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Jůza T, Válek V, Vlk D, Dostál M, Andrašina T. Roles of spectral dual-layer CT, D-dimer concentration, and COVID-19 pneumonia in diagnosis of pulmonary embolism. Eur J Radiol Open 2024; 12:100575. [PMID: 38882633 PMCID: PMC11179566 DOI: 10.1016/j.ejro.2024.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose To demonstrate advantages of spectral dual-layer computed tomography (CT) in diagnosing pulmonary embolism (PE). To compare D-dimer values in patients with PE and concomitant COVID-19 pneumonia to those in patients without PE and COVID-19 pneumonia. To compare D-dimer values in cases of minor versus extensive PE. Methods A monocentric retrospective study of 1500 CT pulmonary angiographies (CTPAs). Three groups of 500 consecutive examinations: 1) using conventional multidetector CT (CTC), 2) using spectral dual-layer CT (CTS), and 3) of COVID-19 pneumonia patients using spectral dual-layer CT (COV). Only patients with known D-dimer levels were enrolled in the study. Results Prevalence of inconclusive PE findings differed significantly between CTS and CTC (0.8 % vs. 5.4 %, p < 0.001). In all groups, D-dimer levels were significantly higher in PE positive patients than in patients without PE (CTC, 8.04 vs. 3.05 mg/L; CTS, 6.92 vs. 2.57 mg/L; COV, 10.26 vs. 2.72 mg/L, p < 0.001). There were also statistically significant differences in D-dimer values between minor and extensive PE in the groups negative for COVID-19 (CTC, 5.16 vs. 8.98 mg/L; CTS 3.52 vs. 9.27 mg/L, p < 0.001). The lowest recorded D-dimer value for proven PE in patients with COVID-19 pneumonia was 1.19 mg/L. Conclusion CTPAs using spectral dual-layer CT reduce the number of inconclusive PE findings. Plasma D-dimer concentration increases with extent of PE. Cut-off value of D-dimer with 100 % sensitivity for patients with COVID-19 pneumonia could be doubled to 1.0 mg/L. This threshold would have saved 110 (22 %) examinations in our cohort.
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Affiliation(s)
- Tomáš Jůza
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 340/20, Brno 625 00, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno 625 00, Czech Republic
| | - Vlastimil Válek
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 340/20, Brno 625 00, Czech Republic
| | - Daniel Vlk
- Department of Biophysics, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno 625 00, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 340/20, Brno 625 00, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno 625 00, Czech Republic
| | - Tomáš Andrašina
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 340/20, Brno 625 00, Czech Republic
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Pannenbecker P, Heidenreich JF, Grunz JP, Huflage H, Gruschwitz P, Patzer TS, Feldle P, Bley TA, Petritsch B. Image Quality and Radiation Dose of CTPA With Iodine Maps: A Prospective Randomized Study of High-Pitch Mode Photon-Counting Detector CT Versus Energy-Integrating Detector CT. AJR Am J Roentgenol 2024; 222:e2330154. [PMID: 37966036 DOI: 10.2214/ajr.23.30154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND. Dual-energy CT pulmonary angiography (CTPA) with energy-integrating detector (EID) technology is limited by the inability to use high-pitch technique. OBJECTIVE. The purpose of this study was to compare the image quality of anatomic images and iodine maps between high-pitch photon-counting detector (PCD) CTPA and dual-energy EID CTPA. METHODS. This prospective study included 117 patients (70 men and 47 women; median age, 65 years) who underwent CTPA to evaluate for pulmonary embolism between March 2022 and November 2022. Fifty-eight patients were randomized to undergo PCD CTPA (pitch, 2.0), and 59 were randomized to undergo EID CTPA (pitch, 0.55). For each examination, 120-kV polychromatic images, 60-keV virtual monogenetic images (VMIs), and iodine maps were reconstructed. One radiologist measured CNR and SNR. Three radiologists independently assessed subjective image quality (on a scale of 1-4, with a score of 1 denoting highest quality). Radiation dose was recorded. RESULTS. SNR and CNR were higher for PCD CTPA than for EID CTPA for polychromatic images and VMIs, for all assessed vessels other than the left upper lobe artery. For example, for PCD CTPA