PETSTEP: Generation of synthetic PET lesions for fast evaluation of segmentation methods

PurposeThis work describes PETSTEP (PET Simulator of Tracers via Emission Projection): a faster and more accessible alternative to Monte Carlo (MC) simulation generating realistic PET images, for studies assessing image features and segmentation techniques.MethodsPETSTEP was implemented within Matlab as open source software. It allows generating three-dimensional PET images from PET/CT data or synthetic CT and PET maps, with user-drawn lesions and user-set acquisition and reconstruction parameters. PETSTEP was used to reproduce images of the NEMA body phantom acquired on a GE Discovery 690 PET/CT scanner, and simulated with MC for the GE Discovery LS scanner, and to generate realistic Head and Neck scans. Finally the sensitivity (S) and Positive Predictive Value (PPV) of three automatic segmentation methods were compared when applied to the scanner-acquired and PETSTEP-simulated NEMA images.ResultsPETSTEP produced 3D phantom and clinical images within 4 and 6 min respectively on a single core 2.7 GHz computer. PETSTEP images of the NEMA phantom had mean intensities within 2% of the scanner-acquired image for both background and largest insert, and 16% larger background Full Width at Half Maximum. Similar results were obtained when comparing PETSTEP images to MC simulated data. The S and PPV obtained with simulated phantom images were statistically significantly lower than for the original images, but led to the same conclusions with respect to the evaluated segmentation methods.ConclusionsPETSTEP allows fast simulation of synthetic images reproducing scanner-acquired PET data and shows great promise for the evaluation of PET segmentation methods.     

Improved SLIC imagine segmentation algorithm based on K-means

Dividing the image into superpixels contributes to further processing of the image. Simple linear iterative clustering (SLIC) algorithm achieves good segmentation result by clustering color and distance characteristics of pixels. However, finite superpixels easily cause under-segmentation. Therefore, the work corrects segmentation result of SLIC by k-means clustering method calculating similarity based on weighted Euclidean distance. After that, the under-segmentation superpixel blocks are conducted with k-means clustering based on binary classification. Result shows that the corrected SLIC segmentation has better visual effect and index.     

Segmentation improvement through denoising of PET images with 3D-context modelling in wavelet domain

Positron emission tomography (PET) images have been incorporated into the radiotherapy process as a powerful tool to assist in the contouring of lesions, leading to the emergence of a broad spectrum of automatic segmentation schemes for PET images (PET-AS). However, not all proposed PET-AS algorithms take into consideration the previous steps of image preparation. PET image noise has been shown to be one of the most relevant affecting factors in segmentation tasks. This study demonstrates a nonlinear filtering method based on spatially adaptive wavelet shrinkage using three-dimensional context modelling that considers the correlation of each voxel with its neighbours. Using this noise reduction method, excellent edge conservation properties are obtained. To evaluate the influence in the segmentation schemes of this filter, it was compared with a set of Gaussian filters (the most conventional) and with two previously optimised edge-preserving filters. Five segmentation schemes were used (most commonly implemented in commercial software): fixed thresholding, adaptive thresholding, watershed, adaptive region growing and affinity propagation clustering. Segmentation results were evaluated using the Dice similarity coefficient and classification error. A simple metric was also included to improve the characterisation of the filters used for induced blurring evaluation, based on the measurement of the average edge width. The proposed noise reduction procedure improves the results of segmentation throughout the performed settings and was shown to be more stable in low-contrast and high-noise conditions. Thus, the capacity of the segmentation method is reinforced by the denoising plan used.     

Automatic analysis of DNA microarray images using mathematical morphology

MOTIVATION: DNA microarrays are an experimental technology which consists in arrays of thousands of discrete DNA sequences that are printed on glass microscope slides. Image analysis is an important aspect of microarray experiments. The aim of this step is to reduce an image of spots into a table with a measure of the intensity for each spot. Efficient, accurate and automatic analysis of DNA spot images is essential in order to use this technology in laboratory routines. RESULTS: We present an automatic non-supervised set of algorithms for a fast and accurate spot data extraction from DNA microarrays using morphological operators which are robust to both intensity variation and artefacts. The approach can be summarised as follows. Initially, a gridding algorithm yields the automatic segmentation of the microarray image into spot quadrants which are later individually analysed. Then the analysis of the spot quadrant images is achieved in five steps. First, a pre-quantification, the spot size distribution law is calculated. Second, the background noise extraction is performed using a morphological filtering by area. Third, an orthogonal grid provides the first approach to the spot locus. Fourth, the spot segmentation or spot boundaries definition is carried out using the watershed transformation. And fifth, the outline of detected spots allows the signal quantification or spot intensities extraction; in this respect, a noise model has been investigated. The performance of the algorithm has been compared with two packages: ScanAlyze and Genepix, showing its robustness and precision.     

