{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T02:08:55Z","timestamp":1773886135204,"version":"3.50.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T00:00:00Z","timestamp":1649289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011699","name":"Siemens Healthineers","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011699","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>The aim of the study was to find the lowest possible tube current and the optimal iterative reconstruction (IR) strength in abdominal imaging.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Material and methods<\/jats:title>\n<jats:p>Reconstruction software was used to insert noise, simulating the use of a lower tube current. A semi-anthropomorphic abdominal phantom (Quality Assurance in Radiology and Medicine, QSA-543, Moehrendorf, Germany) was used to validate the performance of the ReconCT software (S1 Appendix). Thirty abdominal CT scans performed with a standard protocol (120 kV<jats:sub>ref<\/jats:sub>, 150 mAs<jats:sub>ref<\/jats:sub>) scanned at 90 kV, with dedicated contrast media (CM) injection software were selected. There were no other in- or exclusion criteria. The software was used to insert noise as if the scans were performed with 90, 80, 70 and 60% of the full dose. Consequently, the different scans were reconstructed with filtered back projection (FBP) and IR strength 2, 3 and 4. Both objective (e.g. Hounsfield units [HU], signal to noise ratio [SNR] and contrast to noise ratio [CNR]) and subjective image quality were evaluated. In addition, lesion detection was graded by two radiologists in consensus in another 30 scans (identical scan protocol) with various liver lesions, reconstructed with IR 3, 4 and 5.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A tube current of 60% still led to diagnostic objective image quality (e.g. SNR and CNR) when IR strength 3 or 4 were used. IR strength 4 was preferred for lesion detection. The subjective image quality was rated highest for the scans performed at 90% with IR 4.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>A tube current reduction of 10\u201340% is possible in case IR 4 is used, leading to the highest image quality (10%) or still diagnostic image quality (40%), shown by a pairwise comparison in the same patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0266194","type":"journal-article","created":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T17:58:08Z","timestamp":1649354288000},"page":"e0266194","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Finding the optimal tube current and iterative reconstruction strength in liver imaging; two needles in one haystack"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3105-6640","authenticated-orcid":true,"given":"Bibi","family":"Martens","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joris G. A.","family":"Bosschee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sander M. J.","family":"Van Kuijk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9cile R. L. P. N.","family":"Jeukens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maikel T. H.","family":"Brauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim E.","family":"Wildberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Casper","family":"Mihl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,4,7]]},"reference":[{"issue":"Suppl 2","key":"pone.0266194.ref001","first-page":"36","article-title":"Hepatocellular Carcinoma in the Cirrhotic Liver: Evaluation Using Computed Tomography and Magnetic Resonance Imaging","volume":"15","author":"M. Coskun","year":"2017","journal-title":"Exp Clin Transplant"},{"issue":"10","key":"pone.0266194.ref002","doi-asserted-by":"crossref","first-page":"697","DOI":"10.7326\/M14-2509","article-title":"Imaging Techniques for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis","volume":"162","author":"R Chou","year":"2015","journal-title":"Ann Intern Med"},{"issue":"2\u20134","key":"pone.0266194.ref003","first-page":"1","article-title":"The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103","volume":"37","year":"2007","journal-title":"Annals of the ICRP"},{"key":"pone.0266194.ref004","unstructured":"Board of Radiation Effects Research Division on Earth and Life Sciences National Research Council of the National Academies. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII, Phase 2. Washington (DC)2006."},{"issue":"3\u20134","key":"pone.0266194.ref005","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.ypmed.2011.12.017","article-title":"Radiation risks: critical analysis and commentary","volume":"54","author":"B Barrett","year":"2012","journal-title":"Prev Med"},{"issue":"1","key":"pone.0266194.ref006","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1148\/radiol.09090369","article-title":"Body size indexes for optimizing iodine dose for aortic and hepatic enhancement at multidetector CT: comparison of total body weight, lean body weight, and blood volume","volume":"254","author":"H Kondo","year":"2010","journal-title":"Radiology"},{"issue":"9","key":"pone.0266194.ref007","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/RLI.0000000000000172","article-title":"Evolution in Computed Tomography: The Battle for Speed and Dose","volume":"50","author":"MM Lell","year":"2015","journal-title":"Invest Radiol"},{"issue":"3","key":"pone.0266194.ref008","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1148\/radiol.2333031150","article-title":"Techniques and applications of automatic tube current modulation for CT","volume":"233","author":"MK