versus EID CTPA, the right lower lobe artery on polychromatic images had an SNR of 34.5 versus 28.0 (p = .003) and a CNR of 29.2 versus 24.4 (p = .001), and on VMIs it had an SNR of 43.2 versus 32.7 (p = .005) and a CNR of 37.4 versus 29.3 (p = .002). For both scanners for readers 1 and 2, the median image quality score for polychromatic images and VMIs was 1, although distributions indicated significantly better scores for PCD CTPA than for EID CTPA for polychromatic images for reader 1 (p = .02) and reader 2 (p = .005) and for VMIs for reader 1 (p = .001) and reader 2 (p = .006). The image quality of anatomic image sets was not different between PCD CTPA and EID CTPA for reader 3 (p > .05). The image quality of iodine maps was not different between PCD CTPA and EID CTPA for any reader (p > .05). For PCD CTPA versus EID CTPA, the CTDIvol was 3.9 versus 4.5 mGy (p = .03), and the DLP was 123.5 mGy × cm versus 157.0 mGy × cm (p < .001). CONCLUSION. High-pitch PCD CTPA provided anatomic images with better subjective and objective image quality versus dual-energy EID CTPA, with lower radiation dose. Iodine maps showed no significant difference in image quality between scanners. CLINICAL IMPACT. CTPA may benefit from the PCD CT technique.
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Affiliation(s)
- Pauline Pannenbecker
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Theresa S Patzer
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Philipp Feldle
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
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Langius-Wiffen E, Nijholt IM, van Dijk RA, de Boer E, Nijboer-Oosterveld J, Veldhuis WB, de Jong PA, Boomsma MF. An artificial intelligence algorithm for pulmonary embolism detection on polychromatic computed tomography: performance on virtual monochromatic images. Eur Radiol 2024; 34:384-390. [PMID: 37542651 DOI: 10.1007/s00330-023-10048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Virtual monochromatic images (VMI) are increasingly used in clinical practice as they improve contrast-to-noise ratio. However, due to their different appearances, the performance of artificial intelligence (AI) trained on conventional CT images may worsen. The goal of this study was to assess the performance of an established AI algorithm trained on conventional polychromatic computed tomography (CT) images (CPI) to detect pulmonary embolism (PE) on VMI. METHODS Paired 60 kiloelectron volt (keV) VMI and CPI of 114 consecutive patients suspected of PE, obtained with a detector-based spectral CT scanner, were retrospectively analyzed by an established AI algorithm. The CT pulmonary angiography (CTPA) were classified as positive or negative for PE on a per-patient level. The reference standard was established using a comprehensive method that combined the evaluation of the attending radiologist and three experienced cardiothoracic radiologists aided by two different detection tools. Sensitivity, specificity, positive and negative predictive values and likelihood ratios of the algorithm on VMI and CPI were compared. RESULTS The prevalence of PE according to the reference standard was 35.1% (40 patients). None of the diagnostic accuracy measures of the algorithm showed a significant difference between CPI and VMI. Sensitivity was 77.5% (95% confidence interval (CI) 64.6-90.4%) and 85.0% (73.9-96.1%) (p = 0.08) on CPI and VMI respectively and specificity 96.0% (91.4-100.0%) and 94.6% (89.4-99.7%) (p = 0.32). CONCLUSIONS Diagnostic performance of the AI algorithm that was trained on CPI did not drop on VMI, which is reassuring for its use in clinical practice. CLINICAL RELEVANCE STATEMENT A commercially available AI algorithm, trained on conventional polychromatic CTPA, could be safely used on virtual monochromatic images. This supports the sustainability of AI-aided detection of PE on CT despite ongoing technological advances in medical imaging, although monitoring in daily practice will remain important. KEY POINTS • Diagnostic accuracy of an AI algorithm trained on conventional polychromatic images to detect PE did not drop on virtual monochromatic images. • Our results are reassuring as innovations in hardware and reconstruction in CT are continuing, whilst commercial AI algorithms that are trained on older generation data enter healthcare.
