Category: CT Scanners

New CT Protocols Reduce Radiation Dose

Posted on by Brian Casey

With patient safety top of mind these days, radiology professionals are correct to focus on performing CT scans with less radiation. To that end, three recently published research studies highlight new protocols to do just that.

Radiation safety has been one of the top radiology stories in 2025 following several studies underscoring the links between medical radiation and cancer. 

  • The irony is that patient radiation exposure can be reduced dramatically using protocols that already exist – it’s just a matter of applying them consistently in the real world. 

In the first paper, published in European Journal of Radiology, researchers share their MINDS-CAD protocol for coronary CT angiography. 

  • MINDS-CAD relies on tailoring contrast dose to patient weight and CT scanner tube voltage using a five-step process. 

MINDS-CAD was tested with 112 obese patients getting clinically indicated CCTA with Siemens Healthineers’ Somatom Force dual-source CT scanner and Bayer’s Ultravist 370 contrast agent. Researchers found that compared to a conventional tube voltage-adapted protocol, MINDS-CAD…

  • Achieved superior image quality according to cases rated “good” or “excellent” (86% vs. 75%).
  • Generated fewer poor-quality scans (3.5% vs. 8.8%).
  • Produced sharply lower radiation dose (99 vs. 386 mGy•cm).
  • Saw no link between vascular attenuation and BMI or tube voltage.

In a second EJR paper, researchers from India tested the ability of an AI-based reconstruction algorithm to reduce dose in cerebral CTA exams.

  • They used Philips’ Precise Image AI-based reconstruction protocol, which produces images resembling traditional filtered back projection scans while reducing noise like advanced iterative reconstruction methods.

In tests with 68 patients who got cerebral CTA at 100 kVp, compared to iterative reconstruction, Precise Image…

  • Improved contrast-to-noise ratio 26%, signal-to-noise ratio 22%, and visual noise 16%.
  • Generated higher image quality scores from radiologists.
  • Generated an extremely low median effective dose of 0.785 mSv.

Finally, a third study – this one in Clinical Radiology – used a “double low” technique of low-energy 50 keV images on GE HealthCare’s Revolution Apex dual-energy CT scanner with TrueFidelity deep learning image reconstruction on 60 patients with cirrhotic liver disease. 

  • Compared with a conventional protocol, the double-low technique had 48% lower radiation entrance dose (4.10 vs. 7.88 mSv) and 32% lower contrast dose (67.3 vs. 99.1 mL), while image quality was rated higher.

The Takeaway

Taken together, the new papers show that radiology’s radiation dose challenge is eminently solvable thanks to the ingenuity of clinicians and researchers who are pioneering new ways to scan.

Malpractice Reform Linked to Less Imaging Use

Posted on by Brian Casey

We all know it happens – medical imaging scans of questionable clinical value, performed not to improve patient diagnosis but to defend clinicians in the event of malpractice litigation. A new study in AJR supports the idea that defensive medicine is driving up imaging use by finding a link between malpractice reform and lower emergency imaging utilization. 

The proliferation of imaging technology throughout the healthcare enterprise – and especially in the emergency setting – gives clinicians a powerful tool that’s just too tempting not to use.

  • Head CT scans can quickly rule out patients who might have a hemorrhagic stroke, for example, while cardiac CT angiography is showing its value for working up patients with chest pain. 

But with great power comes great responsibility. Unnecessary imaging not only drives up healthcare costs but can expose patients to additional radiation as well as complications from working up suspicious findings.

  • Medical-legal experts speculate that malpractice reform through tools such as damage caps could tamp down defensive medicine by limiting physicians’ legal exposure to lawsuits in the event they make a mistake.

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute tested the idea by analyzing 630k Medicaid encounters for patients with headache presenting to the emergency department in 2019. 

  • They then correlated head and neck imaging volume to various factors that could influence utilization, including whether states had implemented tort reform. 

Their analysis discovered that emergency imaging utilization was less likely to occur…

  • In states with laws on “several liability” (in which parties are only responsible for their own share of damages) (OR = 0.68).
  • In states with malpractice damage caps (OR = 0.79).
  • In states with greater mean malpractice payment (although the effect size was minimal; OR = 0.99).

A couple other interesting findings included…

  • Referring physicians other than emergency medicine were far more likely to order more imaging (OR = 8.45).
  • Facilities with fewer than 100 beds were less likely to order imaging (OR = 0.65).

