# Evaluation of an in-use chest CT protocol in lung cancer screening - A single institutional study

## TL;DR

This study evaluates a low-dose CT protocol for lung cancer screening in Norway, comparing dose and image quality in patients of different sizes.

## Contribution

The study provides empirical evidence on dose compliance and image quality consistency in lung cancer screening using LDCT.

## Key findings

- Dose values were significantly higher in large-size compared to average-size patients.
- Image quality remained consistent between patient groups when using iterative reconstruction.
- CTDIvol values met AAPM recommendations for lung cancer screening.

## Abstract

Lung cancer is the most common cause of cancer-related death worldwide and therefore there has been a growing demand for low-dose computed tomography (LDCT) protocols.

To investigate and evaluate the dose and image quality of patients undergoing lung cancer screening (LCS) using LDCT in Norway.

Retrospective dosimetry data, volumetric CT dose index (CTDIvol) and dose-length product (DLP), from 70 average-size and 70 large-size patients who underwent LDCT scan for LCS were included in the survey. Effective dose and size-specific dose were calculated for each examination and were compared with the American Association of Physicists in Medicine (AAPM) requirement. For a quantitative image quality analysis, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were determined for different regions in the chest with two iterative reconstruction techniques, iDose and Iterative Model Reconstruction. Differences in dose and image quality between average-size and large-size patients were evaluated by Independent sample t test, and Wilcoxon signed rank test within the same patient group.

The independent sample t test revealed significant differences (p < .05) in dose values between average-size and large-size patients. Mean CTDIvol and DLP for average-size patients were 2.8 mGy and 115 mGy.cm, respectively, with appropriate increment for the large-size patients. Image quality (image noise, SNR, and CNR) did not significantly differ between patient groups when images were reconstructed with a model based iterative reconstruction algorithm.

The screening protocol assessed in this study resulted in CTDIvol values that were compliant with AAPM recommendation. No significant differences in objective image quality were found between patient groups.