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Affiliation(s)
- Eline Langius-Wiffen
- Department of Radiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Rogier A van Dijk
- Department of Radiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Erwin de Boer
- Department of Radiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | | | - Wouter B Veldhuis
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Martijn F Boomsma
- Department of Radiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
- Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Pannenbecker P, Huflage H, Grunz JP, Gruschwitz P, Patzer TS, Weng AM, Heidenreich JF, Bley TA, Petritsch B. Photon-counting CT for diagnosis of acute pulmonary embolism: potential for contrast medium and radiation dose reduction. Eur Radiol 2023; 33:7830-7839. [PMID: 37311805 PMCID: PMC10598187 DOI: 10.1007/s00330-023-09777-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the image quality of an ultra-low contrast medium and radiation dose CT pulmonary angiography (CTPA) protocol for the diagnosis of acute pulmonary embolism using a clinical photon-counting detector (PCD) CT system and compare its performance to a dual-energy-(DE)-CTPA protocol on a conventional energy-integrating detector (EID) CT system. METHODS Sixty-four patients either underwent CTPA with the novel scan protocol on the PCD-CT scanner (32 patients, 25 mL, CTDIvol 2.5 mGy·cm) or conventional DE-CTPA on a third-generation dual-source EID-CT (32 patients, 50 mL, CTDIvol 5.1 mGy·cm). Pulmonary artery CT attenuation, signal-to-noise ratio, and contrast-to-noise-ratio were assessed as objective criteria of image quality, while subjective ratings of four radiologists were compared at 60 keV using virtual monoenergetic imaging and polychromatic standard reconstructions. Interrater reliability was determined by means of the intraclass correlation coefficient (ICC). Effective dose was compared between patient cohorts. RESULTS Subjective image quality was deemed superior by all four reviewers for 60-keV PCD scans (excellent or good ratings in 93.8% of PCD vs. 84.4% of 60 keV EID scans, ICC = 0.72). No examinations on either system were considered "non-diagnostic." Objective image quality parameters were significantly higher in the EID group (mostly p < 0.001), both in the polychromatic reconstructions and at 60 keV. The ED (1.4 vs. 3.3 mSv) was significantly lower in the PCD cohort (p < 0.001). CONCLUSIONS PCD-CTPA allows for considerable reduction of contrast medium and radiation dose in the diagnosis of acute pulmonary embolism, while maintaining good to excellent image quality compared to conventional EID-CTPA. CLINICAL RELEVANCE STATEMENT Clinical PCD-CT allows for spectral assessment of pulmonary vasculature with high scan speed, which is beneficial in patients with suspected pulmonary embolism, frequently presenting with dyspnea. Simultaneously PCD-CT enables substantial reduction of contrast medium and radiation dose. KEY POINTS • The clinical photon-counting detector CT scanner used in this study allows for high-pitch multi-energy acquisitions. • Photon-counting computed tomography allows for considerable reduction of contrast medium and radiation dose in the diagnosis of acute pulmonary embolism. • Subjective image quality was rated best for 60-keV photon-counting scans.
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Affiliation(s)
- Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany.
