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Kazimierczak W, Kazimierczak N, Serafin Z. Review of Clinical Applications of Dual-Energy CT in Patients after Endovascular Aortic Repair. J Clin Med 2023; 12:7766. [PMID: 38137834 PMCID: PMC10743598 DOI: 10.3390/jcm12247766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/08/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Abdominal aortic aneurysms (AAAs) are a significant cause of mortality in developed countries. Endovascular aneurysm repair (EVAR) is currently the leading treatment method for AAAs. Due to the high sensitivity and specificity of post-EVAR complication detection, CT angiography (CTA) is the reference method for imaging surveillance in patients after EVAR. Many studies have shown the advantages of dual-energy CT (DECT) over standard polyenergetic CTA in vascular applications. In this article, the authors briefly discuss the technical principles and summarize the current body of literature regarding dual-energy computed tomography angiography (DECTA) in patients after EVAR. The authors point out the most useful applications of DECTA in this group of patients and its advantages over conventional CTA. To conduct this review, a search was performed using the PubMed, Google Scholar, and Web of Science databases.
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Affiliation(s)
- Wojciech Kazimierczak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland
| | - Natalia Kazimierczak
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland
| | - Zbigniew Serafin
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland
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Daniel S, Kopp M, Vollbrecht T, Zeilinger M, Fitz T, Muttke A, Feuerlein U, Uder M, May MS. Personalization of thoracoabdominal CT examinations using scanner integrated clinical decision support systems - Impact on the acquisition technique, scan range, and reconstruction type. Eur J Radiol 2023; 167:111078. [PMID: 37688917 DOI: 10.1016/j.ejrad.2023.111078] [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: 05/07/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES This study evaluates the impact of a scanner-integrated, customized clinical decision support system (CDSS) on the acquisition technique, scan range, and reconstruction in thoracoabdominal CT. MATERIALS AND METHODS We applied CDSS in contrast-enhanced examinations of the trunk with various clinical indications on a recent scanner with the capability of dual-energy CT (DECT), anatomic landmark detection (ALD), and iterative metal-artifact reduction (MAR). Simple and comprehensive questions about the patient's breath hold capability, the anatomical region of interest, and metal implants can be answered after the localizer. The acquisition technique (single energy, SECT, or dual energy), scan range (chest-abdomen-pelvis or chest-abdomen), and reconstruction technique (with or without MAR) were then automatically adapted in the examination protocols in coherence with these selections. Retrospectively, we compared the usage rates for these techniques in 624 examinations on the study scanner with 740 examinations on a comparable scanner without CDSS. Subgroup analysis of effective dose (ED), scan duration, and image quality (IQ) was performed in the study group. RESULTS CDSS leads to an increased usage rate of DECT (64.4% vs. 2.8%) and MAR (75.4% vs. 44.0%). All scan range adaptations by ALD were successful. The resulting subjective IQ between single energy and DECT acquisitions was comparable (all p > 0.05). Scan duration was significantly longer in DECT than in SECT (16.9 s vs. 6.5 s; p < 0.001). However, the objective IQ was significantly higher in DECT (CNRD 2.1 vs. 1.8; p < 0.01), and the ED significantly lower (6.7 mSv vs. 7.6 mSv; p = 0.004). CONCLUSION CDSS for thoracoabdominal CT leads to a substantially increased usage rate of innovative techniques during acquisition and reconstruction. Patients with adapted protocols benefit from improved image quality and increased post-processing options at lower radiation doses.