A recognition method of multispectral images of soybean canopies based on neural network

Multispectral images of soybean canopies can reflect plant physiological information and growth status effectively, which is of great significance for soybean high-quality breeding, scientific cultivation, and fine management. At present, it is uneven of the gray level difference of the soybean multispectral images occurred in the leaf edge, and is also small of the gray level difference between the target and the background, resulting in inaccurate recognition of the soybean canopies from the multispectral images. Thus, a multispectral images' recognition method of soybean canopies was proposed based on the neural network. First, the method of Gaussian smoothing filter was used to preprocess the raw soybean multispectral images (green light, near-infrared, red light, red edge, and visible light), which maintained the leaf edge details of the soybean multispectral image. Second, the feedforward neural network model was established to extract the canopy region in the soybean multispectral images. In addition, image morphology operation was used to improve the recognition effects of the soybean canopy. Finally, four quantitative indexes were used to evaluate the experimental results. The results showed that the average effective segmentation rate of the proposed method was 91.69%, the under-segmentation rate was reduced by 33.34%, and the over-segmentation rate was reduced by 48.43%. The difference between the pixel average entropy of the proposed method and the standard canopy image was only 0.2295. The research results can provide not only reliable data for further analysis of physiological and ecological indexes of the soybean canopy, but also technical support for multispectral image recognition of other crop canopies.     

Automated Movement Correction for Dynamic PET/CT Images: Evaluation with Phantom and Patient Data

Head movement during a dynamic brain PET/CT imaging results in mismatch between CT and dynamic PET images. It can cause artifacts in CT-based attenuation corrected PET images, thus affecting both the qualitative and quantitative aspects of the dynamic PET images and the derived parametric images. In this study, we developed an automated retrospective image-based movement correction (MC) procedure. The MC method first registered the CT image to each dynamic PET frames, then re-reconstructed the PET frames with CT-based attenuation correction, and finally re-aligned all the PET frames to the same position. We evaluated the MC method''s performance on the Hoffman phantom and dynamic FDDNP and FDG PET/CT images of patients with neurodegenerative disease or with poor compliance. Dynamic FDDNP PET/CT images (65 min) were obtained from 12 patients and dynamic FDG PET/CT images (60 min) were obtained from 6 patients. Logan analysis with cerebellum as the reference region was used to generate regional distribution volume ratio (DVR) for FDDNP scan before and after MC. For FDG studies, the image derived input function was used to generate parametric image of FDG uptake constant (K_i) before and after MC. Phantom study showed high accuracy of registration between PET and CT and improved PET images after MC. In patient study, head movement was observed in all subjects, especially in late PET frames with an average displacement of 6.92 mm. The z-direction translation (average maximum = 5.32 mm) and x-axis rotation (average maximum = 5.19 degrees) occurred most frequently. Image artifacts were significantly diminished after MC. There were significant differences (P<0.05) in the FDDNP DVR and FDG Ki values in the parietal and temporal regions after MC. In conclusion, MC applied to dynamic brain FDDNP and FDG PET/CT scans could improve the qualitative and quantitative aspects of images of both tracers.     

Anatomical atlas in the context of head and neck radiotherapy and its use to automatic segmentation

In this paper we present a methodology to form an anatomical atlas based on the analysis of dense deformation fields recovered by the Morphons non-rigid registration algorithm. The methodology is based on measuring the bending energy required to register the whole database to a reference, and the atlas is the one image in the database which yields the smallest bending energy when taken as reference. The suitability of our atlas is demonstrated in the context of head and neck radiotherapy through its application to a database with thirty-one computed tomography (CT) images of the head and neck region. In head and neck radiotherapy, CT is the most frequently used modality for the segmentation of organs at risk and clinical target volumes. One challenge brought by the use of CT images is the presence of important artifacts caused by dental implants. The presence of such artifacts hinders the use of intensity averages, thus severely limiting the application of most atlas building techniques described in the literature in this context. The results presented in the paper show that our bending energy model faithfully represents the shape variability of patients in the head and neck region; they also show its good performance in segmentation of volumes of interest in radiotherapy. Moreover, when compared to other atlases of similar performance in automatic segmentation, our atlas presents the desirable feature of not being blurred after intensity averaging.     

