A Simulation Paradigm for Evaluation of Subtle Liver Lesions at Pediatric CT: Performance and Confidence
Jennifer S Ngo1, Justin B Solomon1, Ehsan Samei1
1Department of Radiology (J.S.N., L.N., B.C.A., J.T.D., A.D., R.G., D.M., C.M.M., V.P., G.R.S.), Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Medical Physics Graduate Program (J.B.S., E.S., T.R.), and Departments of Biomedical Engineering, Electrical and Computer Engineering, and Physics (E.S.), Duke University Medical Center, Box 3808, Durham, NC 27710; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (A.E., B.Z.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (B.N.P., D.P.F.).
Insights
Reducing radiation dose in pediatric CT scans significantly decreased liver lesion detection sensitivity. Reader confidence remained high even with a 25% dose reduction, indicating unawareness of performance changes.
Area of Science:
- Medical Imaging
- Radiology
- Pediatric Imaging
Background:
- Radiation dose reduction in pediatric CT is crucial for minimizing long-term risks.
- Evaluating the impact of dose reduction on diagnostic accuracy and observer confidence is essential.
Purpose of the Study:
- To develop and validate a systematic observer performance platform for assessing simulated liver lesions in pediatric CT.
- To measure the effect of radiation dose reduction on lesion detection and reader confidence.
Main Methods:
- Thirty pediatric abdominal CT scans were retrospectively collected.
- Simulated liver lesions and varying radiation dose levels (0%, 25%, 50% reduction) were introduced.
- Radiologists reviewed scans using an online interface, marking lesions and rating confidence.
Main Results:
- Detection sensitivity significantly decreased with lower radiation doses (P < .001).
- Reader confidence was significantly lower for 50% dose reduction compared to full dose (P = .011, P = .012).
- No significant difference in confidence was observed between full dose and 25% dose reduction (P = .866).
Conclusions:
- Decreased radiation dose in pediatric CT leads to reduced sensitivity for detecting liver lesions.
- Readers may not be aware of performance decrements at reduced doses, highlighting the need for careful consideration during dose reduction strategies.
Purpose:
To create and validate a systematic observer performance platform for evaluation of simulated liver lesions at pediatric CT and to test this paradigm to measure the effect of radiation dose reduction on detection performance and reader confidence.
Materials And Methods:
Thirty normal pediatric (from patients aged 0-10 years) contrast material-enhanced, de-identified abdominal CT scans obtained from July 1, 2012, through July 1, 2016, were retrospectively collected from the clinical database. The study was exempt from institutional review board approval. Zero to three simulated, low-contrast liver lesions (≤6 mm) were digitally inserted by using software, and noise was added to simulate reductions in volume CT dose index (representing radiation dose estimation) of 25% and 50%. Pediatric, abdominal, and resident radiologists (three of each) reviewed 90 data sets in three sessions using an online interface, marking each lesion location and rating confidence (scale, 0-100). Statistical analysis was performed by using software.
Results:
Mixed-effects models revealed a significant decrease in detection sensitivity as radiation dose decreased (P < .001). The mean confidence of the full-dose and 25% dose reduction examinations was significantly higher than that of the 50% dose reduction examinations (P = .011 and .012, respectively) but not different from one another (P = .866). Dose was not a significant predictor of time to complete each case, and subspecialty was not a significant predictor of sensitivity or false-positive results.
Conclusion:
Sensitivity for lesion detection significantly decreased as dose decreased; however, confidence did not change between the full-dose and 25% reduced-dose scans. This suggests that readers are unaware of this decrease in performance, which should be accounted for in clinical dose reduction efforts.Keywords: Abdomen/GI, CT, Liver, Observer Performance, Pediatrics, Perception Image© RSNA, 2019.
More Related Videos
08:41Novel In Vivo Micro-Computed Tomography Imaging Techniques for Assessing the Progression of Non-Alcoholic Fatty Liver Disease
Published on: March 24, 2023
09:23Author Spotlight: Enhancing Transplantation Research Through MicroCT Angiography in Murine Models
Published on: September 22, 2023