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Affiliation(s)
- Sascha Daniel
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.
| | - Markus Kopp
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Thomas Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Martin Zeilinger
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Tim Fitz
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | | | | | - Michael Uder
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany; Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Matthias S May
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany; Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
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Towfighi S, Bajaj S, Aggarwal T, Nguan C, Pang E. An evaluation of the contribution of routine ultrasound when performed with multiphase CT in renal donor imaging assessment. Eur Radiol 2023; 33:6592-6598. [PMID: 37017701 DOI: 10.1007/s00330-023-09578-0] [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: 07/28/2022] [Revised: 02/14/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES We sought to examine the contribution of routine ultrasound when performed with computed tomography in identifying exclusion criteria in potential living kidney donors. METHODS We performed a 10-year retrospective cohort study including all cases of potential renal donors at our center. For each case, the donor workup ultrasound (US) and multiphase computed tomography (MPCT) original reports and imaging were reviewed by a fellowship-trained abdominal radiologist in consultation with a transplant urologist and placed into one of 3 groups: (1) no significant US contribution, (2) US was useful to characterize an incidental finding (either US exclusive or US aided in CT interpretation) but did not impact donor eligibility, and (3) an US exclusive finding contributed to donor exclusion. RESULTS A total of 432 potential live renal donors were evaluated (mean age 41, 263 women). In total, 340 (78.7%, group 1) cases had no significant US contribution. In 90 cases (20.8%, group 2), US helped to characterize one or more incidental findings but did not contribute to donor exclusion. In 1 (0.2%, group 3) case, an US exclusive finding (suspected medullary nephrocalcinosis) contributed towards donor exclusion. CONCLUSION US provided limited contribution to renal donor eligibility decisions when performed routinely with MPCT. CLINICAL RELEVANCE Routine ultrasound could potentially be omitted in the live renal donor workup, with alternative strategies including a selective approach to incorporating ultrasound and an expanded role of dual-energy CT. KEY POINTS • Ultrasound is performed routinely with CT for renal donor assessment in some jurisdictions; however, this practice has come into question particularly with advances in dual-energy CT. • Our study found that routine use of ultrasound provided limited contribution, primarily assisting CT in characterization of benign findings with only 1/432 (0.2%) potential donors in a 10-year period excluded based in part on an ultrasound exclusive finding. • The role of ultrasound can be narrowed to a targeted approach for certain at-risk patients, and can be further reduced if dual-energy CT is utilized.
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Affiliation(s)
- Sohrab Towfighi
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sargun Bajaj
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Trisha Aggarwal
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Nguan
- Department of Urology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Emily Pang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
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Borges AP, Antunes C, Curvo-Semedo L. Pros and Cons of Dual-Energy CT Systems: "One Does Not Fit All". Tomography 2023; 9:195-216. [PMID: 36828369 PMCID: PMC9964233 DOI: 10.3390/tomography9010017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Dual-energy computed tomography (DECT) uses different energy spectrum x-ray beams for differentiating materials with similar attenuation at a certain energy. Compared with single-energy CT, it provides images with better diagnostic performance and a potential reduction of contrast agent and radiation doses. There are different commercially available DECT technologies, with machines that may display two x-ray sources and two detectors, a single source capable of fast switching between two energy levels, a specialized detector capable of acquiring high- and low-energy data sets, and a filter splitting the beam into high- and low-energy beams at the output. Sequential acquisition at different tube voltages is an alternative approach. This narrative review describes the DECT technique using a Q&A format and visual representations. Physical concepts, parameters influencing image quality, postprocessing methods, applicability in daily routine workflow, and radiation considerations are discussed. Differences between scanners are described, regarding design, image quality variabilities, and their advantages and limitations. Additionally, current clinical applications are listed, and future perspectives for spectral CT imaging are addressed. Acknowledging the strengths and weaknesses of different DECT scanners is important, as these could be adapted to each patient, clinical scenario, and financial capability. This technology is undoubtedly valuable and will certainly keep improving.