The Takeaway

The new findings linking malpractice reforms with lower emergency imaging use confirm what many of us have already suspected. Whether they lead to health policy reforms remains to be seen. 

Doubling Lung Screening Rates with Patient Outreach

Posted on by Brian Casey

Low CT lung cancer screening rates have disappointed medical imaging professionals and public health advocates alike since the test received USPSTF recommendation over 10 years ago. But a new study shows how one health system doubled its lung cancer screening rates – to levels approaching those of more established cancer screening exams. 

USPSTF recommended low-dose CT lung cancer screening in 2013, but 10 years later patient screening rates languished in the mid-teens, compared to rates of around 75% for breast and cervical cancer and above 72% for colorectal cancer. 

  • That means many lung cancer patients are showing up with late-stage disease, when it’s more difficult to cure. Perhaps as a result, lung cancer is expected to cause almost 125k deaths in the U.S. in 2025.

Breaking that cycle was the goal of researchers at the University of Rochester Medical Center in New York, who wrote about their experiences in a study published in NEJM Catalyst. 

  • They wanted to boost lung cancer screening adherence across their network of 42 locations in western New York. 

So how did they do it? Success came through a combination of IT innovation and old-fashioned legwork in patient outreach. Clinicians…

  • Provided evidence on lung cancer screening to primary care providers.
  • Updated their EHR software to identify patients eligible for lung screening based on the daily schedule to provide screening prompts during patient visits.
  • Created dashboards to guide outreach to patients due or overdue for screening exams.
  • Developed an extensive follow-up program with patient navigators to facilitate recall for annual exams.
  • Created a centralized pulmonary team to provide referrals for smoking cessation, conduct shared decision making for screening exams, and manage pulmonary nodules.

The program produced immediate results. In an analysis comparing screening rates in March 2022 to June 2025, researchers found…

  • Lung screening rates doubled (from 33% to 72%).
  • On-time completion of annual LDCT screening exceeded 94%.
  • 78% of lung cancer cases in 2023 and 2024 were diagnosed at an early stage.
  • There were no statistically significant differences in screening rates by patient race.

The Takeaway
The new results match up with recent findings – such as those presented at WCLC 2025 in September – underscoring the importance of reaching out to potential lung cancer screening candidates to bring them into the fold. Despite CT lung screening’s halting history, these studies show that it can be done.

Reducing CT Radiation Dose System-Wide

Posted on by Brian Casey

CT radiation dose has been one of the top radiology headlines this year due to the publication of several studies linking radiation to cancer risk. But new research offers hope that CT radiation dose can be reduced, even across large healthcare systems. 

CT’s link to cancer risk has been controversial, but most established models connect low-level radiation to cancer formation.

There are lots of great technologies for reducing CT radiation dose, from photon-counting CT to adjusting scanner parameters like mA and kVp, while image reconstruction algorithms can upscale noisy low-dose images to look like higher-quality exams.

  • But the problem has always been getting these technologies into the hands of clinicians – and then making sure they use them, especially across large multi-center health systems, where dose can vary even within the same network.  

Taking a crack at the problem were cardiologists from Lee Health Heart Institute in Fort Myers, Florida, in a new paper in JACC: Case Reports. 

  • They specifically looked at radiation dose for coronary CT angiography exams, determining that based on the literature an optimal radiation dose for CCTA should be ≤ 4 mSv – lower than the system’s 6.2 mSv median dose. 

So they implemented several strategies for reducing CCTA dose…

  • Standardizing scanning protocols that emphasized prospective ECG gating, reduced field of view, BMI-tailored tube voltage (kVp), and elimination of redundant imaging phases.
  • Setting parameters for single-source CT at 100 kVp for patients with BMI <30 and 120 kVp for BMI ≥30, with prospective scanning for 60-80% of the cardiac cycle.
  • Using similar kVp settings for dual-source CT scanners, but implementing systolic imaging between 250-450 milliseconds.

How well did it work? After reviewing the program, researchers found…

  • System-wide radiation dose fell 23% (4.8 vs. 6.2 mSv).
  • Diagnostic quality improved as measured by the acceptance rate for FFR-CT exams (93% vs. 91%). 
  • Dose consistency was achieved across locations despite differences in scanner models and practices.

