Image quality in ultra-low-dose chest CT versus chest x-rays guiding paediatric cystic fibrosis care.
Authors
Affiliations (6)
Affiliations (6)
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Cork, Ireland. [email protected].
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Cork, Ireland.
- Department of Radiology, Cork University Hospital, Cork, Ireland.
- Sydney School of Health Sciences, University of Sydney, Sydney, NSW, Australia.
- School of Health Sciences, University of Southern Denmark, Odense, Denmark.
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
Abstract
Cystic fibrosis (CF) is a prevalent autosomal recessive disorder, with lung complications being the primary cause of morbidity and mortality. In paediatric patients, structural lung changes begin early, necessitating prompt detection to guide treatment and delay disease progression. This study evaluates ultra-low-dose CT (ULDCT) versus chest x-rays (CXR) for children with CF (CwCF) lung disease assessment. ULDCT uses AI-enhanced deep-learning iterative reconstruction to achieve radiation doses comparable to a CXR. This prospective study recruited radiographers and radiologists to assess the image quality (IQ) of ten paired ULDCT and CXR images of CwCF from a single centre. Statistical analyses, including the Wilcoxon Signed Rank test and visual grading characteristic (VGC) analysis, compared diagnostic confidence and anatomical detail. Seventy-five participants were enrolled, 25 radiologists and 50 radiographers. The majority (88%) preferred ULDCT over CXR for monitoring CF lung disease due to higher perceived confidence (p ≤ 0.001) and better IQ ratings (p ≤ 0.05), especially among radiologists (area under the VGC curve and its 95% CI was 0.63 (asymmetric 95% CI: 0.51-0.73; p ≤ 0.05). While ULDCT showed no significant differences in anatomical visualisation compared to CXR, the overall IQ for lung pathology assessment was rated superior. ULDCT offers superior IQ over CXR in CwCF, with similar radiation doses. It also enhances diagnostic confidence, supporting its use as a viable CXR alternative. Standardising CT protocols to optimise IQ and minimise radiation is essential to improve disease monitoring in this vulnerable group. Question How does chest X-ray (CXR) IQ in children compare to ULDCT at similar radiation doses for assessing CF-related lung disease? Findings ULDCT offers superior IQ over CXR in CwCF. Participants preferred ULDCT due to higher perceived confidence levels and superior IQ. Clinical relevance ULDCT can enhance diagnosis in CwCF while maintaining comparable radiation doses. ULDCT also enhances diagnostic confidence, supporting its use as a viable CXR alternative.