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Affiliation(s)
- Ana P. Borges
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
- Correspondence:
| | - Célia Antunes
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
| | - Luís Curvo-Semedo
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
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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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Hansson J, Månsson LG, Båth M. EVALUATION OF VGC ANALYZER BY COMPARISON WITH GOLD STANDARD ROC SOFTWARE AND ANALYSIS OF SIMULATED VISUAL GRADING DATA. RADIATION PROTECTION DOSIMETRY 2021; 195:378-390. [PMID: 33940628 PMCID: PMC8507457 DOI: 10.1093/rpd/ncab066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/09/2021] [Accepted: 04/03/2021] [Indexed: 06/12/2023]
Abstract
The purpose of the present work was to evaluate the use of resampling statistical methods for analysis of visual grading data-implemented in the software VGC Analyzer-by comparing the reanalyzed results from previously performed visual grading studies with the results calculated by gold standard receiver operating characteristic (ROC) methodology, Obuchowski-Rockette (OR)-Dorfman-Berbaum-Metz (DBM) multiple-readers and multiple-case (MRMC) and by analysis of simulated visual grading data where the true distribution was presumed to be known. The reanalysis was performed on two multiple-reader studies with non-paired data and paired data, respectively. The simulation study was performed by simulating a large number of visual grading characteristics (VGC) studies and by analyzing the statistical distribution of null hypothesis (H0) rejection rate. The comparison with OR-DBM MRMC showed good agreement when analyzing non-paired data for both fixed-reader and random-reader settings for the calculated area under the curve values and the confidence intervals (CIs). For paired data analysis, VGC Analyzer showed significantly lower CIs compared with the ROC software. This effect was also illustrated by the simulation study, where the VGC Analyzer, in general, showed good accuracy for simulated studies with stable statistical basis. For simulated studies with unstable statistics, the accuracy in the H0 rejection rate decreased. The present study has shown that resampling methodology can be used to accurately perform the statistical analysis of a VGC study, although the resampling technique used makes the method sensitive to small data sets.
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Affiliation(s)
| | - Lars Gunnar Månsson
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
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Does dual-energy abdominal computed tomography increase the radiation dose to patients: a prospective observational study. Pol J Radiol 2021; 86:e208-e216. [PMID: 34093917 PMCID: PMC8147716 DOI: 10.5114/pjr.2021.105594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023] Open
Abstract
Purpose The aim of our study was to compare single-energy (SECT) and dual-energy (DECT) abdominal computed tomography (CT) examinations in matched patient cohorts regarding the differences in effective radiation dose (ERD) and image quality performed in a third-generation dual-source computed tomography (DSCT) scanner. Material and methods Our study included 100 patients, who were divided randomly into 2 groups. The patients included in Group A were scanned by SECT, and Group B members were scanned by DECT. Volume CT dose index (CTDIvol), dose length product (DLP), and ERD for venous phase acquisition were recorded in each patient and were normalised for 40 cm. Analyses were performed by using statistical software (SPSS version 20.0 for windows), and Bonferroni correction for multiple comparisons was applied for p-values and confidence intervals. Results Average ERD based on DLP values normalised for 40 cm acquisition were obtained for both Group A and Group B. The mean ERD for Group A was 11.89 mSv, and for group B it was 6.87 mSv. There was a significant difference in these values between Group A and Group B as shown by a p-value of < 0.001. On subjective and objective analysis, there was no statistically significant difference in image quality between the 2 groups. Conclusions The protocols in third-generation DSCT using dual-energy mode resulted in significant reductions in the effective radiation dose (by approximately 58%) compared to SECT in routine abdominal examination in matched cohorts. Therefore, the quantitative imaging potential of DECT can be utilised in needed patients with decreased radiation dose in third-generation DSCT.