The Takeaway

The new study on CCTA radiation dose shows that dose can be reduced system-wide while maintaining – and even improving – diagnostic image quality. Is it a problem that the research was led by cardiologists and not radiologists? Not if you’re a patient. 

Does BMI Affect AI Accuracy?

Posted on by Brian Casey

High body mass index is known to create problems for various medical imaging modalities, from CT to ultrasound. Could it also affect the accuracy of artificial intelligence algorithms? Researchers asked this question as it pertains to lung nodule detection in a new study in European Journal of Radiology. 

X-ray photons attenuate as they pass through body tissue, which can decrease image quality and produce more noise.

  • This is particularly a challenge for CT exams that don’t use a lot of radiation, like low-dose CT lung screening. 

At the same time, AI algorithms are being developed to make LDCT screening more efficient, such as by identifying and classifying lung nodules.

  • But if high BMI makes CT images noisier, will that affect AI’s performance? Researchers from the Netherlands tested the idea in 352 patients who got LDCT screening as part of the Lifelines study.

Researchers compared patients at both the high end of the BMI spectrum (mean 39.8) and low end (mean 18.7). 

  • Lung nodule detection by both Siemens Healthineers’ AI-Rad Companion Chest CT algorithm and a human radiologist was performed and compared. 

Across the study population, researchers found…

  • There was no statistically significant difference in AI’s sensitivity between high and low BMI groups (0.75 vs. 0.80, p = 0.37). 
  • Nor was there any difference in the human radiologist’s sensitivity (0.76 vs. 0.84, p = 0.17).
  • AI had fewer false positives per scan in the high BMI group than low BMI (0.30 vs. 0.55), a difference that was statistically significant (p = 0.05). 
  • While the difference in false positives with the human radiologist was not statistically significant (0.05 vs. 0.16, p = 0.09).

The study authors attributed AI’s lower performance to more noise in the high BMI scans.

  • They recommended that AI developers include people with both high and low BMI in datasets used for training algorithms.

The Takeaway

The results offer some comfort that patient BMI probably doesn’t have a huge effect on AI performance for nodule detection in lung screening, but it suggests a possible effect that might have achieved statistical significance with a larger sample size. More study in the area is definitely needed given the rising importance of AI for CT lung cancer screening. 

Obesity Drives CT Radiation Dose Higher

Posted on by Brian Casey

The proportion of patients getting CT scans with high radiation doses more than tripled over a five-year period. That’s according to a new study in British Journal of Radiology that found the rate of high-dose CT rising along with growing obesity rates – despite technical advances in CT instrumentation.

CT radiation dose has been closely watched due to its potential to cause cancer.

  • A controversial paper published earlier this year in JAMA Internal Medicine estimated that all the CT scans performed in a year in the U.S. would cause 100k cancers.
  • And another recent paper made a connection between the number of CT scanners installed in a country and the number of patients with high cumulative radiation exposure (over 100 mSv) over five years.

In the new paper, a research team led by radiation safety expert Madan Rehani, PhD, tracked radiation exposure to patients who got CT exams at Massachusetts General Hospital from 2013 to 2022. 

  • They defined high-dose CT exams as those in which individual exam radiation dose exceeded 50 mSv. 

Over a 10-year period, nearly 1.4 million CT exams were performed on 382k patients, revealing that the rate of CT exams with effective doses ≥ 50 mSv…

  • Was less than 1%, but more than tripled from 2017 to 2022 (0.25% to 0.86%).
  • 59% of high-dose exams were multiphase studies (≥ 3 phases).
  • The rate of high-dose CT exams rose 7X faster in overweight and obese patients than in their underweight or normal-weight counterparts in a subset of 5k patients with available BMI data.

There was a close association between obesity and radiation dose, as patients with larger body habitus require more radiation to penetrate deeper for diagnostic-quality images. 

  • Ironically, the introduction of CT scanners with higher table weight capacity and larger gantry diameter may have contributed to the increase by making it possible to scan patients who previously were too large to be imaged.

Researchers also believe the rise in radiation dose starting in 2018 occurred around the same time as MGH’s introduction of more advanced CT scanners with more powerful X-ray tubes.

The Takeaway

The new findings on CT radiation dose illustrate the balancing act that imaging providers face between radiation safety and achieving optimal image quality. With obesity rates steadily rising, it’s a choice that will become increasingly common. 

