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Updated: Jun 13, 2025
Author Spotlight: A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules
Published on: May 19, 2023
Pulmonary nodule visualization and evaluation of AI-based detection at various ultra-low-dose levels using
Lisa Jungblut1, André Euler1, Anna Landsmann1
1Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Background:
Radiation dose should be as low as reasonably achievable. With the invention of photon-counting detector computed tomography (PCD-CT), the radiation dose may be considerably reduced.
Purpose:
To evaluate the potential of PCD-CT for dose reduction in pulmonary nodule visualization for human readers as well as for computer-aided detection (CAD) studies.
Material And Methods:
A chest phantom containing pulmonary nodules of different sizes/densities (range 3-12 mm and -800-100 HU) was scanned on a PCD-CT with standard low-dose protocol as well as with half, quarter, and 1/40 dose (CTDIvol 0.4-0.03 mGy). Dose-matched scans were performed on a third-generation energy-integrating detector CT (EID-CT). Evaluation of nodule visualization and detectability was performed by two blinded radiologists. Subjective image quality was rated on a 5-point Likert scale. Artificial intelligence (AI)-based nodule detection was performed using commercially available software.
Results:
Highest image noise was found at the lowest dose setting of 1/40 radiation dose (eff. dose = 0.01mSv) with 166.1 ± 18.5 HU for PCD-CT and 351.8 ± 53.0 HU for EID-CT. Overall sensitivity was 100% versus 93% at standard low-dose protocol (eff. dose = 0.2 mSv) for PCD-CT and EID-CT, respectively. At the half radiation dose, sensitivity remained 100% for human reader and CAD studies in PCD-CT. At the quarter radiation dose, PCD-CT achieved the same results as EID-CT at the standard radiation dose setting (93%, P = 1.00) in human reading studies. The AI-CAD system delivered a sensitivity of 93% at the lowest radiation dose level in PCD-CT.
Conclusion:
At half dose, PCD CT showed pulmonary nodules similar to full-dose PCD, and at quarter dose, PCD CT performed comparably to standard low-dose EID CT. The CAD algorithm is effective even at ultra-low doses.