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Lenga L, Lange M, Martin SS, Albrecht MH, Booz C, Yel I, Arendt CT, Vogl TJ, Leithner D. Head and neck single- and dual-energy CT: differences in radiation dose and image quality of 2nd and 3rd generation dual-source CT. Br J Radiol 2021; 94:20210069. [PMID: 33914613 PMCID: PMC8173672 DOI: 10.1259/bjr.20210069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare radiation dose and image quality of single-energy (SECT) and dual-energy (DECT) head and neck CT examinations performed with second- and third-generation dual-source CT (DSCT) in matched patient cohorts. METHODS 200 patients (mean age 55.1 ± 16.9 years) who underwent venous phase head and neck CT with a vendor-preset protocol were retrospectively divided into four equal groups (n = 50) matched by gender and BMI: second (Group A, SECT, 100-kV; Group B, DECT, 80/Sn140-kV), and third-generation DSCT (Group C, SECT, 100-kV; Group D, DECT, 90/Sn150-kV). Assessment of radiation dose was performed for an average scan length of 27 cm. Contrast-to-noise ratio measurements and dose-independent figure-of-merit calculations of the submandibular gland, thyroid, internal jugular vein, and common carotid artery were analyzed quantitatively. Qualitative image parameters were evaluated regarding overall image quality, artifacts and reader confidence using 5-point Likert scales. RESULTS Effective radiation dose (ED) was not significantly different between SECT and DECT acquisition for each scanner generation (p = 0.10). Significantly lower effective radiation dose (p < 0.01) values were observed for third-generation DSCT groups C (1.1 ± 0.2 mSv) and D (1.0 ± 0.3 mSv) compared to second-generation DSCT groups A (1.8 ± 0.1 mSv) and B (1.6 ± 0.2 mSv). Figure-of-merit/contrast-to-noise ratio analysis revealed superior results for third-generation DECT Group D compared to all other groups. Qualitative image parameters showed non-significant differences between all groups (p > 0.06). CONCLUSION Contrast-enhanced head and neck DECT can be performed with second- and third-generation DSCT systems without radiation penalty or impaired image quality compared with SECT, while third-generation DSCT is the most dose efficient acquisition method. ADVANCES IN KNOWLEDGE Differences in radiation dose between SECT and DECT of the dose-vulnerable head and neck region using DSCT systems have not been evaluated so far. Therefore, this study directly compares radiation dose and image quality of standard SECT and DECT protocols of second- and third-generation DSCT platforms.
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Affiliation(s)
- Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marvin Lange
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christophe T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Doris Leithner
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Choi SJ, Ahn SJ, Park SH, Park SH, Pak SY, Choi JW, Shim YS, Jeong YM, Kim B. Dual-source abdominopelvic computed tomography: Comparison of image quality and radiation dose of 80 kVp and 80/150 kVp with tin filter. PLoS One 2020; 15:e0231431. [PMID: 32881876 PMCID: PMC7470424 DOI: 10.1371/journal.pone.0231431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/19/2020] [Indexed: 12/05/2022] Open
Abstract
Objective To compare the radiation dose and the objective and subjective image quality of 80 kVp and 80/150 kVp with tin filter (80/Sn150 kVp) computed tomography (CT) in oncology patients. Methods One-hundred-and-forty-five consecutive oncology patients who underwent third-generation dual-source dual-energy CT of the abdomen for evaluation of malignant visceral, peritoneal, extraperitoneal, and bone tumor were retrospectively recruited. Two radiologists independently reviewed each observation in 80 kVp CT and 80/Sn150 kVp CT. Modified line-density profile of the tumor and contrast-to-noise ratio (CNR) were measured. Diagnostic confidence, lesion conspicuity, and subjective image quality were calculated and compared between image sets. The effective dose and size-specific dose estimate (SSDE) were calculated in the image sets. Results Modified line-density profile analysis revealed higher attenuation differences between the tumor and normal tissue in 80 kVp CT than in 80/Sn150 kVp CT (127 vs. 107, P = 0.05). The 80 kVp CT showed increased CNR in the liver (8.0 vs. 7.6) and the aorta (18.9 vs. 16.3) than the 80/Sn150 kVp CT. The 80 kVp CT yielded higher enhancement of organs (4.9 ± 0.2 vs. 4.7 ± 0.4, P<0.001) and lesion conspicuity (4.9 ± 0.3 vs. 4.8 ± 0.5, P = 0.035) than the 80/Sn150 kVp CT; overall image quality and confidence index were comparable. The effective dose was reduced by 45.2% with 80 kVp CT (2.3 mSv ± 0.9) compared to 80/Sn150 kVp CT (4.1 mSv ± 1.5). The SSDE was 7.4 ± 3.8 mGy on 80/Sn150 kVp CT and 4.1 ± 2.2 mGy on 80 kVp CT. Conclusions The 80 kVp CT reduced the radiation dose by 45.2% in oncology patients while showing comparable or superior image quality to that of 80/Sn150 kVp CT for abdominal tumor evaluation.