CT Lung Screening Chats Pay Off

Posted on by Brian Casey

Patients who talked about CT lung cancer screening with their doctors were more likely to actually follow through on getting scanned. That’s according to a study this week in CHEST that offers support for shared decision making – a process that some screening proponents have criticized.

The U.S. continues to see disappointing compliance rates for CT lung cancer screening, over 10 years after the USPSTF recommended the exam.

  • Some lung screening proponents suggest that one barrier to screening is a CMS rule requiring a shared decision-making session between patients and doctors before the first scan is performed – a requirement that’s not in place for any of the other major cancer screening tests.

But the new study indicates that shared decision making could actually work to boost compliance. 

  • Researchers from the Harvey L. Neiman Health Policy Institute led by first author YoonKyung Chung, PhD, examined lung screening compliance rates for 22.6k people who had their first CT exam between 2016 and 2019.

Researchers looked at differences in annual follow-up lung screening rates between people who got shared decision-making sessions and those who didn’t, finding… 

  • Only 11% of study participants had a session before their first scan.
  • One year after the initial scan, those who participated in sessions were 27% more likely to get a follow-up exam.
  • Four years later, the compliance rate rose to 33%. 

If CMS requires shared decision-making sessions for reimbursement, why are they occurring so infrequently? 

  • The authors called this phenomenon “puzzling,” and suggested it’s because CMS is not enforcing the mandate through tools like claims denial. CMS could also boost utilization by providing higher reimbursement for the discussions.

The Takeaway

The new findings suggest that shared decision making should be viewed as an opportunity rather than a barrier to convincing patients of CT lung cancer screening’s value. The results track with other studies showing that a high-touch approach with tools like patient navigators can work.

CT Use Linked to Higher Radiation Exposure

Posted on by Brian Casey

A new study revisits the debate over CT radiation risk, finding a link between greater use of CT scanning in a country and the percentage of patients getting higher cumulative doses of radiation over time.

Managing medical radiation has been a priority for decades, but the issue gained new prominence in April with the publication of a controversial paper linking CT use to future cancers. 

  • Critics accused study authors of sensationalizing the radiation dose issue, but researchers pointed out that they used existing models for radiation dose and cancer risk.

Enter the new study, in which a team led by international radiation safety expert Madan Rehani, PhD, calculated the number of patients getting over 100 mSv of cumulative radiation dose over five years across 27 countries, mostly in Europe. 

  • Radiation at such levels is concerning due to the established dose-response nature of current radiation theory – that is, higher doses are believed to lead to higher cancer risk.

Radiation dose exposure rates for CT, fluoroscopy-guided interventions, and PET were analyzed for 2022 for 513M people from Austria to the U.K., with a particular focus on patients getting over 100 mSv in a five-year period. 

  • For point of reference, a chest X-ray PA view is typically 0.02 mSv, a CT scan 1-10 mSv, and the average for a year of background radiation is about 3 mSv.

Researchers found … 

  • In all, 0.27% of the population received cumulative radiation exposure over 100 mSv.
  • The countries with the highest rates of patients per 1k getting over 100 mSv included Belgium (4.52), Portugal (4.48), Luxembourg (4.19), and France (4.15).
  • These same countries also tended to have the highest use rates of CT exams per 1k population, led by Portugal (285), Luxembourg (249), Belgium (226), and France (224).
  • Countries with the lowest exposure rates over 100 mSv included Finland (1.09), Romania (1.1), Norway (1.64), and Bulgaria (1.76), and all had CT use rates below 100 exams per 1k population.

While the U.S. was not included in the study, other research shows it might fall at the upper end of the scale – if not at the top. 

The Takeaway

The new study offers a sobering take on the radiation dose issue. While reasonable people can debate the exact link between low-level radiation exposure and cancer risk, it’s harder to justify such wide variation in CT use and cumulative radiation exposure between countries, especially those at similar levels of economic development.

Integrated Solutions for Managing Incidental CAC Findings

Posted on by Partner Content

The rising prominence of coronary artery calcium as a prognostic marker for heart disease has created an emerging challenge for radiologists: how should they manage incidental CAC findings discovered on routine CT exams? Fortunately, new industry collaborations are making it possible to deliver CAC reports to clinicians without disrupting workflow. 

