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Patient-based Performance Assessment for Pediatric Abdominal CT: An Automated Monitoring System Based on Lesion
Tyler Lacy1, Aiping Ding1, Vivian Minkemeyer1
1Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710.
Insights
An automated tool was developed to assess pediatric CT image quality and radiation dose for liver lesion detection. The system demonstrated that younger patients had better image quality, enabling enhanced performance audits.
Area of Science:
- Radiology
- Medical Imaging
- Pediatric Imaging
Background:
- Pediatric body computed tomography (CT) requires evaluation of both radiation dose and image quality.
- Assessing image quality in pediatric CT is crucial for accurate diagnosis, particularly for tasks like liver lesion detection.
Purpose of the Study:
- To deploy an automated tool for evaluating pediatric body CT performance.
- To utilize metrics of radiation dose and image quality for the specific task of liver lesion detection.
Main Methods:
- Retrospective analysis of 507 pediatric abdominopelvic CT scans (age <18 years).
- Evaluation of radiation metrics (CTDIvol, DLP, SSDE) and task-based performance using a detectability index (d').
- An informatics algorithm extracted d' to assess the likelihood of detecting a 5 mm liver lesion with a 10 HU difference.
Main Results:
- Minimal variability in size-specific dose estimates (SSDE) by age.
- Image quality, assessed by d', was higher in younger pediatric patients compared to older ones.
- Similar trends in image quality variation were observed across all evaluated CT scanner models.
Conclusions:
- An automated method can effectively assess clinical image quality in pediatric CT.
- The developed tool provides a metric for image quality that varies predictably with patient age.
- This tool can establish a quality reference level, enhancing the assessment and auditing of CT imaging performance alongside dose estimations.
Rationale And Objective:
To deploy an automated tool for evaluating pediatric body computed tomography (CT) performance utilizing metrics of radiation dose and image quality for the task of liver lesion detection.
Materials And Methods:
This IRB approved retrospective investigation used 507 IV-contrast-enhanced abdominopelvic CT scans of pediatric patients (<18 years) between June 2014 and November 2017 acquired on three scanner models from two manufacturers. The scans were evaluated in terms of radiation metrics (CTDIvol, DLP, and SSDE) as well as task-based performance based on the clinical task of detecting a 5 mm liver lesion with a 10 HU attenuation difference from background liver. An informatics algorithm extracted a previously-validated quantitative detectability index (d') from each case reflective of the likelihood of detecting a liver lesion. The results were analyzed in terms of the relationship between d' and radiation dose metrics.
Results:
There was minimal SSDE variability by age. Median SSDE at 100 kV on one scanner model was 5.2 mGy (5.0-5.4 mGy interquartile range). However, when assessing image quality by applying d', the age groups separated such that the younger patients had higher d' values than older patients. Similar trends were seen in all scanners.
Conclusions:
An automated method to assess clinical image quality for pediatric CT provided a metric of image quality that varied as expected across ages (i.e., higher quality for younger patients). This tool affords the establishment of a quality reference level that, in addition to dose estimations currently available, would allow for enhanced assessment (e.g., facilitated audit) of CT imaging performance.
