Ultra-low-dose sequential computed tomography for quantitative lung aeration assessment—a translational study

Background: Quantitative lung computed tomography (CT) provides fundamental information about lung aeration in critically ill patients. We tested a scanning protocol combining reduced number of CT slices and tube current, comparing quantitative analysis and radiation exposure to conventional CT. Methods: In pigs, CT scans were performed during breath hold in a model of lung injury with three different protocols: standard spiral with 180 mAs tube current-time product (Spiral180), sequential with 20-mm distance between slices and either 180 mAs (Sequential180) or 50 mAs (Sequential50). Spiral scans of critically ill patients were collected retrospectively, and subsets of equally spaced slices were extracted. The agreement between CT protocols was assessed with Bland–Altman analysis. Results: In 12 pigs, there was good concordance between the sequential protocols and the spiral scan (all biases ≤1.9%, agreements ≤±6.5%). In Spiral180, Sequential180 and Sequential50, estimated dose exposure was 2.3 (2.1–2.8), 0.21 (0.19–0.26), and 0.09 (0.07–0.10) mSv, respectively (p < 0.001 compared to Spiral180); number of acquired slices was 244 (227–252), 12 (11–13) and 12 (11–13); acquisition time was 7 (6–7), 23 (21–25) and 24 (22–26) s. In 32 critically ill patients, quantitative analysis extrapolated from 1-mm slices interleaved by 20 mm had a good concordance with the analysis performed on the entire spiral scan (all biases <1%, agreements ≤2.2%). Conclusions: In animal CT data, combining sequential scan and low tube current did not affect significantly the quantitative analysis, with a radiation exposure reduction of 97%, reaching a dose comparable to chest X-ray, but with longer acquisition time. In human CT data, lung aeration analysis could be extrapolated from a subset of thin equally spaced slices.