Reducing the Radiation Dose for CT Colonography: Effect of Low Tube Voltage and Iterative Reconstruction

Rationale and Objectives: The purpose of this study was to assess the effect of a low-tube-voltage technique and iterative reconstruction (IR) on the radiation dose and image quality of computed tomography colonography (CTC). Materials and Methods: We studied 30 patients (14 women and 16 men; mean age, 64.5 +/- 13.1 years; range, 39-90 years) with colorectal cancer referred for surgical treatment. All underwent CTC with fecal tagging under a standard 120-kVp protocol in the supine position and a 100-kVp protocol in the prone position. The 120-kVp images were reconstructed with filtered back projection (FBP). The 100-kVp images were postprocessed using FBP and a hybrid type of IR (adaptive iterative dose reduction 3D). The effective radiation dose (ED), image noise, and contrast-to-noise ratio (CNR) were compared among the three protocols. The visual image quality was scored on a four-point scale. Results: The mean ED was significantly lower under the 100-kVp protocol than the 120-kVp protocol, resulting in a 27% radiation dose decrease (3.6 +/- 2.0 vs 2.5 +/- 1.5 mSv; P < .01). Image noise decreased by 48%, and the mean attenuation of tagged fluid increased from 452 to 558 HU on images acquired at 100 kVp with IR compared to that in the 120-kVp protocol; these differences were significant. The mean CNR was significantly higher under the 100 kVp with IR than the other two protocols. We found no significant differences in the visual scores for diagnostic utility between the 100 kVp with IR and the 120 kVp with FBP protocol (P = .10). Conclusions: Low-tube-voltage CTC reduced the radiation dose by approximately 27% while maintaining the image quality.