose CT by two radiologists. CAD was performed in standard dose and ultralow dose CT with two different reconstruction kernels. CAD detection rate of nodules was evaluated including subgroups of different nodule sizes (<5, 5-7, >7mm). Sensitivity was further analysed in multivariable mixed effects logistic regression.
  
  
  RESULTS
  The SOR included 279 solid nodules (mean diameter 4.3±3.4mm, range 1-24mm). There was no significant difference in per-nodule sensitivity of CAD in standard dose with 70% compared to 68% in ultralow dose CT both overall and in different size subgroups (all p>0.05). CAD led to a significant increase of sensitivity for both radiologists reading the ultralow dose CT scans (all p<0.001). In multivariable analysis, the use of CAD (p<0.001), and nodule size (p<0.0001) were independent predictors for nodule detection, but not BMI (p=0.933) and the use of contrast agents (p=0.176).
  
  
  CONCLUSIONS
  Computer-aided detection of solid pulmonary nodules using ultralow dose CT with chest X-ray equivalent radiation dose has similar sensitivities to those from standard dose CT. Adding CAD in ultralow dose CT significantly improves the sensitivity of radiologists.
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland. Electronic address: Michael.Messerli@usz.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Messerli
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kluckert
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: Meinhard
authors.initials: M
authors.lastname: Knitel
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Rengier
authors.affiliation: Department of Surgery, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Warschkow
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Switzerland.
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Wildermuth
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Bauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods* / Q000592:standards; D012015:Reference Standards; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Computed tomography; Iterative reconstruction; Pulmonary nodule; Radiation dosage; Tin filtration