{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T03:16:21Z","timestamp":1780456581189,"version":"3.54.1"},"reference-count":27,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T00:00:00Z","timestamp":1700006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Esbjerg Fund (IC M\u00f8llers Fond)"},{"name":"Danish Radiographers Association (Radiograf R\u00e5det)"},{"name":"Karola J\u00f8rgensen Fund for Health Research at Esbjerg University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Measuring left ventricular ejection fraction (LVEF) is important for detecting heart failure, e.g., in treatment with potentially cardiotoxic chemotherapy. MRI is considered the reference standard for LVEF, but availability may be limited and claustrophobia or metal implants still present challenges. CT has been shown to be accurate and would be advantageous, as LVEF could be measured in conjunction with routine chest\u2013abdomen\u2013pelvis oncology CT. However, the use of CT is not recommended due to the excessive radiation dose. This study aimed to explore the potential for dose reduction using simulation. Using an anthropomorphic heart phantom scanned at 13 dose levels, a noise simulation algorithm was developed to introduce controlled Poisson noise. Filtered backprojection parameters were iteratively tested to minimise differences in myocardium-to-ventricle contrast\/noise ratio, as well as structural similarity index (SSIM) differences between real and simulated images at all dose levels. Fifty-one clinical CT coronary angiographies, scanned with full dose through end-systolic and -diastolic phases, were located retrospectively. Using the developed algorithm, noise was introduced corresponding to 25, 10, 5 and 2% of the original dose level. LVEF was measured using clinical software (Syngo.via VB50) with papillary muscles in and excluded from the LV volume. At each dose level, LVEF was compared to the 100% dose level, using Bland\u2013Altman analysis. The effective dose was calculated from DLP using a conversion factor of 0.026 mSv\/mGycm. Results: In the clinical images, mean CTDIvol and DLP were 47.1 mGy and 771.9 mGycm, respectively (effective dose 20.0 mSv). Measurements with papillary muscles excluded did not exhibit statistically significant LVEF bias to full-dose images at 25, 10 and 5% simulated dose. At 2% dose, a significant bias of 4.4% was found. With papillary muscles included, small but significant biases were found at all simulated dose levels. Conclusion: Provided that measurements are performed with papillary muscles excluded from the LV volume, the dose can be reduced by a factor of 20 without significantly affecting LVEF measurements. This corresponds to an effective dose of 1 mSv. CT can potentially be used for LVEF measurement with minimal excessive radiation.<\/jats:p>","DOI":"10.3390\/tomography9060164","type":"journal-article","created":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T08:19:43Z","timestamp":1700122783000},"page":"2089-2102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-6497","authenticated-orcid":false,"given":"Martin Weber","family":"Kusk","sequence":"first","affiliation":[{"name":"Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin 4 Belfield, Ireland"},{"name":"IRIS\u2014Imaging Research Initiative Southwest, Department of Radiology & Nuclear Medicine, Esbjerg University Hospital, 6700 Esbjerg, Denmark"},{"name":"Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense M, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1249-133X","authenticated-orcid":false,"given":"S\u00f8ren","family":"Hess","sequence":"additional","affiliation":[{"name":"IRIS\u2014Imaging Research Initiative Southwest, Department of Radiology & Nuclear Medicine, Esbjerg University Hospital, 6700 Esbjerg, Denmark"},{"name":"Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense M, Denmark"},{"name":"Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6335-3303","authenticated-orcid":false,"given":"Oke","family":"Gerke","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-2802","authenticated-orcid":false,"given":"Shane J.","family":"Foley","sequence":"additional","affiliation":[{"name":"Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin 4 Belfield, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1200\/OP.20.00924","article-title":"Monitoring for Chemotherapy-Related Cardiotoxicity in the Form of Left Ventricular Systolic Dysfunction: A Review of Current Recommendations","volume":"17","author":"Stone","year":"2021","journal-title":"JCO Oncol. 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