Optimizing Quantum Iterative Reconstruction for Ultra–high-resolution Photon-counting Computed Tomography of the Lung

Purpose: The aim of this study was to find the optimal strength level of QIR for ultra–high-resolution (UHR) PCCT of the lung. Materials and Methods: This retrospective study included 24 patients who had unenhanced chest CT with the novel UHR scan protocol on the PCCT scanner between March 24, 2023 and May 18, 2023. Two sets of reconstructions were made using different slice thicknesses: standard resolution (SR, 1 mm) and ultra–high-resolution (UHR, 0.2 mm), reconstructed with all strength levels of QIR (0 to 4). Attenuation of the lung parenchyma, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were assessed as objective criteria of image quality. Two fellowship-trained radiologists compared image quality and noise level, sharpness of the images, and the airway details using a 5-point Likert scale. Wilcoxon signed-rank test was used for statistical analysis of reader scores, and one-way repeated measures analysis of variance for comparing the objective image quality scores. Results: Objective image quality linearly improved with higher strength levels of QIR, reducing image noise by 66% from QIR-0 to QIR-4 ( P <0.001). Subjective image noise was best for QIR-4 ( P <0.001). Readers rated QIR-1 and QIR-2 best for SR, and QIR-2 and QIR-3 best for UHR in terms of subjective image sharpness and airway detail, without significant differences between them ( P =0.48 and 0.56, respectively). Conclusions: Higher levels of QIR provided excellent objective image quality, but readers’ preference was for intermediate levels. Considering all metrics, we recommend QIR-3 for ultra–high-resolution PCCT of the lung.