Routine CT scans are revealing data beyond their original diagnostic intent.

  • AI solutions – such as AVIEW CAC from Coreline Soft – play a pivotal role in identifying risks for cardiovascular disease, osteoporosis, and metabolic disorders – all from a single scan.

AI allows one CT scan to assess lung, cardiovascular, and skeletal health, improving diagnosis and treatment planning.

One imaging services provider that has put AVIEW CAC into use is 3DR Labs, which has been actively integrating the solution into its nationwide clinical network.

  • The partnership enables 3DR Labs radiologists to generate consistent, high-quality CAC reports directly within PACS, while significantly reducing turnaround times.

3DR Labs is finding that AVIEW CAC optimizes workflow efficiency and significantly reduces the time required for CAC assessment. 

  • It also ensures that radiologic technologists can perform quick QA checks, enhancing consistency and reliability in the delivery of the report.

The latest generation of the FDA-cleared AVIEW CAC features an upgraded user interface and advanced batch-scoring functionality. 

  • 3DR Labs is now working to expand AI-driven insights into lung and neuroimaging through Coreline’s broader AVIEW platform (AVIEW ILA for interstitial lung abnormalities and AVIEW BAS for brain CT).

Beyond diagnostic imaging, this collaboration supports growing demands for cost-efficiency in healthcare. 

  • As U.S. insurers and government agencies recognize the ROI potential of early AI detection, platforms like AVIEW CAC offer scalable, high-performance solutions that lower costs and streamline care delivery.

3DR Labs has also highlighted Coreline Soft’s role as a founding partner in AI Labs, the company’s vendor-neutral platform to deliver the latest AI innovations to radiology workflows.

The Takeaway

New partnerships like the collaboration between Coreline Soft and 3DR Labs are advancing the future of AI in radiology – focusing on automation, early detection, and better patient outcomes through powerful, clinically validated technologies. Such partnerships not only reflect increasing adoption of AI in U.S. healthcare but set the stage for global transformation in diagnostic imaging.

CT Cancer Risk Study Raises Questions

Posted on by Brian Casey

The radiology world was turned on its head this week with the publication of a new paper in JAMA Internal Medicine on CT radiation risk. Researchers estimated that all the CT scans performed in the U.S. in a single year would cause more than 100k cancers over the lives of the patients who got them. 

Radiation risk has always been the Achilles heel of CT, radiology’s workhorse modality for advanced imaging. 

  • But CT is plagued by dose variation and a lack of reporting on exactly how much dose patients are getting – especially when it exceeds guidelines.

In the new study, researchers led by radiation safety expert Rebecca Smith-Bindman, MD, of UCSF used existing estimates of low-level radiation risk to calculate how many cancers would result from the 93M CT scans performed in the U.S. in 2023, finding …

  • CT radiation dose would cause 103k future cancers over the lifetimes of the patients.
  • At the current rate, “CT-associated cancer” would account for 5% of all cancers – about the same number caused by alcohol. 
  • The study’s projection of CT-linked cancers is 3X-4X higher than previous estimates, mostly due to the growth in CT utilization. 

The paper generated pushback from sources including the ACR and AAPM, who questioned whether it really reveals any new information about the risks of CT radiation. 

  • They reiterated the medical value of CT scans, noting that the research was based on statistical models and that there are no published studies directly linking CT scans to cancer.

Another thing the paper doesn’t touch on are the dramatic reductions in CT radiation dose that have occurred in recent years. 

  • CT protocol optimization and AI-based data reconstruction – as well as technologies like photon-counting CT – have enabled imaging professionals to reduce doses to levels previously thought impossible, such as under 1 mSv for a routine chest exam. 

To help providers manage dose, CMS this year launched new dose reporting quality measures, CMS1074v2, designed to reward radiology practices for tracking and reporting radiation dose. 

  • Smith-Bindman is a co-founder of Alara Imaging, which provides software to help radiology providers comply with the new CMS measures. ACR also offers a variety of dose optimization and monitoring tools.

The Takeaway

So what to make of the new study? On the one hand, the sensational headlines it generated could scare many patients away from getting medically necessary CT scans. On the other, any attention toward radiation dose reduction and appropriate imaging is a good thing, and if it spurs new efforts toward more judicious and consistent use of CT at lower radiation levels, so much the better. 

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