Ultra-low dose chest CT with denoising for lung nodule detection

Ariel Kerpel*, Edith Michelle Marom, Michael Green, Michal Eifer, Eli Konen, Arnaldo Mayer, Sonia L. Betancourt Cuellar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Medical imaging and the resultant ionizing radiation exposure is a public concern due to the possible risk of cancer induction. Objectives: To assess the accuracy of ultra-low-dose (ULD) chest computed tomography (CT) with denoising versus normal dose (ND) chest CT using the Lung CT Screening Reporting and Data System (Lung-RADS). Methods: This prospective single-arm study comprised 52 patients who underwent both ND and ULD scans. Subsequently AI-based denoising methods were applied to produce a denoised ULD scan. Two chest radiologists independently and blindly assessed all scans. Each scan was assigned a Lung-RADS score and grouped as 1 + 2 and 3 + 4. Results: The study included 30 men (58%) and 22 women (42%); mean age 69.9 ± 9 years (range 54–88). ULD scan radiation exposure was comparable on average to 3.6–4.8% of the radiation depending on patient BMI. Denoising increased signal-to-noise ratio by 27.7%. We found substantial inter-observer agreement in all scans for Lung-RADS grouping. Denoised scans performed better than ULD scans when negative likelihood ratio (LR-) was calculated (0.04–-0.08 vs. 0.08–0.12). Other than radiation changes, diameter measurement differences and part-solid nodules misclassification as a ground-glass nodule caused most Lung-RADS miscategorization. Conclusions: When assessing asymptomatic patients for pulmonary nodules, finding a negative screen using ULD CT with denoising makes it highly unlikely for a patient to have a pulmonary nodule that requires aggressive investigation. Future studies of this technique should include larger cohorts and be considered for lung cancer screening as radiation exposure is radically reduced.

Original languageEnglish
Pages (from-to)550-555
Number of pages6
JournalIsrael Medical Association Journal
Volume23
Issue number9
StatePublished - Sep 2021

Keywords

  • Computerized tomography (CT)
  • Lung cancer screening
  • Lung imaging reporting and data system (Lung-RADS)
  • Screening chest CT scan
  • Ultra-low-dose (ULD) computerized tomography (CT)

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