Non-rigid registration of serial dedicated breast CT,longitudinal dedicated breast CT and PET/CT images using the diffeomorphic demons method

Rationale and objectivesDedicated breast CT and PET/CT scanners provide detailed 3D anatomical and functional imaging data sets and are currently being investigated for applications in breast cancer management such as diagnosis, monitoring response to therapy and radiation therapy planning. Our objective was to evaluate the performance of the diffeomorphic demons (DD) non-rigid image registration method to spatially align 3D serial (pre- and post-contrast) dedicated breast computed tomography (CT), and longitudinally-acquired dedicated 3D breast CT and positron emission tomography (PET)/CT images.MethodsThe algorithmic parameters of the DD method were optimized for the alignment of dedicated breast CT images using training data and fixed. The performance of the method for image alignment was quantitatively evaluated using three separate data sets; (1) serial breast CT pre- and post-contrast images of 20 women, (2) breast CT images of 20 women acquired before and after repositioning the subject on the scanner, and (3) dedicated breast PET/CT images of 7 women undergoing neo-adjuvant chemotherapy acquired pre-treatment and after 1 cycle of therapy.ResultsThe DD registration method outperformed no registration (p < 0.001) and conventional affine registration (p ≤ 0.002) for serial and longitudinal breast CT and PET/CT image alignment. In spite of the large size of the imaging data, the computational cost of the DD method was found to be reasonable (3–5 min).ConclusionsCo-registration of dedicated breast CT and PET/CT images can be performed rapidly and reliably using the DD method. This is the first study evaluating the DD registration method for the alignment of dedicated breast CT and PET/CT images.     

Improving gene quantification by adjustable spot-image restoration

MOTIVATION: One of the major factors that complicate the task of microarray image analysis is that microarray images are distorted by various types of noise. In this study a robust framework is proposed, designed to take into account the effect of noise in microarray images in order to assist the demanding task of microarray image analysis. The proposed framework, incorporates in the microarray image processing pipeline a novel combination of spot adjustable image analysis and processing techniques and consists of the following stages: (1) gridding for facilitating spot identification, (2) clustering (unsupervised discrimination between spot and background pixels) applied to spot image for automatic local noise assessment, (3) modeling of local image restoration process for spot image conditioning (adjustable wiener restoration using an empirically determined degradation function), (4) automatic spot segmentation employing seeded-region-growing, (5) intensity extraction and (6) assessment of the reproducibility (real data) and the validity (simulated data) of the extracted gene expression levels. RESULTS: Both simulated and real microarray images were employed in order to assess the performance of the proposed framework against well-established methods implemented in publicly available software packages (Scanalyze and SPOT). Regarding simulated images, the novel combination of techniques, introduced in the proposed framework, rendered the detection of spot areas and the extraction of spot intensities more accurate. Furthermore, on real images the proposed framework proved of better stability across replicates. Results indicate that the proposed framework improves spots' segmentation and, consequently, quantification of gene expression levels. AVAILABILITY: All algorithms were implemented in Matlab (The Mathworks, Inc., Natick, MA, USA) environment. The codes that implement microarray gridding, adaptive spot restoration and segmentation/intensity extraction are available upon request. Supplementary results and the simulated microarray images used in this study are available for download from: ftp://users:bioinformatics@mipa.med.upatras.gr. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.     

