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Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study

Background: Measuring left ventricular ejection fraction (LVEF) is important for detecting heart failure, e.g., in treatment with potentially cardiotoxic chemotherapy. MRI is considered the reference standard for LVEF, but availability may be limited and claustrophobia or metal implants still presen...

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Autores principales: Kusk, Martin Weber, Hess, Søren, Gerke, Oke, Foley, Shane J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10661257/
https://www.ncbi.nlm.nih.gov/pubmed/37987350
http://dx.doi.org/10.3390/tomography9060164
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author Kusk, Martin Weber
Hess, Søren
Gerke, Oke
Foley, Shane J.
author_facet Kusk, Martin Weber
Hess, Søren
Gerke, Oke
Foley, Shane J.
author_sort Kusk, Martin Weber
collection PubMed
description Background: Measuring left ventricular ejection fraction (LVEF) is important for detecting heart failure, e.g., in treatment with potentially cardiotoxic chemotherapy. MRI is considered the reference standard for LVEF, but availability may be limited and claustrophobia or metal implants still present challenges. CT has been shown to be accurate and would be advantageous, as LVEF could be measured in conjunction with routine chest–abdomen–pelvis oncology CT. However, the use of CT is not recommended due to the excessive radiation dose. This study aimed to explore the potential for dose reduction using simulation. Using an anthropomorphic heart phantom scanned at 13 dose levels, a noise simulation algorithm was developed to introduce controlled Poisson noise. Filtered backprojection parameters were iteratively tested to minimise differences in myocardium-to-ventricle contrast/noise ratio, as well as structural similarity index (SSIM) differences between real and simulated images at all dose levels. Fifty-one clinical CT coronary angiographies, scanned with full dose through end-systolic and -diastolic phases, were located retrospectively. Using the developed algorithm, noise was introduced corresponding to 25, 10, 5 and 2% of the original dose level. LVEF was measured using clinical software (Syngo.via VB50) with papillary muscles in and excluded from the LV volume. At each dose level, LVEF was compared to the 100% dose level, using Bland–Altman analysis. The effective dose was calculated from DLP using a conversion factor of 0.026 mSv/mGycm. Results: In the clinical images, mean CTDIvol and DLP were 47.1 mGy and 771.9 mGycm, respectively (effective dose 20.0 mSv). Measurements with papillary muscles excluded did not exhibit statistically significant LVEF bias to full-dose images at 25, 10 and 5% simulated dose. At 2% dose, a significant bias of 4.4% was found. With papillary muscles included, small but significant biases were found at all simulated dose levels. Conclusion: Provided that measurements are performed with papillary muscles excluded from the LV volume, the dose can be reduced by a factor of 20 without significantly affecting LVEF measurements. This corresponds to an effective dose of 1 mSv. CT can potentially be used for LVEF measurement with minimal excessive radiation.
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spelling pubmed-106612572023-11-15 Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study Kusk, Martin Weber Hess, Søren Gerke, Oke Foley, Shane J. Tomography Article Background: Measuring left ventricular ejection fraction (LVEF) is important for detecting heart failure, e.g., in treatment with potentially cardiotoxic chemotherapy. MRI is considered the reference standard for LVEF, but availability may be limited and claustrophobia or metal implants still present challenges. CT has been shown to be accurate and would be advantageous, as LVEF could be measured in conjunction with routine chest–abdomen–pelvis oncology CT. However, the use of CT is not recommended due to the excessive radiation dose. This study aimed to explore the potential for dose reduction using simulation. Using an anthropomorphic heart phantom scanned at 13 dose levels, a noise simulation algorithm was developed to introduce controlled Poisson noise. Filtered backprojection parameters were iteratively tested to minimise differences in myocardium-to-ventricle contrast/noise ratio, as well as structural similarity index (SSIM) differences between real and simulated images at all dose levels. Fifty-one clinical CT coronary angiographies, scanned with full dose through end-systolic and -diastolic phases, were located retrospectively. Using the developed algorithm, noise was introduced corresponding to 25, 10, 5 and 2% of the original dose level. LVEF was measured using clinical software (Syngo.via VB50) with papillary muscles in and excluded from the LV volume. At each dose level, LVEF was compared to the 100% dose level, using Bland–Altman analysis. The effective dose was calculated from DLP using a conversion factor of 0.026 mSv/mGycm. Results: In the clinical images, mean CTDIvol and DLP were 47.1 mGy and 771.9 mGycm, respectively (effective dose 20.0 mSv). Measurements with papillary muscles excluded did not exhibit statistically significant LVEF bias to full-dose images at 25, 10 and 5% simulated dose. At 2% dose, a significant bias of 4.4% was found. With papillary muscles included, small but significant biases were found at all simulated dose levels. Conclusion: Provided that measurements are performed with papillary muscles excluded from the LV volume, the dose can be reduced by a factor of 20 without significantly affecting LVEF measurements. This corresponds to an effective dose of 1 mSv. CT can potentially be used for LVEF measurement with minimal excessive radiation. MDPI 2023-11-15 /pmc/articles/PMC10661257/ /pubmed/37987350 http://dx.doi.org/10.3390/tomography9060164 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kusk, Martin Weber
Hess, Søren
Gerke, Oke
Foley, Shane J.
Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study
title Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study
title_full Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study
title_fullStr Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study
title_full_unstemmed Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study
title_short Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study
title_sort potential for dose reduction in ct-derived left ventricular ejection fraction: a simulation study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10661257/
https://www.ncbi.nlm.nih.gov/pubmed/37987350
http://dx.doi.org/10.3390/tomography9060164
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