Image quality in ultra-low-dose chest CT versus chest x-rays guiding paediatric cystic fibrosis care
Niamh Moore1, Patrick O'Regan2,3, Rena Young2
1Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Cork, Ireland. niamh.moore@ucc.ie.
Insights
Ultra-low-dose CT (ULDCT) provides superior image quality for assessing cystic fibrosis (CF) lung disease in children compared to chest X-rays (CXR). This advanced imaging technique enhances diagnostic confidence, offering a promising alternative for early detection and monitoring of CF in pediatric patients.
Area of Science:
- Medical Imaging
- Pulmonology
- Pediatric Radiology
Background:
- Cystic fibrosis (CF) is a genetic disorder primarily affecting the lungs, leading to significant morbidity and mortality in children.
- Early detection of lung complications in pediatric CF patients is crucial for timely intervention and disease management.
- Traditional chest X-rays (CXR) have limitations in fully assessing early structural lung changes in CF.
Purpose of the Study:
- To compare the image quality (IQ) and diagnostic confidence of ultra-low-dose CT (ULDCT) with conventional chest X-rays (CXR) for evaluating lung disease in children with CF (CwCF).
- To assess the potential of ULDCT, utilizing AI-enhanced reconstruction, as a viable alternative to CXR in pediatric CF patients, maintaining comparable radiation doses.
Main Methods:
- A prospective study involving radiographers and radiologists assessing paired ULDCT and CXR images from ten pediatric CF patients.
- Utilized statistical analyses, including Wilcoxon Signed Rank test and visual grading characteristic (VGC) analysis, to compare diagnostic confidence and anatomical detail between imaging modalities.
- Enrolled 75 participants (25 radiologists, 50 radiographers) to evaluate image quality and diagnostic preference.
Main Results:
- A significant majority (88%) of participants preferred ULDCT over CXR for CF lung disease assessment due to higher diagnostic confidence (p≤0.001) and superior IQ ratings (p≤0.05).
- Radiologists showed a particular preference for ULDCT, indicated by a higher area under the VGC curve (0.63; 95% CI: 0.51-0.73; p≤0.05).
- While ULDCT did not show significant differences in anatomical visualization, its overall IQ for assessing lung pathology in CwCF was rated superior to CXR.
Conclusions:
- ULDCT demonstrates superior image quality compared to CXR for assessing lung disease in children with CF, at similar radiation doses.
- The enhanced diagnostic confidence and superior IQ offered by ULDCT support its adoption as a valuable alternative to CXR for monitoring CF progression in pediatric patients.
- Standardizing ULDCT protocols is essential to optimize image quality and minimize radiation exposure, thereby improving disease management for this vulnerable population.
Objectives:
Cystic fibrosis (CF) is a prevalent autosomal recessive disorder, with lung complications being the primary cause of morbidity and mortality. In paediatric patients, structural lung changes begin early, necessitating prompt detection to guide treatment and delay disease progression. This study evaluates ultra-low-dose CT (ULDCT) versus chest x-rays (CXR) for children with CF (CwCF) lung disease assessment. ULDCT uses AI-enhanced deep-learning iterative reconstruction to achieve radiation doses comparable to a CXR.
Materials And Methods:
This prospective study recruited radiographers and radiologists to assess the image quality (IQ) of ten paired ULDCT and CXR images of CwCF from a single centre. Statistical analyses, including the Wilcoxon Signed Rank test and visual grading characteristic (VGC) analysis, compared diagnostic confidence and anatomical detail.
Results:
Seventy-five participants were enrolled, 25 radiologists and 50 radiographers. The majority (88%) preferred ULDCT over CXR for monitoring CF lung disease due to higher perceived confidence (p ≤ 0.001) and better IQ ratings (p ≤ 0.05), especially among radiologists (area under the VGC curve and its 95% CI was 0.63 (asymmetric 95% CI: 0.51-0.73; p ≤ 0.05). While ULDCT showed no significant differences in anatomical visualisation compared to CXR, the overall IQ for lung pathology assessment was rated superior.
Conclusion:
ULDCT offers superior IQ over CXR in CwCF, with similar radiation doses. It also enhances diagnostic confidence, supporting its use as a viable CXR alternative. Standardising CT protocols to optimise IQ and minimise radiation is essential to improve disease monitoring in this vulnerable group.
Key Points:
Question How does chest X-ray (CXR) IQ in children compare to ULDCT at similar radiation doses for assessing CF-related lung disease? Findings ULDCT offers superior IQ over CXR in CwCF. Participants preferred ULDCT due to higher perceived confidence levels and superior IQ. Clinical relevance ULDCT can enhance diagnosis in CwCF while maintaining comparable radiation doses. ULDCT also enhances diagnostic confidence, supporting its use as a viable CXR alternative.
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