Deep Learning-based calculation of patient size and attenuation surrogates from localizer Image: Toward personalized chest CT protocol optimization

Extracting water equivalent diameter (DW), as a good descriptor of patient size, from the CT localizer before the spiral scan not only minimizes truncation errors due to the limited scan field-of-view but also enables prior size-specific dose estimation as well as scan protocol optimization. This study proposed a unified methodology to measure patient size, shape, and attenuation parameters from a 2D anterior-posterior localizer image using deep learning algorithms without the need for labor-intensive vendor-specific calibration procedures. 3D CT chest images and 2D localizers were collected for 4005 patients. A modified U-NET architecture was trained to predict the 3D CT images from their corresponding localizer scans. The algorithm was tested on 648 and 138 external cases with fixed and variable table height positions. To evaluate the performance of the prediction model, structural similarity index measure (SSIM), body area, body contour, Dice index, and water equivalent diameter (DW) were calculated and compared between the predicted 3D CT images and the ground truth (GT) images in a slicewise manner. The average age of the patients included in this study (1827 male and 1554 female) was 53.8 ± 17.9 (18–120) years. The DW, tube current,and CTDI vol measured on original axial images in the external 138 cases group were significantly larger than those of the external 648 cases (P < 0.05). The SSIM and Dice index calculated between the prediction and GT for body contour were 0.998 ± 0.001 and 0.950 ± 0.016, respectively. The average percentage error in the calculation of DW was 2.7 ± 3.5 %. The error in the DW calculation was more considerable in larger patients (p-value < 0.05). We developed a model to predict the patient size, shape, and attenuation factors slice-by-slice prior to spiral scanning. The model exhibited remarkable robustness to table height variations. The estimated parameters are helpful for patient dose reduction and protocol optimization.