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Affiliation(s)
- Seung Joon Choi
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Su Joa Ahn
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- * E-mail:
| | - Seong Ho Park
- Division of Abdominal Radiology, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Yong Pak
- Imaging and Computer Vision Division, Siemens Healthcare, Seoul, Korea
| | - Jae Won Choi
- Imaging and Computer Vision Division, Siemens Healthcare, Seoul, Korea
| | - Young Sup Shim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul Saint Mary's Hospital, Seoul, Korea
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Abstract
Dual-energy CT (DECT) has been available for clinical use in the United States for close to 15 years. Although multiple applications in all areas of the body have been described that are only possible with DECT, the adoption into clinical practice has been slow. This paper will attempt to address many of the impediments the author has encountered from his discussions with radiologists across the country. A hopeful outcome would result in more practices adopting more DECT into their CT practices.
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Affiliation(s)
- Alec J Megibow
- Department of Radiology, NYU-Langone Health, 550 1st Ave, Rm HCC 232, New York, NY, 10016, USA.
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Wortman JR, Shyu JY, Dileo J, Uyeda JW, Sodickson AD. Dual-energy CT for routine imaging of the abdomen and pelvis: radiation dose and image quality. Emerg Radiol 2019; 27:45-50. [PMID: 31673838 DOI: 10.1007/s10140-019-01733-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the radiation dose and image quality of routine dual energy CT (DECT) of the abdomen and pelvis performed in the emergency department setting, compared with single energy CT (SECT). MATERIALS AND METHODS Seventy-five consecutive routine contrast-enhanced SECT scans of the abdomen and pelvis meeting inclusion criteria were compared with 75 routine contrast-enhanced DECT scans matched by size and patient weight (within 10 lbs), performed on the same dual-source DECT scanner. Cohorts were compared in terms of radiation dose metrics of CT dose index (CTDIvol) and dose length product (DLP), objective measurements of image quality (signal, noise, and signal-to-noise ratio of a variety of anatomical landmarks), and subjective measurements of image quality scored by two emergency radiologists. RESULTS Demographics and patient size were not statistically different between DECT and SECT cohorts. Both average scans CTDIvol and DLP were significantly lower with DECT than with SECT. Average scan CTDIvol for SECT was 14.7 mGy (± 6.6) and for DECT was 10.9 mGy (± 3.8) (p < 0.0001). Average scan DLP for SECT was 681.5 mGy cm (± 339.3) and for DECT was 534.8 mGy cm (± 201.9) (p < 0.0001). For objective image quality metrics, for all structures measured, noise was significantly lower and SNR was significantly higher with DECT compared with SECT. For subjective image quality, for both readers, there was no significant difference between SECT and DECT in subjective image quality for soft tissues and vascular structures, or for subjective image noise. CONCLUSIONS DECT was performed with decreased radiation dose when compared with SECT, demonstrated improved objective measurements of image quality, and equivalent subjective image quality.
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Affiliation(s)
- Jeremy R Wortman
- Department of Radiology, Section of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA. .,Lahey Hospital and Medical Center, Burlington, MA, USA.
