Seventy kilovolt ultra-low dose CT of the paranasal sinus: first clinical results

•Image quality and radiation dose of 70 kV ultra-low dose CT of the paranasal sinus.•70 kV ultra-low dose CT of the paranasal sinus allows for dose reduction by 61%.•70 kV CT of the paranasal sinus increased attenuation of organ structures.•Image quality was maintained with a slight reduction in subjective image quality.•70 kV CT could be beneficial for imaging of children suspected of sinusitis.

AimTo evaluate the diagnostic image quality and radiation dose of low-dose 70 kV computed tomography (CT) of the paranasal sinus in comparison to 100 and 120 kV CT.Materials and methodsCT of the paranasal sinus was performed in 127 patients divided into three groups using different tube voltages and currents (70 kV/75 mAs, ultra-low dose protocol, n = 44; 100 kV/40 mAs, standard low-dose protocol, n = 42; 120 kV/40 mAs, standard protocol, n = 41). CT dose index (CTDIvol), dose-length product (DLP), attenuation, image noise and signal-to-noise ratio (SNR) were compared between the groups using Wilcoxon-Mann-Whitney U-test. Subjective diagnostic image quality was compared by using a five-point scale (1 = non-diagnostic, 5 = excellent, read by two readers in consensus) and Cohen's weighted kappa analysis for interobserver agreement.ResultsRadiation dose was significantly lower with 70 kV acquisition than 100 and 120 kV (DLP: 31 versus 52 versus 82 mGy·cm; CTDI 2.33 versus 3.95 versus 6.31 mGy, all p < 0.05). Mean SNR (70 kV: 0.37; 100 kV: 0.21; 120 kV: 0.13; p < 0.05) and organ attenuation increased significantly with lower voltages. All examinations showed diagnostic image quality. Subjective diagnostic image quality was higher with standard protocols than the 70 kV protocol (120 kV: 5.0; 100 kV: 4.5; 70 kV: 3.5, p < 0.05) without significant differences with substantial interobserver agreement (κ > 0.59).ConclusionThe ultra-low dose (70 kV) CT imaging of the paranasal sinus allowed for significant dose reduction by 61% and an increased attenuation of organ structures in comparison to standard acquisition while maintaining diagnostic image quality with a slight reduction in subjective image quality.