Dose reduction for coronary calcium scoring with hybrid and model-based iterative reconstruction: an ex vivo study

Purpose To determine the influence of dose reduction on coronary calcium scoring using hybrid and model-based iterative reconstruction (IR) techniques. Methods Fifteen ex vivo hearts were scanned in a phantom representing an average adult person at routine dose and three levels of dose reduction; 27, 55 and 82 % reduced-dose, respectively. All images were reconstructed using filtered back-projection (FBP), hybrid IR (iDose⁴, levels 1, 4 and 7) as well as model-based IR iterative model reconstruction (IMR, levels 1, 2 and 3). Agatston, mass and volume scores found with iDose⁴ and IMR were compared to FBP reconstruction (routine dose) as well as objective image quality. Results With FBP calcium scores remained unchanged at 82 % reduced dose. With IR Agatston scores differed significantly at routine dose, using IMR level 3 and iDose⁴ level 7, and at 82 % reduced dose, using IMR levels 1–3 and iDose⁴ level 7. The maximum median difference was 5.3 %. Mass remained unchanged at reduced dose levels while volume was significantly lower at 82 % reduced dose with IMR (maximum median difference 5.0 %). Objective image quality improved with IR, at 82 % reduced dose the CNR of iDose⁴ level 7 was similar to the reference dose CNR, and IMR levels 1–3 resulted in an even higher CNR. Conclusion Calcium scores were not affected by radiation-dose reduction with FBP and low levels of hybrid IR. Objective image quality increased significantly using hybrid and model-based IR. Therefore low level hybrid IR has the potential to reduce radiation-dose of coronary calcium scoring with up to 82 %.