Small-animal imaging using clinical positron emission tomography/computed tomography and super-resolution

Considering the high cost of dedicated small-animal positron emission tomography/computed tomography (PET/CT), an acceptable alternative in many situations might be clinical PET/CT. However, spatial resolution and image quality are of concern. The utility of clinical PET/CT for small-animal research and image quality improvements from super-resolution (spatial subsampling) were investigated. National Electrical Manufacturers Association (NEMA) NU 4 phantom and mouse data were acquired with a clinical PET/CT scanner, as both conventional static and stepped scans. Static scans were reconstructed with and without point spread function (PSF) modeling. Stepped images were postprocessed with iterative deconvolution to produce super-resolution images. Image quality was markedly improved using the super-resolution technique, avoiding certain artifacts produced by PSF modeling. The 2 mm rod of the NU 4 phantom was visualized with high contrast, and the major structures of the mouse were well resolved. Although not a perfect substitute for a state-of-the-art small-animal PET/CT scanner, a clinical PET/CT scanner with super-resolution produces acceptable small-animal image quality for many preclinical research studies.     

A New Method of Detecting Pulmonary Nodules with PET/CT Based on an Improved Watershed Algorithm

Background

Integrated ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) is widely performed for staging solitary pulmonary nodules (SPNs). However, the diagnostic efficacy of SPNs based on PET/CT is not optimal. Here, we propose a method of detection based on PET/CT that can differentiate malignant and benign SPNs with few false-positives.

Method

Our proposed method combines the features of positron-emission tomography (PET) and computed tomography (CT). A dynamic threshold segmentation method was used to identify lung parenchyma in CT images and suspicious areas in PET images. Then, an improved watershed method was used to mark suspicious areas on the CT image. Next, the support vector machine (SVM) method was used to classify SPNs based on textural features of CT images and metabolic features of PET images to validate the proposed method.

Results

Our proposed method was more efficient than traditional methods and methods based on the CT or PET features alone (sensitivity 95.6%; average of 2.9 false positives per scan).     

CT image segmentation using FEM with optimized boundary condition

The authors propose a CT image segmentation method using structural analysis that is useful for objects with structural dynamic characteristics. Motivation of our research is from the area of genetic activity. In order to reveal the roles of genes, it is necessary to create mutant mice and measure differences among them by scanning their skeletons with an X-ray CT scanner. The CT image needs to be manually segmented into pieces of the bones. It is a very time consuming to manually segment many mutant mouse models in order to reveal the roles of genes. It is desirable to make this segmentation procedure automatic. Although numerous papers in the past have proposed segmentation techniques, no general segmentation method for skeletons of living creatures has been established. Against this background, the authors propose a segmentation method based on the concept of destruction analogy. To realize this concept, structural analysis is performed using the finite element method (FEM), as structurally weak areas can be expected to break under conditions of stress. The contribution of the method is its novelty, as no studies have so far used structural analysis for image segmentation. The method's implementation involves three steps. First, finite elements are created directly from the pixels of a CT image, and then candidates are also selected in areas where segmentation is thought to be appropriate. The second step involves destruction analogy to find a single candidate with high strain chosen as the segmentation target. The boundary conditions for FEM are also set automatically. Then, destruction analogy is implemented by replacing pixels with high strain as background ones, and this process is iterated until object is decomposed into two parts. Here, CT image segmentation is demonstrated using various types of CT imagery.     

不同放射剂量CT在早期非小细胞肺癌中筛检价值对比

摘要 目的：探讨与对比不同放射剂量计算机断层扫描(Computed Tomography,CT)在早期非小细胞肺癌中筛检价值。方法：2020年1月到2020年12月选择在本院经病理确诊为肺内磨玻璃样结节患者98例作为研究对象,所有患者都给予常规剂量正电子发射计算机断层扫描(Positron emission tomography,PET)/CT检查与低剂量PET/CT检查,记录成像特征、辐射剂量并判定筛检价值。结果：低剂量PET/CT对肺部增厚、边界不规则、钙化、囊变的检出率高于常规剂量PET/CT(P<0.05)。低剂量PET/CT与常规剂量PET/CT的图像质量优良率为98.0 %和96.9 %,对比差异无统计学意义(P>0.05)。低剂量PET/CT的有效放射剂量、剂量长度乘积低于常规剂量PET/CT(P<0.05)。低剂量PET/CT的最大标准摄取值(maximum standardized uptake value,SUVmax)值低于常规剂量PET/CT(P<0.05)。低剂量PET/CT与常规剂量PET/CT分别筛检非小细胞肺癌51例与37例,筛检敏感性分别为98.1 %和69.2 %,特异性分别为100.0 %和97.8 %。结论：低放射剂量PET/CT在肺结节中的应用不会影响图像质量,且能降低辐射剂量,提高对早期非小细胞肺癌患者的筛检效果。     