| | - Jeffrey Y Shyu
- Department of Radiology, Section of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey Dileo
- Department of Radiology, Section of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Jennifer W Uyeda
- Department of Radiology, Section of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Aaron D Sodickson
- Department of Radiology, Section of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
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Bläckberg L, Sajedi S, Mandl S, Mohan A, Vittum B, El Fakhri G, Sabet H. Exploring light confinement in laser-processed LYSO:Ce for photon counting CT application. Phys Med Biol 2019; 64:095020. [PMID: 30897557 PMCID: PMC7191943 DOI: 10.1088/1361-6560/ab1213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With the goal of developing a low-cost scintillator-based photon counting detector (PCD) with high dose efficiency suitable for CT, the light transport characteristics in LYSO:Ce detectors containing laser induced optical barriers (LIOB) are simulated. Light confinement and light collection efficiencies (LCE) are studied for a variety of optical barrier patterns and properties (refractive index (RI) and barrier/crystal interface roughness). Up to 80% confinement is achievable with a simple pixel pattern with one barrier wall separating each pixel coupled one-to-one to a photodetector (PD) pixel. Confinement is heavily dependent on barrier properties, and rough interfaces and higher RI results in increased cross-talk. Three approaches to enhance performance beyond the basic pattern are explored: (1) Multiple barrier walls separating each crystal pixel. (2) Introduction of long and short range confinement by having multiple crystal pixels per PD pixel. (3) Combination of LIOB and laser ablation (LA). (1) Is effective for rough interfaces where confinement can be increased by up to 24% for double compared to single walls. (2) Results in high confinement in the pixel centered on the PD pixel, but lower confinement closer to the PD edge. This feature may be explored to achieve spatial resolution beyond the PD pixel size using light sharing based positioning algorithms. (3) Can increase confinement for smooth interfaces using a smooth ablation in the bottom part of the crystal. A general trend across all configurations is a trade-off between light confinement and LCE. The LCE attainable is found comparable to that for mechanically pixelated arrays. While the confinement achievable with LIOB is always lower compared to a mechanically pixelated array, the former may offer a high level of flexibility in terms of detector design. This, in combination with the possibility to fabricate sub-mm pixels in a cost-effective manner, makes LIOB a promising technology for scintillator-based PCDs.
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Affiliation(s)
- L Bläckberg
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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Lenga L, Trapp F, Albrecht MH, Wichmann JL, Johnson AA, Yel I, D'Angelo T, Booz C, Vogl TJ, Martin SS. Single- and dual-energy CT pulmonary angiography using second- and third-generation dual-source CT systems: comparison of radiation dose and image quality. Eur Radiol 2019; 29:4603-4612. [PMID: 30666446 DOI: 10.1007/s00330-018-5982-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/23/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate radiation exposure and image quality in matched patient cohorts for CT pulmonary angiography (CTPA) acquired in single- and dual-energy mode using second- and third-generation dual-source CT (DSCT) systems. METHODS We retrospectively included 200 patients (mean age, 65.5 years ± 15.7 years) with suspected pulmonary embolism-equally divided into four study groups (n = 50) and matched by gender and body mass index. CTPA was performed with vendor-predefined second-generation (group A, 100-kV single-energy computed tomography (SECT); group B, 80/Sn140-kV dual-energy computed tomography (DECT)) or third-generation DSCT (group C, 100-kV SECT; group D, 90/Sn150-kV DECT) devices. Radiation metrics were assessed using a normalized scan range of 27.5 cm. For objective image quality evaluation, dose-independent figure-of-merit (FOM) contrast-to-noise ratios (CNRs) were calculated. Subjective image analysis included ratings for overall image quality, reader confidence, and image artifacts using five-point Likert scales. RESULTS Calculations of the effective dose (ED) of radiation for a normalized scan range of 27.5 cm showed nonsignificant differences between SECT and DECT acquisitions for each scanner generation (p ≥ 0.253). The mean effective radiation dose was lower for third-generation groups C (1.5 mSv ± 0.8 mSv) and D (1.4 mSv ± 0.7 mSv) compared to second-generation groups A (2.5 mSv ± 0.9 mSv) and B (2.3 mSv ± 0.6 mSv) (both p ≤ 0.013). FOM-CNR measurements were highest for group D. Qualitative image parameters of overall image quality, reader confidence, and image artifacts showed nonsignificant differences among the four groups (p ≥ 0.162). CONCLUSIONS Third-generation DSCT systems show lower radiation dose parameters for CTPA compared to second-generation DSCT. DECT can be performed with both scanner generations without radiation dose penalty or detrimental effects on image quality compared to SECT. KEY POINTS • Radiation exposure showed nonsignificant differences between SECT and DECT for both DSCT scanner devices. • Dual-energy CTPA provides equivalent image quality compared to standard image acquisition. • Subjective image quality assessment was similar among the four study groups.
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Affiliation(s)
- Lukas Lenga
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Franziska Trapp
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Moritz H Albrecht
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Julian L Wichmann
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Addison A Johnson
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Tommaso D'Angelo
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Simon S Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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