Quantitative analysis of image quality in low-dose computed tomography imaging for COVID-19 patients

Computed tomography (CT) scan is one of the main tools to diagnose and grade COVID‑19 progression. To avoid the side effects of CT imaging, low‑dose CT imaging is of crucial importance to reduce population absorbed dose. However, this approach introduces considerable noise levels in CT images.

In this light, we set out to simulate four reduced dose levels (60% dose, 40% dose, 20% dose, and 10% dose) of standard CT imaging using Beer– Lambert’s law across 49 patients infected with COVID‑19. Then, three denoising filters, namely Gaussian, bilateral, and median, were applied to the different low‑dose CT images, the quality of which was assessed prior to and after the application of the various filters via calculation of peak signal‑to‑noise ratio, root mean square error (RMSE), structural similarity index measure, and relative CT‑value bias, separately for the lung tissue and whole body.

The quantitative evaluation indicated that 10%‑dose CT images have inferior quality (with RMSE = 322.1 ± 104.0 HU and bias = 11.44% ± 4.49% in the lung) even after the application of the denoising filters. The bilateral filter exhibited superior performance to suppress the noise and recover the underlying signals in low‑dose CT images compared to the other denoising techniques. The bilateral filter led to RMSE and bias of 100.21 ± 16.47 HU and − 0.21% ± 1.20%, respectively, in the lung regions for 20%‑dose CT images compared to the Gaussian filter with RMSE = 103.46 ± 15.70 HU and bias = 1.02% ± 1.68% and median filter with RMSE = 129.60 ± 18.09 HU and bias = −6.15% ± 2.24%.

The 20%‑dose CT imaging followed by the bilateral filtering introduced a reasonable compromise between image quality and patient dose reduction.