Model observers applied to low contrast detectability in computed tomography

Introduction. Medical imaging has become one of the comerstones in modem healthcare. Computed tomography (CT) is a widely used imaging modality in radiology worldwide. This technique allows to obtain three-dimensional volume reconstructions ofdifferent parts of the patient with isotropic spatial resolution. Also, to acquire sharp images of moving organs, such as the heart orthe lungs, without artifacts. The spectrum ofindications which can be tackled with this technique is wide, and it comprises brain perfusion, cardiology, oncology, vascular radiology, interventionism and traumatology, amongst others. CT is a very popular imaging technique, widely implanted in healthcare services worldwide. The amount of CT scans performed per year has been continuously growing in the past decades, which has led to a great benefit for the patients. At the same time, CT exams represent the highest contribution to the collective radiation dose. Patient dose in CT is one order ofmagnitude higher than in conventional X-ray studies. Regarding patient dose in X-ray imaging the ALARA criteria is universally accepted. It states that patient images should be obtained using adose as low as reasonably achievable and compatible with the diagnostic task. Sorne cases ofpatients' radiation overexposure, most ofthem in brain perfusion procedures have come to the public eye and hada great impact in the USA media. These cases, together with the increasing number ofCT scans performed per year, have raised a red flag about the patient imparted doses in CT. Several guidelines and recommendation for dose optimization in CT have been published by different organizations, which have been included in European and National regulations and adopted by CT manufacturers. In CT, the X-ray tube is rotating around the patient, emitting photons in beams from different angles or projections. These photons interact with the tissues in the patient, depending on their energy and the tissue composition and density. A fraction of these photons deposit all or part of their energy inside the patient, resulting in organs absorbed dose. The images are generated using the data from the projections ofthe X-ray beam that reach the detectors after passing through the patient. Each proj ection represents the total integrated attenuation of the X-ray beam along its path. A CT protocol is defined as a collection of settings which can be selected in the CT console and affect the image quality outcome and the patient dose. They can be acquisition parameters such as beam collimation, tube current, rotation time, kV, pitch, or reconstruction parameters such as the slice thickness and spacing, reconstruction filter and method (filtered back projection (FBP) or iterative algorithms). All main CT manufacturers offer default protocols for different indications, depending on the anatomical region. The user can frequently set the protocol parameters selecting amongst a range of values to adapt them to the clinical indication and patient characteristics, such as size or age. The selected settings in the protocol affect greatly image quality and dose. Many combinations ofsean parameters can render an appropriate image quality for a particular study. Protocol optimization is a complex task in CT because most sean protocol parameters are intertwined and affect image quality and patient dose..