Scout-based automated tube potential selection technique (kv assist) in enhanced chest computed tomography: Effects on radiation exposure and image quality

Objective: The aim of our study was to assess radiation dose reduction and image quality for enhanced chest CT examinations with a scoutbased automated tube potential selection technique (kVAssist) compared with a standard 120-kV protocol. Methods: Prospective study of enhanced chest CTexaminations was performed in 100 consecutive patients with kVAssist and in 100 consecutive patients with conventional 120-kV protocol on a multislice CT (Discovery CT750HD). The body mass index, CT dose index volume, and dose length product were recorded from the examination protocol. Image noise and CT value was measured on region of interest, signal-to-noise ratio, and contrastto-noise ratio was calculated. The subjective image quality was assessed by two radiologists blinded to the respective protocol with the use of a 3-grade scale (3, superior quality; 2, moderate quality; 1, inferior quality). Results: With kVAssist, the percentages of patients being scanned using 80, 100, and 120 kV were 12.0%, 80.0%, and 8.0%, respectively. The kilovolt setting was related with body mass index (r = 0.565, P = 0.000). Compared with the conventional 120 kV protocol, kV Assist allowed for an overall average decrease of 30.6% in CT dose index volume (kV Assist, 11.05 ± 4.78 mGy; 120 kV, 15.92 ± 6.89 mGy) (P < 0.001) and 32.3% in dose length product (kV Assist, 386.41 ± 184.02 mGy cm1; 120 kV, 571.14 ± 286.68 mGy cm1) (P < 0.001). In the kVAssist, mean attenuation of regions of interest inside the aorta was significantly higher than that in 120-kV protocols (kV Assist, 310.27 ± 73.70 HU; 120 kV, 239.44 ± 47.65 HU) (P < 0.001), resulting in increased contrast-to-noise ratio (kVAssist, 26.69 ± 7.78; 120 kV, 21.38 ± 6.05) (P < 0.001). There was no significant difference in subjective image quality scores between the 2 groups. Conclusions: The use of attenuation-based kVAssist technique enables significant dose reduction in enhanced chest CT scan while improving arterial enhancement and preserving image quality at adequate levels.