Protocol optimization is critical in Computed Tomography (CT) to achieve high diagnostic image quality while minimizing radiation dose. However, due to the complex interdependencies among CT acquisition and reconstruction parameters, traditional optimization methods rely on exhaustive testing of combinations of these parameters, which is often impractical. This study introduces a novel methodology that combines virtual imaging tools with reinforcement learning to optimize CT protocols more efficiently. Human models with liver lesions were imaged using a validated CT simulator and reconstructed with a novel CT reconstruction toolkit. The optimization parameter space included tube voltage, tube current, reconstruction kernel, slice thickness, and pixel size. The optimization process was performed using a Proximal Policy Optimization (PPO) agent, which was trained to maximize an image quality objective, specifically the detectability index (d') of liver lesions in the reconstructed images. Optimization performance was compared against an exhaustive search performed on a supercomputer. The proposed reinforcement learning approach achieved the global maximum d' across test cases while requiring 79.7% fewer steps than the exhaustive search, demonstrating both accuracy and computational efficiency. The proposed framework is flexible and can accommodate various image quality objectives. The findings highlight the potential of integrating virtual imaging tools with reinforcement learning for CT protocol management.

Automated medical image classification with convolutional neural networks (CNNs) has great potential to impact healthcare, particularly in resource-constrained healthcare systems where fewer trained radiologists are available. However, little is known about how well a trained CNN can perform on images with the increased noise levels, different acquisition protocols, or additional artifacts that may arise when using low-cost scanners, which can be underrepresented in datasets collected from well-funded hospitals. In this work, we investigate how a model trained to triage head computed tomography (CT) scans performs on images acquired with reduced x-ray tube current, fewer projections per gantry rotation, and limited angle scans. These changes can reduce the cost of the scanner and demands on electrical power but come at the expense of increased image noise and artifacts. We first develop a model to triage head CTs and report an area under the receiver operating characteristic curve (AUROC) of 0.77. We then show that the trained model is robust to reduced tube current and fewer projections, with the AUROC dropping only 0.65% for images acquired with a 16x reduction in tube current and 0.22% for images acquired with 8x fewer projections. Finally, for significantly degraded images acquired by a limited angle scan, we show that a model trained specifically to classify such images can overcome the technological limitations to reconstruction and maintain an AUROC within 0.09% of the original model.