PT  - JOURNAL ARTICLE
AU  - Southard, R.N.
AU  - Bardo, D.M.E.
AU  - Temkit, M.H.
AU  - Thorkelson, M.A.
AU  - Augustyn, R.A.
AU  - Martinot, C.A.
TI  - Comparison of Iterative Model Reconstruction versus Filtered Back-Projection in Pediatric Emergency Head CT: Dose, Image Quality, and Image-Reconstruction Times
AID  - 10.3174/ajnr.A6034
DP  - 2019 May 01
TA  - American Journal of Neuroradiology
PG  - 866--871
VI  - 40
IP  - 5
4099  - http://www.ajnr.org/content/40/5/866.short
4100  - http://www.ajnr.org/content/40/5/866.full
SO  - Am. J. Neuroradiol.2019 May 01; 40
AB  - BACKGROUND AND PURPOSE: Noncontrast CT of the head is the initial imaging test for traumatic brain injury, stroke, or suspected nonaccidental trauma. Low-dose head CT protocols using filtered back-projection are susceptible to increased noise and decreased image quality. Iterative reconstruction noise suppression allows the use of lower-dose techniques with maintained image quality. We review our experience with children undergoing emergency head CT examinations reconstructed using knowledge-based iterative model reconstruction versus standard filtered back-projection, comparing reconstruction times, radiation dose, and objective and subjective image quality.MATERIALS AND METHODS: This was a retrospective study comparing 173 children scanned using standard age-based noncontrast head CT protocols reconstructed with filtered back-projection with 190 children scanned using low-dose protocols reconstructed with iterative model reconstruction. ROIs placed on the frontal white matter and thalamus yielded signal-to-noise and contrast-to-noise ratios. Volume CT dose index and study reconstruction times were recorded. Random subgroups of patients were selected for subjective image-quality review.RESULTS: The volume CT dose index was significantly reduced in studies reconstructed with iterative model reconstruction compared with filtered back-projection, (mean, 24.4 ± 3.1 mGy versus 31.1 ± 6.0 mGy, P < .001), while the SNR and contrast-to-noise ratios improved 2-fold (P < .001). Radiologists graded iterative model reconstruction images as superior to filtered back-projection images for gray-white matter differentiation and anatomic detail (P < .001). The average reconstruction time of the filtered back-projection studies was 101 seconds, and with iterative model reconstruction, it was 147 seconds (P < .001), without a practical effect on work flow.CONCLUSIONS: In children referred for emergency noncontrast head CT, optimized low-dose protocols with iterative model reconstruction allowed us to significantly reduce the relative dose, on average, 22% compared with filtered back-projection, with significantly improved objective and subjective image quality.ASIRadaptive statistical iterative reconstructionCNRcontrast-to-noise ratioCTDIvolvolume CT dose indexFBPfiltered back-projectionIMRiterative model reconstructionMBIRmodel-based iterative reconstructionIRiterative reconstruction