Impact of an artificial intelligence deep‐learning reconstruction algorithm for CT on image quality and potential dose reduction: A phantom study

BACKGROUND: Recently, computed tomography (CT) manufacturers have developed deep‐learning‐based reconstruction algorithms to compensate for the limitations of iterative reconstruction (IR) algorithms, such as image smoothing and the spatial resolution's dependence on contrast and dose levels. PURPOSE: To assess the impact of an artificial intelligence deep‐learning reconstruction (AI‐DLR) algorithm on image quality and dose reduction compared with a hybrid IR algorithm in chest CT for different clinical indications. METHODS: Acquisitions on the CT American College of Radiology (ACR) 464 and CT Torso CTU‐41 phantoms were performed at five dose levels (CTDI(vol): 9.5/7.5/6/2.5/0.4 mGy) used for chest CT conditions. Raw data were reconstructed using filtered backprojection, two levels of IR (iDose(4) levels 4 (i4) and 7 (i7)), and five levels of AI‐DLR (Precise Image; Smoother, Smooth, Standard, Sharp, Sharper). Noise power spectrum (NPS), task‐based transfer function, and detectability index (d′) were computed: d′‐modeled detection of a soft tissue mediastinal nodule (low‐contrast soft tissue chest nodule within the mediastinum [LCN]), ground‐glass opacity (GGO), or high‐contrast pulmonary (HCP) lesion. The subjective image quality of chest anthropomorphic phantom images was independently evaluated by two radiologists. They assessed image noise, image smoothing, contrast between vessels and fat in the mediastinum for mediastinal images, visual border detection between bronchus and lung parenchyma for parenchymal images, and overall image quality using a commonly used four‐ or five‐point scale. RESULTS: From Standard to Smoother levels, on average, the noise magnitude decreased (for all dose levels: −66.3% ± 0.5% for mediastinal images and −63.1% ± 0.1% for parenchymal images), the average NPS spatial frequency decreased (for all dose levels: −35.3% ± 2.2% for mediastinal images and −13.3% ± 2.2% for parenchymal images), and the detectability (d′) of the three lesions increased. The opposite pattern was found from Standard to Sharper levels. From Smoother to Sharper levels, the spatial resolution increased for the low‐contrast polyethylene insert and the opposite for the high‐contrast air insert. Compared to the i4 used in clinical practice, d′ values were higher using Smoother (mean for all dose levels: 338.7% ± 29.4%), Smooth (103.4% ± 11.2%), and Standard (34.1% ± 6.6%) levels for the LCN on mediastinal images and Smoother (169.5% ± 53.2% for GGO and 136.9% ± 1.6% for HCP) and Smooth (36.4% ± 22.1% and 24.1% ± 0.9%, respectively) levels for parenchymal images. Radiologists considered the images satisfactory for clinical use at these levels, but adaptation to the dose level of the protocol is required. CONCLUSION: With AI‐DLR, the smoothest levels reduced the noise and improved the detectability of chest lesions but increased the image smoothing. The opposite was found with the sharpest levels. The choice of level depends on the dose level and type of image: mediastinal or parenchymal.