Automatic Region-Based Brain Classification of MRI-T1 Data

Image segmentation of medical images is a challenging problem with several still not totally solved issues, such as noise interference and image artifacts. Region-based and histogram-based segmentation methods have been widely used in image segmentation. Problems arise when we use these methods, such as the selection of a suitable threshold value for the histogram-based method and the over-segmentation followed by the time-consuming merge processing in the region-based algorithm. To provide an efficient approach that not only produce better results, but also maintain low computational complexity, a new region dividing based technique is developed for image segmentation, which combines the advantages of both regions-based and histogram-based methods. The proposed method is applied to the challenging applications: Gray matter (GM), White matter (WM) and cerebro-spinal fluid (CSF) segmentation in brain MR Images. The method is evaluated on both simulated and real data, and compared with other segmentation techniques. The obtained results have demonstrated its improved performance and robustness.     

Segmentation of parotid glands from registered CT and MR images

PurposeTo develop an automatic multimodal method for segmentation of parotid glands (PGs) from pre-registered computed tomography (CT) and magnetic resonance (MR) images and compare its results to the results of an existing state-of-the-art algorithm that segments PGs from CT images only.MethodsMagnetic resonance images of head and neck were registered to the accompanying CT images using two different state-of-the-art registration procedures. The reference domains of registered image pairs were divided on the complementary PG regions and backgrounds according to the manual delineation of PGs on CT images, provided by a physician. Patches of intensity values from both image modalities, centered around randomly sampled voxels from the reference domain, served as positive or negative samples in the training of the convolutional neural network (CNN) classifier. The trained CNN accepted a previously unseen (registered) image pair and classified its voxels according to the resemblance of its patches to the patches used for training. The final segmentation was refined using a graph-cut algorithm, followed by the dilate-erode operations.ResultsUsing the same image dataset, segmentation of PGs was performed using the proposed multimodal algorithm and an existing monomodal algorithm, which segments PGs from CT images only. The mean value of the achieved Dice overlapping coefficient for the proposed algorithm was 78.8%, while the corresponding mean value for the monomodal algorithm was 76.5%.ConclusionsAutomatic PG segmentation on the planning CT image can be augmented with the MR image modality, leading to an improved RT planning of head and neck cancer.     

基于多孔小波融合的PET/CT 图像增强及其评价

目的:为解决融合图像视觉效果增强与量化信息损失之间的矛盾,本文提出一种基于非降采样的多孔小波(àtrous wavelet)分解的PET/CT图像融合方法,使得融合图像既有利于肿瘤诊断又能用于放疗靶区勾画和放射性定量分析。方法:对PET和CT图像分别进行多孔小波分解,以包含肿瘤目标的适当大小的感兴趣区域的清晰度为目标函数,采用Nelder-Mead算法对PET和CT图像高频分解系数之比进行优化获得最终的融合系数,使融合图像充分增加解剖学信息的同时又尽量保持PET图像原有的局部和整体灰度信息。结果:融合图像质量评价表明,本文方法能将有价值的PET功能信息与精确的CT解剖信息结合在一起,并克服传统小波融合损失图像量化信息的不足。结论:基于多孔小波融合的PET/CT图像既能用于肿瘤诊断,又能同时用于肿瘤学放射性计算和适形放疗计划制定等量化研究。     

Comparaison de la dose efficace en TEP/TDM et en TDM

Hybrid imaging, particularly positron emission tomography (PET) combined with CT has emerged in the field of oncology as a modality of choice. The concomitant realization of a standard CT examination, however, raises the question of the additional dose delivered to the patient. This radiation burden could be avoided by performing a single PET/CT examination with injection of contrast media. To verify the potential dosimetric gain of this strategy, we compared the effective dose associated with each modality in a retrospective cohort of 151 patients, homogeneous in weight and size. The average effective dose for a PET/CT (injection of 5-6 MBq/kg of ¹⁸FDG) was 13.5 mSv, the CT dose representing approximately 80% of the PET dose. In our study, the average effective dose in CT thorax/abdomen/pelvis was 21.4 mSv, 60% higher than the PET/CT effective dose.     

