The Use of Adaptive Statistical Iterative Reconstruction (Asir) On Image Quality and Radiation Dose in Thorax CT Scan (Phantom Study)

International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163
Issue 12, Volume 5 (December 2018) www.ijirae.com
THE USE OF ADAPTIVE STATISTICAL ITERATIVE

RECONSTRUCTION (ASIR) ON IMAGE QUALITY AND
RADIATION DOSE IN THORAX CT SCAN (PHANTOM STUDY)
Trisna Budiwati*
*DiponegoroUniversity, Indonesia
trisna_budiwati@st.fisika.undip.ac.id
Wahyu Setia Budi
Diponegoro University, Indonesia
wahyu.sb@undip.ac.id
Heri Sutanto
Diponegoro University, Indonesia
herisutanto@undip.ac.id
Manuscript History
Number: IJIRAE/RS/Vol.05/Issue12/DCAE10081
Received: 02, December 2018
Final Correction: 13, December 2018
Final Accepted: 26, December 2018
Published: December 2018
Citation: Trisna, Wahyu & Heri (2018). The Use of Adaptive Statistical Iterative Reconstruction (ASIR) on image
Quality and radiation dose in Thorax CT Scan (Phantom Study). IJIRAE::International Journal of Innovative
Research in Advanced Engineering, Volume V, 406-411. doi://10.26562/IJIRAE.2018.DCAE10081
Editor: Dr.A.Arul L.S, Chief Editor, IJIRAE, AM Publications, India
Copyright: ©2018 This is an open access article distributed under the terms of the Creative Commons Attribution
License, Which Permits unrestricted use, distribution, and reproduction in any medium, provided the original author
and source are credited
Abstract: Use of Adaptive Statistical Iterative Reconstruction (ASIR) on CT scan of thorax has been investigated.
This study aims is to determine the effect of the use of ASIR on the radiation dose and image quality. The study was
conducted using phantom anthropomorphic using CT Scan GE Optima 580 with setting ASIR Dose Reduction 0% -
50%. This study was carried out by using two parameters: fixed tube current and Tube Current Modulation (TCM).
Analyzing of radiation dose is done by calculation of CTDIvol. While image quality are investigated by calculated
Signal to Noise Ratio (SNR) and Contrast to Noise Ratio (CNR). There is a difference in the CTDIvol value, between
the fixed tube current and TCM settings. At fixed tube current strength, the CTDIvol value is measured, starting
from 0% to 50% ASIR, respectively: 48.60 mGy; 43.74 mGy; 38.88 mGy; 34.02 mGy; 29.16 mGy; and 24.30 mGy.
While the CTDIvol value measured in TCM settings uses 0% to 50% ASIR as follows: 21.92 mGy; 20.09 mGy; 18.33
mGy; 16.51 mGy; 14.59 mGy; and 12.75 mGy. Using ASIR with TCM can produce CTDIvol values that are smaller than
ASIR with fixed tube current. The difference in the average CTDIvol value is 51.80% between the use of TCM and
fixed tube current. The greater the percentage of ASIR regulated, the greater the decrease in the CTDIvol dose. There
is no significant difference in the SNR and CNR values produced by 0% to 50% ASIR with a fixed current strength.
There is no significant difference in the SNR and CNR values produced by ASIR 0% to 50% with TCM. The average
CNR value shown in TCM is higher than that of fixed tube current. The use of ASIR influence in dose radiation
decreases without change the image quality.
Keywords: Adaptive Statistical Iterative Reconstruction (ASIR); Tube Current Modulation (TCM); CTDIvol, Signal to
Noise Ratio (SNR); Contrast to Noise Ratio (CNR);
I. INTRODUCTION
In Thorax CT examination, there are very large variations in the setting of scanning parameters, namely using a
tube voltage with a range of 120-140 kVp as well as strong current and time products with a range of 100-533 mAs
so that the radiation dose produced on CT Thorax examination also varies [1-5].
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Therefore an effort is needed to reduce the radiation dose on a CT scan where it can increase the potential for
Cancer due to radiation exposure, because radiation can cause carcinogenesis as a stochastic effect, so that
possibility can be eliminated by decreasing the radiation dose. Reduction of the radiation dose to excessive CT can
cause an increase in noise in the image and reduce diagnostic assessment in cases of detection of lesions. Radiation
dose reduction by maintaining diagnostic image quality can be done by optimizing scanning parameters (such as
tube current, kilovoltage peak, pitch, and using techniques that can improve image quality in low CT doses) [6-9].
Reducing tube current and tube tension is a direct way to achieve a reduction in radiation dose. Tube current
modification is the simplest method in reducing radiation doses and being a mainstay. Technical advance including
automated tube current modulation (ATCM) and tube potential selection as well as adaptive statistical iteration
reconstruction (ASIR) have resulted in decrease radiation dose. Implementation of ATCM varies by vendor but is
generally based on an assessment of the size attenuation, and shape of the subject. Tube current is adjusted to
maintain desired image quality across a range of patient size, attenuation, and shape of the subject [10-13].
In reducing the CT radiation dose, image noise increases because the existing reconstruction method, Filtered Back
Projection (FBP) cannot maintain image quality consistently, along with the reduction of tube current [6,14].
However, there is a new method in reducing doses based on the reconstruction iteration algorithm developed to
improve image quality. The algorithm is Adaptive Statistical Iterative Reconstruction (ASIR), which is able to
improve CT diagnostic capabilities in reducing doses [14]. Low Dose CT using ASIR is an effective method for
diagnosing urinary stones, which can obviously reduce the radiation dose while maintain image quality
comparable to conventional dose CT [15]. During the low dose chest CT scan, it is good recommended to apply
ASIR 20% during the inspection. About 16.7% of dose could be reduced by applying low-dose CT scan without
degradation of image quality [16]. In this study, the low dose technique in the application of CT scan focuses on
chest scanning, by comparing the settings of fixed tube current and Tube Current Modulation (TCM) by using
Adaptive Statistical Iterative Reconstruction (ASIR) to determine the effect on dose reduction and image quality.
II. METHOD
This study aims to determine the effect of using Adaptive Statistical Iterative Reconstruction (ASIR) on the
regulation of fixed tube current and Tube Current Modulation (TCM) to CTDIvol, SNR, and CNR values on Thorax
CT, which will be applied to antrophomorphic phantoms by using CT Scan GE Optima 580. The percentage of ASIR
chosen is 0%, 10%, 20%, 30%, 40% and 50%. Furthermore, the results to be analyzed are dose values, namely
CTDIvol and image quality calculated as Signal to Noise Ratio (SNR) and Contrast to Noise Ratio (CNR) values.
Fig. 1 Anthropomorphic phantom

