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To compare a novel thick-slab projection technique for ultra-low dose computed tomography (CT; thoracic tomogram) with conventional chest x ray with respect to 13 diagnostic categories.With the approval of the institutional ethics board, a dataset was retrospectively collected of 22 consecutive patients who had undergone a clinically requested emergency room conventional chest x ray (CXR) and a same-day standard-of-care non-contrast CT. Scanner specific noise was added to the CT images to simulate a target dose of 0.18 mSv. A novel algorithm was used to post-process CT images as coronal isotropic reformats by applying a voxel-based, locally normalized weighted-intensity projection to generate 2 cm thick slabs with 1 cm overlap. Three chest radiologists with no prior training for the study reviewed the CXR and thoracic tomogram for each case and assessed each diagnostic category (pneumonic infiltrates, pulmonary edema, interstitial lung disease, nodules 5 mm, nodules 5 mm, pleural effusion, pericardial effusion, heart size, acute bone fractures, foreign bodies, pneumothorax, mediastinal vessel diameter, free abdominal air) on a Likert scale from -4 (definitely absent/normal) to +4 (definitely present/abnormal). MRMC ROC curves were generated for each category. Time for interpretation and subjective image quality score (0-10) were also assessed.For focal lung disease (pneumonic infiltrates, nodules 5 mm, nodules 5mm), the area under the ROC curve (AUC) was significantly higher for thoracic tomograms than CXR (0.803 vs 0.648, respectively, P = 0.02). For non-focal lung disease (pulmonary edema, interstitial lung disease) and effusions (pulmonary, pericardial), the AUC was larger for thoracic tomograms than CXR but the difference did not reach significance (0.870 vs 0.833, P = 0.141; and 0.823 vs 0.752, P = 0.296, respectively). For acute bone fractures and foreign bodies, the AUC was smaller for thoracic tomograms than CXR, the difference was however not significant (0.491 vs 0.532, P = 0.42; and 0.871 vs 0.971, P = 0.39, respectively). Other diagnostic categories had no true positive cases in the dataset. The mean time for interpretation for each was 36.9 and 24.0 s with standard deviations of 0.857 and 5.977. The image quality score for each was 8.2 and 7.8 with standard deviations of 0.970 and 1.614.Thoracic tomograms were found to be diagnostically superior to CXR for focal lung disease, at no increased radiation dose. The thoracic tomogram presents an opportunity to improve the standard-of-care for patients who would otherwise receive a conventional CXR.

To evaluate a contiguous helical CT protocol with two different target noise levels in chest/abdomen/pelvis CT. 41 patients (study group) underwent a helical scan (P1) with two different target noise levels (SDs), SD = 16 for chest and SD = 13 for abdomen/pelvis. Two further protocols were planned but not executed: a single helical scan with only one SD (SD = 13) for the entire scan range (P2), and two separate helical scans overlapping over the liver and same SD settings as for P1 (P3). All DLPs were recorded. Image quality was assessed qualitatively and quantitatively on all scans. The control group consisted of 40 patients, was scanned with protocol P3 and analysed using the same metrics. DLPs (mean/SD) for P1, P2 and P3 were 859.5/392.9, 1040.2/510.5 and 1027.4/469.4, respectively. P1 offered a mean dose reduction of 17.4% compared to P2, and 16.3% compared to P3 (both p 0.3). Contiguous helical scanning of the chest/abdomen/pelvis with variable target noise levels results in approximately 17% dose reduction if compared to a single acquisition with only abdominal dose settings or two separate acquisitions of the chest and abdomen/pelvis. • Low dose chest and standard abdomen CTs can be combined. • Variable SD CT scanning allows for radiation dose reduction. • Variable SD CT scanning maintains image quality.