Radiobiological risks in terms of effective dose and organ dose from 18F-FDG whole-body PET/CT procedures

IntroductionIntegrated Positron Emission Tomography (PET) with Computerized tomography (CT) (PET/CT) are widely used to diagnose, stage and track human diseases during whole body scanning. Multi-modality imaging is an interesting area of research that aims at acquiring united morphological-functional image information for accurate diagnosing and staging of the disease. However, PET/CT procedure accompanied with high radiation dose from CT and administered radioactivity. The aim of the present study was to estimate the patients’ dose from ¹⁸F-fluorodeoxyglucose imaging (18F-FDG) hybrid PET/CT whole body scan.Materials and methodsRADAR (Radiation Dose Assessment Resource) software was used to estimate the effective dose for 156 patients (110 (70.5%)) males and 46 (39.5%) female) examined using Discovery PET/CT 710, GE Medical Systems installed at Kuwait Cancer Control Center (KCCC).ResultsThe effective dose results presented in this PET/CT study ranged from (1.56–9.94 mSv). The effective dose was calculated to be 3.88 mSv in females and 3.71 mSv in males. The overall breast (female), lung, liver, kidney and thyroid were 7.4, 7.2, 5.2, 4, 3 and 2.9, respectively.For females, the body mass index (BMI) was 28.49 kg/m² and for males it was 26.50 kg/m² which showed overweight values for both genders. Conclusions: The findings indicate that the effective dose of 18F-FDG in both male and female patients was not substantially different. The study suggested that the risk–benefit proportions of any ¹⁸F-FDG whole body PET/CT scan should be clarified and carefully weighed. Patient’s doses are lower compared with previous studies.     

A novel approach to spot detection for two-dimensional gel electrophoresis images using pixel value collection

Separation of complex mixtures of proteins by two-dimensional gel electrophoresis (2-DE) is a fundamental component of current proteomic technology. Quantitative analysis of the images generated by digitization of such gels is critical for the identification of alterations in protein expression within a given biological system. Despite the availability of several commercially available software packages designed for this purpose, image analysis is extremely resource intensive, subjective and remains a major bottleneck. In addition to reducing throughput, the requirement for manual intervention results in the introduction of operator subjectivity, which can limit the statistical significance of the numerical data generated. A key requirement of image analysis is the accurate definition of protein spot boundaries using a suitable method of image segmentation. We describe a method of spot detection applicable to 2-DE image files using a segmentation method involving pixel value collection via serial analysis of the image through its range of density levels. This algorithm is reproducible, sensitive, accurate and primarily designed to be automatic, removing operator subjectivity. Furthermore, it is believed that this method may offer the potential for improved spot detection over currently available software.     

Optimization of SPECT-CT Hybrid Imaging Using Iterative Image Reconstruction for Low-Dose CT: A Phantom Study

Background

Hybrid imaging combines nuclear medicine imaging such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) with computed tomography (CT). Through this hybrid design, scanned patients accumulate radiation exposure from both applications. Imaging modalities have been the subject of long-term optimization efforts, focusing on diagnostic applications. It was the aim of this study to investigate the influence of an iterative CT image reconstruction algorithm (ASIR) on the image quality of the low-dose CT images.

Methodology/Principal Findings

Examinations were performed with a SPECT-CT scanner with standardized CT and SPECT-phantom geometries and CT protocols with systematically reduced X-ray tube currents. Analyses included image quality with respect to photon flux. Results were compared to the standard FBP reconstructed images. The general impact of the CT-based attenuation maps used during SPECT reconstruction was examined for two SPECT phantoms. Using ASIR for image reconstructions, image noise was reduced compared to FBP reconstructions for the same X-ray tube current. The Hounsfield unit (HU) values reconstructed by ASIR were correlated to the FBP HU values(R² ≥ 0.88) and the contrast-to-noise ratio (CNR) was improved by ASIR. However, for a phantom with increased attenuation, the HU values shifted for low X-ray tube currents I ≤ 60 mA (p ≤ 0.04). In addition, the shift of the HU values was observed within the attenuation corrected SPECT images for very low X-ray tube currents (I ≤ 20 mA, p ≤ 0.001).

Conclusion/Significance

In general, the decrease in X-ray tube current up to 30 mA in combination with ASIR led to a reduction of CT-related radiation exposure without a significant decrease in image quality.