Kalra","year":"2004","journal-title":"Radiology"},{"issue":"1036","key":"pone.0266194.ref009","doi-asserted-by":"crossref","first-page":"20130613","DOI":"10.1259\/bjr.20130613","article-title":"Using \"iDose4\" iterative reconstruction algorithm in adults\u2019 chest-abdomen-pelvis CT examinations: effect on image quality in relation to patient radiation exposure","volume":"87","author":"I Arapakis","year":"2014","journal-title":"Br J Radiol"},{"issue":"3","key":"pone.0266194.ref010","doi-asserted-by":"crossref","first-page":"R74","DOI":"10.1088\/0952-4746\/36\/3\/R74","article-title":"Setting up computed tomography automatic tube current modulation systems","volume":"36","author":"CJ Martin","year":"2016","journal-title":"J Radiol Prot"},{"issue":"1","key":"pone.0266194.ref011","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/RLI.0000000000000601","article-title":"Recent and upcoming technological developments in computed tomography: high speed, low dose, deep learning, multienergy","volume":"55","author":"MM Lell","year":"2020","journal-title":"Invest Radiol"},{"issue":"5","key":"pone.0266194.ref012","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/RLI.0000000000000537","article-title":"Automatic tube current modulation and tube voltage selection in pediatric computed tomography: a phantom study on radiation dose and image quality","volume":"54","author":"AE Papadakis","year":"2019","journal-title":"Invest Radiol"},{"issue":"10","key":"pone.0266194.ref013","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/RLI.0b013e318260c5d6","article-title":"Attenuation-based automatic kilovolt selection in abdominal computed tomography: effects on radiation exposure and image quality","volume":"47","author":"A Eller","year":"2012","journal-title":"Invest Radiol"},{"issue":"1","key":"pone.0266194.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/RLI.0b013e31826e7902","article-title":"Virtual unenhanced images of the abdomen with second-generation dual-source dual-energy computed tomography: image quality and liver lesion detection","volume":"48","author":"CN De Cecco","year":"2013","journal-title":"Invest Radiol"},{"issue":"3","key":"pone.0266194.ref015","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/RLI.0000000000000525","article-title":"Individually Body Weight-Adapted Contrast Media Application in Computed Tomography Imaging of the Liver at 90 kVp","volume":"54","author":"B Martens","year":"2019","journal-title":"Invest Radiol"},{"key":"pone.0266194.ref016","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ejrad.2018.10.025","article-title":"Basics of iterative reconstruction methods in computed tomography: a vendor-independent overview","volume":"109","author":"W. Stiller","year":"2018","journal-title":"Eur J Radiol"},{"issue":"2","key":"pone.0266194.ref017","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1148\/radiol.2015132766","article-title":"State of the art: iterative CT reconstruction techniques","volume":"276","author":"LL Geyer","year":"2015","journal-title":"Radiology"},{"issue":"1","key":"pone.0266194.ref018","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s12194-014-0288-8","article-title":"What is the preferred strength setting of the sinogram-affirmed iterative reconstruction algorithm in abdominal CT imaging?","volume":"8","author":"AD Hardie","year":"2015","journal-title":"Radiological physics and technology"},{"issue":"1","key":"pone.0266194.ref019","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s00261-018-1687-9","article-title":"Comparison of image noise and image quality between full-dose abdominal computed tomography scans reconstructed with weighted filtered back projection and half-dose scans reconstructed with improved sinogram-affirmed iterative reconstruction (SAFIRE*)","volume":"44","author":"S Choy","year":"2019","journal-title":"Abdom Radiol (NY)"},{"issue":"2","key":"pone.0266194.ref020","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/RLI.0000000000000312","article-title":"Noise Texture Deviation: A Measure for Quantifying Artifacts in Computed Tomography Images With Iterative Reconstructions","volume":"52","author":"F Morsbach","year":"2017","journal-title":"Invest Radiol"},{"key":"pone.0266194.ref021","article-title":"Comparison of image noise and image quality between full-dose abdominal computed tomography scans reconstructed with weighted filtered back projection and half-dose scans reconstructed with improved sinogram-affirmed iterative reconstruction (SAFIRE*)","volume":"44","author":"S Choy","year":"2018","journal-title":"Abdominal Radiology"},{"issue":"2","key":"pone.0266194.ref022","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/RCT.0000000000000005","article-title":"Diagnostic accuracy of coronary CT angiography: comparison of filtered back projection and iterative reconstruction with different strengths","volume":"38","author":"R Wang","year":"2014","journal-title":"Journal of computer assisted tomography"},{"key":"pone.0266194.ref023","doi-asserted-by":"crossref","first-page":"108703","DOI":"10.1016\/j.ejrad.2019.108703","article-title":"Assessment of image quality in abdominal computed tomography: effect of model-based iterative reconstruction, multi-planar reconstruction and slice thickness on potential dose reduction","volume":"122","author":"B Kataria","year":"2020","journal-title":"Eur J Radiol"},{"issue":"5","key":"pone.0266194.ref024","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/RLI.0000000000000243","article-title":"A novel pairwise comparison-based method to determine radiation dose reduction