RESEARCH ARTICLE Low-dose abdominopelvic computed tomography in patients with lymphoma: An image quality and radiation dose reduction study Sungjin Yoon 1¤‡ , Kwai Han Yoo 2‡ , So Hyun Park ID 1 *, Hawk Kim 2 , Jae Hoon Lee 2 , Jinny Park 2 , Seong Ho Park 3 , Hwa Jung Kim 4 1 Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea, 2 Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea, 3 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, 4 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea ¤ Current address: Department of Radiology, Chungju Medical Center, Chungju-si, Chungcheongbuk-do, Republic of Korea ‡ SY and KHY are contributed equally to this study and share the first authorship. * nnoleeter@naver.com Abstract This study aimed to evaluate image quality, the detection rate of enlarged lymph nodes, and radiation dose exposure of ultralow-dose and low-dose abdominopelvic computed tomogra- phy (CT) in patients with lymphoma. Patients with lymphoma who underwent abdominopelvic CT using dual-source scanner were retrospectively recruited from a single center. CT images were obtained at 90 kVp dual-source mode reformatted in three data sets using the advanced modelled iterative reconstruction algorithm: 100% (standard-dose CT), 66.7% (low-dose CT), and 33.3% (ultralow-dose CT). Two radiologists analyzed subjective image quality and detection of abdominal enlarged lymph nodes on ultralow-dose, low-dose, and standard- dose CT blindly and independently. The results were compared with reference standards. Three readers (two radiologists and one hematologist) reviewed overall image quality and spleen size. In total, 128 consecutive CT scans (77 complete response, 44 partial response, 6 progressive disease, and 1 initial evaluation) from 86 patients (64 B-cell lymphoma, 14 T/ NK-cell lymphoma, and 8 Hodgkin’s lymphoma cases) were assessed. The enlarged lymph node-based detection rates for two readers were 97.0% (96/99) and 94.0% (93/99) on stan- dard-dose CT, 97.0% (96/99) and 94.0% (93/99) on low-dose CT, and 94.0% (93/99) and 89.9% (89/99) on ultralow-dose CT. Overall image quality was 3.8 ± 0.5, 3.9 ± 0.5, and 4.1 ± 0.5 on ultralow-dose CT; 4.7 ± 0.4, 4.6 ± 0.5, and 4.8 ± 0.3 on low-dose CT; and 4.8 ± 0.4, 4.7 ± 0.4, and 4.9 ± 0.2 on standard-dose CT, according to two radiologists and one hematolo- gist, respectively. Intraclass correlation coefficients of spleen size were 0.90 (95% confidence interval [CI], 0.87–0.93), 0.91 (95% CI, 0.88–0.93), and 0.91 (95% CI, 0.88–0.93) on ultra- low-dose, low-dose, and standard-dose CT, respectively. Mean effective radiation doses of standard-dose, low-dose, and ultralow-dose CT were 5.7 ±1.8 mSv, 3.8 ± 1.2 mSv, and 1.9 ± 0.6 mSv, respectively. Our findings suggest that ultralow-dose and low-dose CT, even with PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0272356 August 11, 2022 1 / 14 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Yoon S, Yoo KH, Park SH, Kim H, Lee JH, Park J, et al. (2022) Low-dose abdominopelvic computed tomography in patients with lymphoma: An image quality and radiation dose reduction study. PLoS ONE 17(8): e0272356. https://doi.org/ 10.1371/journal.pone.0272356 Editor: Gayle E. Woloschak, Northwestern University Feinberg School of Medicine, UNITED STATES Received: January 8, 2022 Accepted: July 18, 2022 Published: August 11, 2022 Copyright: © 2022 Yoon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data for this study contain potentially identifying information. The data are contained in the Supporting Information files and available from the Data Access Gil hospital contact via Young-Sup Shim (shimbong78@gilhospital.com). Funding: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea and funded by the Ministry of Science ICT and Future Planning