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Theresa S Patzer
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
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Azour L, Ko JP, Toussie D, Gomez GV, Moore WH. Current imaging of PE and emerging techniques: is there a role for artificial intelligence? Clin Imaging 2022; 88:24-32. [DOI: 10.1016/j.clinimag.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
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Huang R, Yan J, Geng H, Yu Q, Sun Z, Liu W, Zhang L, Li C, Li Y. Reduced-Dose Full-Body CT in Lymphoma Follow-up: A Pilot Study. Curr Med Imaging 2022; 19:77-90. [PMID: 35578866 DOI: 10.2174/1573405618666220516123155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND How to reduce the radiation dose received from full-body CT scans during the follow-up of lymphoma patients is a concern. OBJECTIVE The aim of the study was to investigate the image quality and radiation dose of reduced-dose full-body computerized tomography (CT) in lymphoma patients during the follow-up. METHODS 121 patients were included and divided into conventional CT group (group 1, 120-kVp, n = 61) or reduced-dose CT group (group 2, 100-kVp combined dual-energy CT (DECT), n = 60). 140-kVp polychromatic images and 70-keV monochromatic images were reconstructed from DECT. The abdominal virtual non-enhanced (VNE) images were reconstructed from monochromatic images. Two radiologists rated the overall image quality with a five-point scale and graded the depiction of lesions using a four-point scale. The objective image quality was evaluated using image noise, signal-to-noise ratio, and contrast-to-noise ratio. The radiation dose and image quality were compared between the groups. RESULTS The comparable subjective image quality was observed between 70-keV and 120-kVp images in the neck, while 120-kVp images showed better objective image quality. 70-keV images showed better objective image quality in the chest. While the subjective image quality of abdominal VNE images was inferior to that of true non-enhanced images, the improved objective image quality was observed in VNE images. In the abdominal arterial phase, similar subjective image quality was observed between the groups. Abdominal 70-keV images in the arterial phase showed improved objective image quality. Similar image quality was obtained in the abdominal venous phase between the groups. The effective radiation dose in group 2 showed a significant reduction. CONCLUSION The application of reduced-dose full-body CT can significantly reduce the radiation dose for lymphoma patients during the follow-up while maintaining or improving the image quality.
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Affiliation(s)
- Renjun Huang
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Jiulong Yan
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Hongzhi Geng
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Qiuyu Yu
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Zongqiong Sun
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Wenyan Liu
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Ling Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province 510060, P.R. China
- State Key Laboratory of Oncology in South Chinal, Guangzhou City, Guangdong Province 510060, P.R. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province 510060, P.R. China
| | - Caixia Li
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Yonggang Li
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
- Institute of Medical Imaging, Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
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Forss V, Yli-Ollila H, Vatanen J, Kölhi P, Poutanen VP, Palomäki A. The reliability of radiation dose display of a computed tomography scanner. Eur J Radiol Open 2021; 8:100345. [PMID: 33898654 PMCID: PMC8056233 DOI: 10.1016/j.ejro.2021.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
There is variation in the difference between the radiation dose reported by the CT scanner and actual measured dose. This variation is substantial and may differ from zero. To achieve more precise radiation dose data, especially in comparing studies, the average difference should be determined. A correction factor for radiation dose should be utilized for every scanner used in studies.
Background Internationally, the typical allowed difference between the measured radiation dose and dose reported by a computed tomography (CT) scanner is ±20 %. The objective is to describe a method in order to analyse this difference in a CT scanner in the Emergency Department of Kanta-Häme Central Hospital, and to calculate a correction factor for more comparable radiation dose values in further studies. Methods Ten intra-day radiation dose measurements were performed with undisturbed setting. Measurement reports on differences between measured and displayed dose were gathered from the vendor maintenance and supervising authority over a 12-year period. Additionally, two in-house measurements were made. A total of 18 datapoints were collected, with some differences in measurement settings. Data were also analysed against imaging parameters, ambient air pressure and time to identify trends or associations in the variation of the discrepancy. Results Measured doses were generally lower than displayed doses. Differences between displayed and measured doses varied between −3.46 and −0.10 %, with a mean of −1.26 % in the intra-day measurements, and between +4.65 and −17.3 %, with a mean of −7.53 % in the long-term data. There were no trends nor connections in the variations. Conclusion Since the acceptable difference between the radiation dose display and the measured dose is relevant, the average difference for every CT scanner should be determined before radiation dose studies, especially when comparing multiple scanners.
