Ultra-Low-Dose CT Outperforms Chest X-Rays in Paediatric CF

TOPLINE:

At similar radiation doses, ultra-low-dose CT (ULDCT) achieved superior image quality using AI-enhanced iterative reconstruction than chest x-rays for assessing cystic fibrosis-related lung disease in children. About 88% of healthcare professionals reported greater confidence in diagnosing cystic fibrosis-related lung disease when using CT images rather than x-rays.

METHODOLOGY:

• Researchers recruited 75 observers (50 radiographers and 25 radiologists) from 24 countries who assessed the image quality of 10 randomly selected paired ULDCT and chest x-ray images from a cohort of 70 children with cystic fibrosis (age, 3-18 years).
• ULDCT scans were acquired at 80 kV, 10 mA with deep learning iterative reconstruction to produce images at lower radiation doses.
• Image quality analysis was performed using an image quality survey that was organised into four distinct sections and hosted on DetectED-X.
• Observers rated images on the basis of a 0-4 scale rating system for quality and a 5-point Likert scale for diagnostic confidence evaluation.

TAKEAWAY:

• Overall, 88% of observers reported higher levels of confidence with ULDCT (P < .05) than with chest x-rays (P < .001) in diagnosing cystic fibrosis-related lung disease, with comparable radiation doses between the two modalities.
• The combined visual grading analysis indicated higher image quality for ULDCT images, with radiologists rating ULDCT significantly superior to chest x-rays for lung pathology detection (area under the curve, 0.63; P = .03).
• Overall, 69% vs 50% of observers rated the quality of ULDCT images vs chest x-rays as either adequate (score 3) or better than needed (score 4).
• No significant differences in anatomic visualisation were observed between ULDCT and chest x-rays (P = .306).

IN PRACTICE:

“ULDCT provides superior IQ [image quality] compared to CXR [chest x-rays] in CwCF [children with cystic fibrosis], while maintaining comparable radiation doses,” the authors wrote. “ULDCT also significantly improves diagnostic confidence, highlighting its potential as a viable alternative to CXR,” they concluded.

SOURCE:

This study was led by Niamh Moore, University College Cork, Cork, Ireland. It was published online on July 25, 2025, in European Radiology.

LIMITATIONS: 

Chest x-rays were used as a comparator instead of conventional dose CT, and exposures were not patient specific for ethical reasons. The recruitment of observers from different research hubs having varying illumination levels affected image quality ratings. Additional limitations included the small sample size and selection bias.

DISCLOSURES:

This study received open access funding provided by the IReL Consortium. One author reported having a relationship with DetectED-X.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.