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Radiation Dose Reduction in Contrast-Enhanced Abdominal CT: Comparison of Photon-Counting Detector CT with 2nd Generation Dual-Source Dual-Energy CT in an oncologic cohort

      Rational and Objectives

      Comparison of radiation dose and image quality in routine abdominal and pelvic contrast-enhanced computed tomography (CECT) between a photon-counting detector CT (PCD-CT) and a dual energy dual source CT (DSCT).

      Materials and Methods

      70 oncologic patients (mean age 66 ± 12 years, 29 females) were prospectively enrolled between November 2021 and February 2022. Abdominal CECT were clinically indicated and performed first on a 2nd-generation DSCT and at follow-up on a 1st-generation dual-source PCD-CT. The same contrast media (Imeron 350, Bracco imaging) and pump protocol was used for both scans. For both scanners, polychromatic images were reconstructed with 3mm slice thickness and comparable kernel (I30f[DSCT] and Br40f[PCD-CT]); for PCD-CT data from all counted events above the lowest energy threshold at 20 keV (“T3D”) were used. Results were compared in terms of radiation dose metrics of CT dose index (CTDIvol), dose length product (DLP) and size-specific dose estimation (SSDE), objective and subjective measurements of image quality were scored by two emergency radiologists including lesion conspicuity.

      Results

      Median time interval between the scans was 4 months (IQR: 3–6). CNRvessel and SNRvessel of T3D reconstructions from PCD-CT were significantly higher than those of DSCT (all, p < 0.05). Qualitative image noise analysis from PCD-CT and DSCT yielded a mean of 4 each. Lesion conspicuity was rated significantly higher in PCD-CT (Q3 strength) compared to DSCT images. CTDI, DLP and SSDE mean values for PCD-CT and DSCT were 7.98 ± 2.56 mGy vs. 14.11 ± 2.92 mGy, 393.13 ± 153.55 mGy*cm vs. 693.61 ± 185.76 mGy*cm and 9.98 ± 2.41 vs. 14.63 ± 1.63, respectively, translating to a dose reduction of around 32% (SSDE).

      Conclusion

      PCD-CT enables oncologic abdominal CT with a significantly reduced dose while keeping image quality similar to 2nd-generation DSCT.

      Key words

      Abbreviation:

      BMI (Body Mass Index), CNR (Contrast to Noise Ratio), CTDIvol (Computed Tomography Dose Index), DLP (Dose Lengths Product), DSCT (Dual Source Computed Tomography), EID-CT (Energy Integrating Detector Computed Tomography), ICC (Intraclass Correlation Coefficient), PCD-CT (Photon Counting Detector Computed Tomography), ROI (Region Of Interest), SNR (Signal to Noise Ratio), SSDE (Size Specific Dose Estimation)
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      References