The radiation dose was determined by using analysis of CTDI value, while to determine the quality of CT scan
images was by using SNR and CNR values which obtained with the mathematical equation below:
CT Number
SNR=
NI Eq.1
(Mean of CT Number Area 1 - Mean of CT Number Area 2)
CNR=
(NI Area 1)2 +(NI Area 2)2
Eq.2
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III. RESULT AND DISCUSSION

A. Radiation Dose
Figure 2 and Figure 3 below show a recapitulation of the current values recorded in each slice of phantom scan
results and also CTDIvol value, using the IndoseCT software. Y-axis is tube current value in milliampere, and x-axis is
slice thickness in millimetre. Figure 2 shows an example of CTDIvol measurement in fixed tube current with ASIR
0%, and it also show the same tube current value in each scanning slice. Tube current value changed according to
percentage of ASIR: 300 mA, 270 mA, 240 mA, 210 mA, 180 mA, 150 mA respectively from ASIR 0% to 50%. While
in figure 3, show an example of CTDIvol measurement in TCM with ASIR 0%. Tube current value in each slice was
varian. It caused by attenuation, which is according to water equivalent diameter of phantom. Average of this tube
current value in ASIR 0% to 50% respectively are 135.30 mA; 124.01 mA; 113.16 mA; 101.18 mA; 90.06 mA; 78.70
mA. Higher presentage of ASIR make decrease of tube current.
Fig. 2 Example of CTDIvol measurement in fixed tube current setting with ASIR 0%
Fig. 3 Example of CTDIvol measurement in Tube Current Modulation (TCM) setting with ASIR 0%
The results of CTDIvol measurement using the IndoseCT software are shown in Figure 4. There is a difference in the
CTDIvol value, between the tube current and TCM strong settings. At fixed current strength, the CTDIvol value is
measured, starting from 0% to 50% ASIR, respectively: 48.60 mG; 43.74 mGy; 38.88 mGy; 34.02 mGy; 29.16 mGy;
and 24.30 mGy. While the CTDIvol value measured in TCM settings uses 0% to 50% ASIR as follows: 21.92 mGy;
20.09 mGy; 18.33 mGy; 16.51 mGy; 14.59 mGy; and 12.75 mGy.
_________________________________________________________________________________________________
Using ASIR with TCM can produce CTDIvol values that are smaller than ASIR with static mA. The difference in the
average CTDIvol between the use of TCM and fixed tube current value is 51.80%. This is due to the use of TCM, the
tube current issued by the CT Scan plane is not fixed.
A 29% decrease in CTDIvol and a 20% decrease in DLP were obtained in scans with ASIR compared with scans
without ASIR, without a quantitative loss of image quality [17]. In this study, combination of ASIR and TCM is more
effective to decrease dose radiation. The outflow strength adjusts the size of the body part and composition of the
internal organs (water equivalent diameter). In thinner parts of the body the resulting tube current is also
relatively smaller, then in parts of the body where the composition of the tissue is less and the density is lower then
a small tube current will also be produced. The decrease in current strength in the tube affects the amount or
quantity of radiation, because the current strength is one of the factors that affect the amount of radiation output in
addition to voltage, distance, and filtration.
Fig. 4 CTDIvol value by using fixed tube current and Tube Current Modulation (TCM)
B. Image Quality
In this study, the assessment of image quality uses the Signal to Noise Ratio (SNR) and Contrast to Noise Ratio (CNR)
values. Measurements use 25 samples images from each scan result of the ASIR percentage mode setting (0-50%),
to the use of fixed tube current and TCM. Each picture has 4 points of Region of Interest (ROI) with an area of ± 20
mm2, namely soft tissue, heart, spinal cord, spine. Values that appear in ROI include CT numbers in units of HU
(Hounsfield Unit) and Noise Index (NI) which are displayed in standard deviation (SD) values. The SNR value is
calculated mathematically, using Eq.1. The resulting SNR value can be used in calculating CNR, using Eq.2. CNR is
analyzed into 3 categories, namely low contrast, medium contrast, and high contrast. In low contrast, the area
compared is the heart with soft tissue. In contrast medium, the area compared is the heart with the spine. Whereas
in high contrast, namely the spine and spinal cord. The ROI measurement will be shown in Figure 5.
Fig. 5 Example of ROI in CT image to analyzed SNR and CNR

