The Impact of Dose Reduction in Quantitative Kinematic CT of Ankle Joints Using a Full Model-Based Iterative Reconstruction Algorithm: A Cadaveric Study

OBJECTIVE:The objective of our study was to evaluate the quality and reproducibility of semiautomatic measurements of the ankle in low-dose kinematic CT studies using a full model-based iterative reconstruction (MBIR). MATERIALS AND METHODS:Kinematic CT was performed in five cadaveric ankles at three acquisition dose levels: standard dose (1020 mGy × cm), low dose (10% of the standard dose), and ultra-low-dose (1.5% of the standard dose). All images were reconstructed using a full MBIR algorithm. Two semiautomatic measurements (one distance and one angle) were performed by two readers. Registration error was evaluated. The bone aspect on CT and presence of metallic implants were considered in the analysis. The influence of dose on the measurements obtained, reproducibility, and image quality was assessed. RESULTS:With the standard- and low-dose protocols, registration quality was good (registration error, 0.65-4.72%), measurements were similar (p = 0.9), and reproducibility was excellent (intraclass correlation coefficient [ICC] = 0.881). With the ultra-low-dose protocol, the registration quality was poor, yielding measurements significantly different from the other protocols (p < 0.001) and poor reproducibility (ICC = 0.39). In a specimen with normal bone and no metal implant, the registration error was low (0.61-1.01%), measurements were similar (p > 0.5), and reproducibility was excellent (ICC, 0.885-0.996) for the three dose levels tested. CONCLUSION:Full MBIR allows reliable and reproducible measurements in ankle kinematic CT with a low-dose protocol, but an ultra-low-dose protocol may lead to unreliable results.