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Characterization of the Relation Between CT Technical Parameters and Accuracy of Quantification of Lung Attenuation on Quantitative Chest CT

¹ Department of Radiology, University of Virginia Medical Center, Charlottesville, VA.
² Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
³ Department of Radiology, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104.

OBJECTIVE. The purpose of this study was to assess the compromise between CT technical parameters and the accuracy of CT quantification of lung attenuation.

MATERIALS AND METHODS. Materials that simulate water (0 H), healthy lung (–650 H), borderline emphysematous lung (–820 H), and severely emphysematous lung (–1,000 H) were placed at both the base and the apex of the lung of an anthropomorphic phantom and outside the phantom. Transaxial CT images through the samples were obtained while the effective tube current was varied from 440 to 10 mAs, kilovoltage from 140 to 80 kVp, and slice thickness from 0.625 to 10 mm. Mean ± SD attenuation within the samples and the standard quantitative chest CT measurements, the percentage of pixels with attenuation less than –910 H and 15th percentile of attenuation, were computed.

RESULTS. Outside the phantom, variations in CT parameters produced less than 2.0% error in all measurements. Within the anthropomorphic phantom at 30 mAs, error in measurements was much larger, ranging from zero to 200%. Below approximately 80 mAs, mean attenuation became increasingly biased. The effects were most pronounced at the apex of the lungs. Mean attenuation of the borderline emphysematous sample of apex decreased 55 H as the tube current was decreased from 300 to 30 mAs. Both the 15th percentile of attenuation and percentage of pixels with less than –910 H attenuation were more sensitive to variations in effective tube current than was mean attenuation. For example, the –820 H sample should have 0% of pixels less than –910 H, which was true at 400 mA. At 30 mA in the lung apex, however, the measurement was highly inaccurate, 51% of pixels being below this value. Decreased kilovoltage and slice thickness had analogous, but lesser, effects.

CONCLUSION. The accuracy of quantitative chest CT is determined by the CT acquisition parameters. There can be significant decreases in accuracy at less than 80 mAs for thin slices in an anthropomorphic phantom, the most pronounced effects occurring in the lung apex.

Keywords: chest CT • emphysema • lung disease • lung volume reduction surgery • radiation

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