_________________________________________________________________________________________________
The results of the calculation of SNR and CNR values are then analyzed statistically, to determine the significance of
the differences between several modes of ASIR settings and current strength. The following Table 1 and Table 2
will show the difference in the average SNR and CNR value in ASIR setting with fixed tube current and TCM. Result
show that p value in all of parameter SNR are >0.05. It means there is no significant difference between ASIR 0%-
50% in fixed current setting. SNR value in fixed current setting is higher than TCM (especially heart and spinal
cord). Also in CNR, the result of p value is >0.05, there is no significant difference between all CNR value in ASIR
setting with fixed tube current and TCM. Average of CNR value in TCM setting is higher than fixed tube current.
However it resulted that there is no significant difference in SNR and CNR value in ASIR 0%-50%, TCM can make
higher CNR. The higher CNR maybe considered the dominant factor of the well-accepted image quality parameter.
TABLE I - CALCULATION OF SNR
SNR
ROI Scan Parameter ASIR ASIR ASIR ASIR ASIR ASIR p
0% 10% 20% 30% 40% 50%
Fixed tube current 0.058 - 0.192 -0.019 -0.109 0.061 -0.013 0.911
Soft Tissue
TCM -0.221 -0.193 -0.245 -0.126 -0.189 -0.116 0.792
Fixed tube current 4.615 5.882 4.331 4.458 4.430 4.576 0.827
Heart
TCM 2.203 2.861 3.602 2.898 2.673 2.822 0.209
Spine
TCM 15.652 16.460 17.072 17.826 16.747 16.338 0.597
Spinal cord
TCM 1.219 0.766 0.687 0.734 0.753 0.921 0.917
TABLE II -CALCULATION OF CNR
CNR
ROI Scan Parameter ASIR ASIR ASIR ASIR ASIR ASIR p
0% 10% 20% 30% 40% 50%
Low contrast
TCM 15.602 13.880 13.082 14.025 15.012 9.046 0.452
Medium Fixed tube current 29.574 24.591 27.190 23.551 24.532 23.634 0.853
contrast TCM 39.020 43.981 41.665 42.429 45.281 45.449 0.894
High contrast
TCM 43.450 57.620 50.113 50.615 59.796 45.644 0.976
IV. CONCLUSIONS
The greater the percentage of ASIR regulated, the greater the decrease in the CTDIvol dose. Combination of ASIR
with TCM has more signifikan decrease in CTDIvol than its combination with fixed tube current. There is no
significant difference in the SNR and CNR values produced by 0% to 50% ASIR with a fixed tube current. There is
no significant difference in the SNR and CNR values produced by ASIR 0% to 50% with Tube Current Modulation.
The average CNR value shown in TCM is higher than that of fixed tube current. The use of ASIR influence in dose
radiation decrease without change the image quality.
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The Use of Adaptive Statistical Iterative Reconstruction (Asir) On Image Quality and Radiation Dose in Thorax CT Scan (Phantom Study)

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International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163

Issue 12, Volume 5 (December 2018) www.ijirae.com

THE USE OF ADAPTIVE STATISTICAL ITERATIVE

Fig. 1 Anthropomorphic phantom

III. RESULT AND DISCUSSION

Fig. 5 Example of ROI in CT image to analyzed SNR and CNR

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