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Affiliation(s)
- V Forss
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Kanta-Häme Central Hospital, Emergency Department, Hämeenlinna, Finland
| | - H Yli-Ollila
- Kanta-Häme Central Hospital, Department of Radiology, Hämeenlinna, Finland
| | - J Vatanen
- Kanta-Häme Central Hospital, Emergency Department, Hämeenlinna, Finland
| | - P Kölhi
- Kanta-Häme Central Hospital, Department of Radiology, Hämeenlinna, Finland
| | - V-P Poutanen
- Kanta-Häme Central Hospital, Department of Radiology, Hämeenlinna, Finland
| | - A Palomäki
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Kanta-Häme Central Hospital, Emergency Department, Hämeenlinna, Finland
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Petritsch B, Pannenbecker P, Weng AM, Veldhoen S, Grunz JP, Bley TA, Kosmala A. Comparison of Dual- and Single-Source Dual-Energy CT for Diagnosis of Acute Pulmonary Artery Embolism. ROFO-FORTSCHR RONTG 2020; 193:427-436. [PMID: 33003244 DOI: 10.1055/a-1245-0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Comparison of dual-source dual-energy CT (DS-DECT) and split-filter dual-energy CT (SF-DECT) regarding image quality and radiation dose in patients with suspected pulmonary embolism. MATERIALS AND METHODS We retrospectively analyzed pulmonary dual-energy CT angiography (CTPA) scans performed on two different CT scanners in 135 patients with suspected pulmonary embolism (PE). Scan parameters for DS-DECT were 90/Sn150 kV (n = 68 patients), and Au/Sn120 kV for SF-DECT (n = 67 patients). The iodine delivery rate was 1400 mg/s in the DS-DECT group vs. 1750 mg/s in the SF-DECT group. Color-coded iodine distribution maps were generated for both protocols. Objective (CT attenuation of pulmonary trunk [HU], signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective image quality parameters (two readers [R], five-point Likert scale), as well as radiation dose parameters (effective radiation dose, size-specific dose estimations [SSDE]) were compared. RESULTS All CTPA scans in both groups were of diagnostic image quality. Subjective CTPA image quality was rated as good or excellent in 80.9 %/82.4 % (R1 / R2) of DS-DECT scans, and in 77.6 %/76.1 % of SF-DECT scans. For both readers, the image quality of split-filter iodine distribution maps was significantly lower (p < 0.05) with good or excellent ratings in only 43.3 %/46.3 % (R1 / R2) vs. 83.8 %/88.2 % for maps from DS-DECT. The HU values of the pulmonary trunk did not differ between the two techniques (p = n. s.), while both the SNR and CNR were significantly higher in the split-filter group (p < 0.001; p = 0.003). Both effective radiation dose (2.70 ± 1.32 mSv vs. 2.89 ± 0.94 mSv) and SSDE (4.71 ± 1.63 mGy vs. 5.84 ± 1.11 mGy) were significantly higher in the split-filter group (p < 0.05). CONCLUSION The split-filter allows for dual-energy imaging of suspected pulmonary embolism but is associated with lower iodine distribution map quality and higher radiation dose. KEY POINTS · The split-filter allows for dual-energy data acquisition from single-source single-layer CT scanners.. · Compared to the assessed dual-source dual-energy system, split-filter dual-energy imaging of a suspected pulmonary embolism is associated with lower iodine distribution map quality and higher radiation dose.. · Both the split-filter and the dual-source scanner provide diagnostic image quality in CTPA.. CITATION FORMAT · Petritsch B, Pannenbecker P, Weng AM et al. Comparison of Dual- and Single-Source Dual-Energy CT for Diagnosis of Acute Pulmonary Artery Embolism. Fortschr Röntgenstr 2021; 193: 427 - 436.
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Affiliation(s)
- Bernhard Petritsch
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Pauline Pannenbecker
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas Max Weng
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Simon Veldhoen
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Aleksander Kosmala
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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