        • Kalra MK
        • Maher MM
        • Toth TL
        • et al.
        Strategies for CT radiation dose optimization.
        Radiology. 2004; 230: 619-628https://doi.org/10.1148/radiol.2303021726
        • McCollough CH
        • Bruesewitz MR
        • Kofler JM.
        CT dose reduction and dose management tools: overview of available options.
        Radiographics: a rev publ Radiol Soc N Am, Inc. 2006; 26: 503-512https://doi.org/10.1148/rg.262055138
        • Papadakis AE
        • Perisinakis K
        • Damilakis J.
        Angular on-line tube current modulation in multidetector CT examinations of children and adults: the influence of different scanning parameters on dose reduction.
        Med phys. 2007; 34: 2864-2874https://doi.org/10.1118/1.2747048
        • Huda W
        • Scalzetti EM
        • Levin G.
        Technique factors and image quality as functions of patient weight at abdominal CT.
        Radiology. 2000; 217: 430-435https://doi.org/10.1148/radiology.217.2.r00nv35430
      1. FDA public health notification: reducing radiation risk from computed tomography for pediatric and small adult patients.
        Pediatr radiol. 2002; 32: 314-316https://doi.org/10.1007/s00247-002-0687-6
        • Higashigaito K
        • Euler A
        • Eberhard M
        • et al.
        Contrast-enhanced abdominal CT with clinical photon-counting detector CT: assessment of image quality and comparison with energy-integrating detector CT.
        Acadradiol. 2021; https://doi.org/10.1016/j.acra.2021.06.018
        • Rajendran K
        • Petersilka M
        • Henning A
        • et al.
        First clinical photon-counting detector CT system: Technical evaluation.
        Radiology. 2022; 212579https://doi.org/10.1148/radiol.212579
        • Hsieh SS
        • Leng S
        • Rajendran K
        • et al.
        Photon Counting CT: Clinical applications and future developments.
        IEEE trans radiat plasma med sci. 2021; 5: 441-452https://doi.org/10.1109/TRPMS.2020.3020212
        • Wichmann JL
        • Hardie AD
        • Schoepf UJ
        • et al.
        Single- and dual-energy CT of the abdomen: comparison of radiation dose and image quality of 2nd and 3rd generation dual-source CT.
        Eur radiol. 2017; 27: 642-650https://doi.org/10.1007/s00330-016-4383-6
        • Tabatabaei SMH
        • Talari H
        • Gholamrezanezhad A
        • et al.
        A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study.
        Emerg radiol. 2020; 27: 607-615https://doi.org/10.1007/s10140-020-01838-6
        • Willemink MJ
        • Persson M
        • Pourmorteza A
        • et al.
        Photon-counting CT: Technical principles and clinical prospects.
        Radiology. 2018; 289: 293-312https://doi.org/10.1148/radiol.2018172656
        • Flohr T
        • Petersilka M
        • Henning A
        • et al.
        Photon-counting CT review.
        Physica medica: PM: an int j devot app phys medicand bio: off j Ital Assoc Biomed Phys (AIFB). 2020; 79: 126-136https://doi.org/10.1016/j.ejmp.2020.10.030
        • Yu L
        • Primak AN
        • Liu X
        • et al.
        Image quality optimization and evaluation of linearly mixed images in dual-source, dual-energy CT.
        Med phys. 2009; 36: 1019-1024https://doi.org/10.1118/1.3077921
        • Sartoretti T
        • Landsmann A
        • Nakhostin D
        • et al.
        Quantum iterative reconstruction for abdominal photon-counting detector CT improves image quality.
        Radiology. 2022; 211931https://doi.org/10.1148/radiol.211931
        • Forbrig R
        • Ingrisch M
        • Stahl R
        • et al.
        Radiation dose and image quality of high-pitch emergency abdominal CT in obese patients using third-generation dual-source CT (DSCT).
        Sci Rep. 2019; 9https://doi.org/10.1038/s41598-019-52454-5
        • Voelker R.
        Advanced CT technology counts photons to produce sharper images.
        JAMA. 2021; 326: 1667https://doi.org/10.1001/jama.2021.19146
        • Hagen F
        • Hofmann J
        • Wrazidlo R
        • et al.
        Image quality and dose exposure of contrast-enhanced abdominal CT on a 1st generation clinical dual-source photon-counting detector CT in obese patients vs. a 2nd generation dual-source dual energy integrating detector CT.
        Euro j of radiol. 2022; 151110325https://doi.org/10.1016/j.ejrad.2022.110325
        • Giersch J
        • Niederlöhner D
        • Anton G
        The influence of energy weighting on X-ray imaging quality.
        Nucl Instrum Met in Phys Res Sec A: Accel, Spectrom, Detec and AssocEquip. 2004; 531: 68-74https://doi.org/10.1016/j.nima.2004.05.076
        • Pourmorteza A
        • Symons R
        • Reich DS
        • et al.
        Photon-counting CT of the brain: in vivo human results and image-quality assessment.
        AJNR. Am j neuroradiol. 2017; 38: 2257-2263https://doi.org/10.3174/ajnr.A5402
        • Shikhaliev PM.
        Computed tomography with energy-resolved detection: a feasibility study.
        Phys medicine and biology. 2008; 53: 1475-1495https://doi.org/10.1088/0031-9155/53/5/020
        • Shuman WP
        • Green DE
        • Busey JM
        • et al.
        Dual-energy liver CT: effect of monochromatic imaging on lesion detection, conspicuity, and contrast-to-noise ratio of hypervascular lesions on late arterial phase.
        AJR. Am j roentgenol. 2014; 203: 601-606https://doi.org/10.2214/AJR.13.11337
        • Kappler S
        • Hannemann T
        • Kraft E
        • et al.
        First results from a hybrid prototype CT scanner for exploring benefits of quantum-counting in clinical CT.
        Medical Imaging 2012: Physics of Medical Imaging. SPIE, San Diego, California, USA2012: 83130X (SPIE Medical Imaging)
        • Rajagopal JR
        • Farhadi F
        • Solomon J
        • et al.
        Comparison of low dose performance of photon-counting and energy integrating CT.
        Acad radiol. 2021; 28: 1754-1760https://doi.org/10.1016/j.acra.2020.07.033
        • Kataria B
        • Nilsson Althén J
        • et al.
        Image quality and potential dose reduction using advanced modeled iterative reconstruction (admire) in abdominal ct - a review.
        Radi protec dosim. 2021; 195: 177-187https://doi.org/10.1093/rpd/ncab020
        • Gupta RV
        • Kalra MK
        • Ebrahimian S
        • et al.
        Complex relationship between artificial intelligence and CT radiation dose.
        Acad radiol. 2021; https://doi.org/10.1016/j.acra.2021.10.024