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Ultra-low dose computed tomography protocols using spectral shaping for lung cancer screening: Comparison with low-dose for volumetric LungRADS classification.

PURPOSE: To compare Low-Dose Computed Tomography (LDCT) with four different Ultra-Low-Dose Computed Tomography (ULDCT) protocols for PN classification according to the Lung Reporting and Data System (LungRADS).

METHODS: Three hundred sixty-one participants of an ongoing lung cancer screening (LCS) underwent single-breath-hold double chest Computed Tomography (CT), including LDCT (120kVp, 25mAs; CTDIvol 1,62 mGy) and one ULDCT among: fully automated exposure control ("ULDCT1 "); fixed tube-voltage and current according to patient size ("ULDCT2 "); hybrid approach with fixed tube-voltage ("ULDCT3 ") and tube current automated exposure control ("ULDCT4 "). Two radiologists (R1, R2) assessed LungRADS 2022 categories on LDCT, and then after 2 weeks on ULDCT using two different kernels (R1: Qr49ADMIRE 4 ; R2: Br49ADMIRE 3 ). Intra-subject agreement for LungRADS categories between LDCT and ULDCT was measured by the k-Cohen Index with Fleiss-Cohen weights.

RESULTS: LDCT-dominant PNs were detected in ULDCT in 87 % of cases on Qr49ADMIRE 4 and 88 % on Br49ADMIRE 3 . The intra-subject agreement was: κULDCT1  = 0.89 [95 %CI 0.82-0.96]; κULDCT2  = 0.90 [0.81-0.98]; κULDCT3  = 0.91 [0.84-0.99]; κULDCT4  = 0.88 [0.78-0.97] on Qr49ADMIRE 4 , and κULDCT1  = 0.88 [0.80-0.95]; κULDCT2  = 0.91 [0.86-0.96]; κULDCT3  = 0.87 [0.78-0.95]; and κULDCT4  = 0.88 [0.82-0.94] on Br49ADMIRE 3 . LDCT classified as LungRADS 4B were correctly identified as LungRADS 4B at ULDCT3 , with the lowest radiation exposure among the tested protocols (median effective doses were 0.31, 0.36, 0.27 and 0.37 mSv for ULDCT1 , ULDCT2 , ULDCT3 , and ULDCT4 , respectively).

CONCLUSIONS: ULDCT by spectral shaping allows the detection and characterization of PNs with an excellent agreement with LDCT and can be proposed as a feasible approach in LCS.

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