potentials of iterative reconstruction algorithms, exemplified through circle of willis computed tomography angiography","volume":"51","author":"S Ellmann","year":"2016","journal-title":"Invest Radiol"},{"issue":"26","key":"pone.0266194.ref025","doi-asserted-by":"crossref","first-page":"e1058","DOI":"10.1097\/MD.0000000000001058","article-title":"Computed Tomography Angiography of Carotid Arteries and Vertebrobasilar System: A Simulation Study for Radiation Dose Reduction","volume":"94","author":"M Kramer","year":"2015","journal-title":"Medicine (Baltimore)"},{"issue":"10","key":"pone.0266194.ref026","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1097\/RLI.0000000000000693","article-title":"A solution for homogeneous liver enhancement in computed tomography: results from the COMpLEx trial","volume":"55","author":"B Martens","year":"2020","journal-title":"Invest Radiol"},{"issue":"Suppl 1","key":"pone.0266194.ref027","first-page":"S1","article-title":"Normal liver anatomy","volume":"2","author":"L. Sibulesky","year":"2013","journal-title":"Clin Liver Dis (Hoboken)"},{"issue":"12","key":"pone.0266194.ref028","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1111\/j.1365-2929.2004.02012.x","article-title":"Likert scales: how to (ab)use them","volume":"38","author":"S. Jamieson","year":"2004","journal-title":"Med Educ"},{"issue":"1","key":"pone.0266194.ref029","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1148\/radiol.2018172875","article-title":"Triple arterial phase CT of the liver with radiation dose equivalent to that of single arterial phase CT: initial experience","volume":"289","author":"K Brehmer","year":"2018","journal-title":"Radiology"},{"issue":"34","key":"pone.0266194.ref030","doi-asserted-by":"crossref","first-page":"e11857","DOI":"10.1097\/MD.0000000000011857","article-title":"Reduction of the radiation dose and the amount of contrast material in hepatic dynamic CT using low tube voltage and adaptive iterative dose reduction 3-dimensional","volume":"97","author":"A Nakamoto","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"pone.0266194.ref031","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.clinimag.2018.05.027","article-title":"Low-voltage (80-kVp) abdominopelvic computed tomography allows 60% contrast dose reduction in patients at risk of contrast-induced nephropathy","volume":"51","author":"K Araki","year":"2018","journal-title":"Clin Imaging"},{"issue":"4","key":"pone.0266194.ref032","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1007\/s00330-014-3510-5","article-title":"Contrast agent and radiation dose reduction in abdominal CT by a combination of low tube voltage and advanced image reconstruction algorithms","volume":"25","author":"N Buls","year":"2015","journal-title":"Eur Radiol"},{"issue":"4","key":"pone.0266194.ref033","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/0284185119866807","article-title":"80-kVp hepatic CT to reduce contrast medium dose in azotemic patients: a feasibility study","volume":"61","author":"F Holmquist","year":"2020","journal-title":"Acta Radiol"},{"issue":"8","key":"pone.0266194.ref034","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1007\/s00330-014-3227-5","article-title":"Determination of optimal intravenous contrast agent iodine dose for the detection of liver metastasis at 80-kVp CT","volume":"24","author":"S Goshima","year":"2014","journal-title":"Eur Radiol"},{"issue":"11","key":"pone.0266194.ref035","doi-asserted-by":"crossref","first-page":"3755","DOI":"10.1007\/s00261-020-02565-9","article-title":"Image quality in dual-source multiphasic dynamic computed tomography of the abdomen: evaluating the effects of a low tube voltage (70 kVp) in combination with contrast dose reduction","volume":"45","author":"K Miyoshi","year":"2020","journal-title":"Abdom Radiol (NY)"},{"issue":"11","key":"pone.0266194.ref036","doi-asserted-by":"crossref","first-page":"6163","DOI":"10.1007\/s00330-019-06170-3","article-title":"Deep learning reconstruction improves image quality of abdominal ultra-high-resolution CT","volume":"29","author":"M Akagi","year":"2019","journal-title":"Eur Radiol"},{"issue":"9","key":"pone.0266194.ref037","doi-asserted-by":"crossref","first-page":"e0231431","DOI":"10.1371\/journal.pone.0231431","article-title":"Dual-source abdominopelvic computed tomography: comparison of image quality and radiation dose of 80 kVp and 80\/150 kVp with tin filter","volume":"15","author":"SJ Choi","year":"2020","journal-title":"PLoS One"},{"issue":"7","key":"pone.0266194.ref038","doi-asserted-by":"crossref","first-page":"071904","DOI":"10.1118\/1.4881148","article-title":"Objective assessment of image quality and dose reduction in CT iterative reconstruction","volume":"41","author":"JY Vaishnav","year":"2014","journal-title":"Med Phys"},{"key":"pone.0266194.ref039","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12880-015-0075-y","article-title":"Correlation of clinical and physical-technical image quality in chest CT: a human cadaver study applied on iterative reconstruction","volume":"15","author":"A De Crop","year":"2015","journal-title":"BMC Med Imaging"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266194","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T17:58:38Z","timestamp":1649354318000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266194"}},"subtitle":[],"editor":[{"given":"Alessandra","family":"Giuliani","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,7]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0266194","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,7]]}}}