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Abu-Omar A, Murray N, Ali IT, Khosa F, Barrett S, Sheikh A, Nicolaou S, Tamburrini S, Iacobellis F, Sica G, Granata V, Saba L, Masala S, Scaglione M. Utility of Dual-Energy Computed Tomography in Clinical Conundra. Diagnostics (Basel) 2024; 14:775. [PMID: 38611688 PMCID: PMC11012177 DOI: 10.3390/diagnostics14070775] [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: 01/29/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Advancing medical technology revolutionizes our ability to diagnose various disease processes. Conventional Single-Energy Computed Tomography (SECT) has multiple inherent limitations for providing definite diagnoses in certain clinical contexts. Dual-Energy Computed Tomography (DECT) has been in use since 2006 and has constantly evolved providing various applications to assist radiologists in reaching certain diagnoses SECT is rather unable to identify. DECT may also complement the role of SECT by supporting radiologists to confidently make diagnoses in certain clinically challenging scenarios. In this review article, we briefly describe the principles of X-ray attenuation. We detail principles for DECT and describe multiple systems associated with this technology. We describe various DECT techniques and algorithms including virtual monoenergetic imaging (VMI), virtual non-contrast (VNC) imaging, Iodine quantification techniques including Iodine overlay map (IOM), and two- and three-material decomposition algorithms that can be utilized to demonstrate a multitude of pathologies. Lastly, we provide our readers commentary on examples pertaining to the practical implementation of DECT's diverse techniques in the Gastrointestinal, Genitourinary, Biliary, Musculoskeletal, and Neuroradiology systems.
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Affiliation(s)
- Ahmad Abu-Omar
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Nicolas Murray
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Ismail T. Ali
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Faisal Khosa
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Sarah Barrett
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Adnan Sheikh
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Savvas Nicolaou
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy;
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS Di Napoli, 80131 Naples, Italy
| | - Luca Saba
- Medical Oncology Department, AOU Cagliari, Policlinico Di Monserrato (CA), 09042 Monserrato, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy; (S.M.)
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy; (S.M.)
- Department of Radiology, Pineta Grande Hospital, 81030 Castel Volturno, Italy
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
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Kang Y, Hwang SH, Han K, Shin HJ. Comparison of image quality, contrast administration, and radiation doses in pediatric abdominal dual-layer detector dual-energy CT using propensity score matching analysis. Eur J Radiol 2023; 169:111177. [PMID: 37944333 DOI: 10.1016/j.ejrad.2023.111177] [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: 06/14/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To compare the image quality, contrast administration, and radiation dose between single-energy CT (SECT) and dual-energy CT (DECT) in pediatric patients. METHODS From March to December 2021, children who underwent abdominal SECT or DECT were retrospectively included in this study. The DECT group received 10-30 % less contrast than the routine dose. CT images were obtained at hepatic venous phase using a routine reconstruction method (iDose4). DECT scans were additionally reconstructed with a virtual monoenergetic image (VMI) at 40 and 65 keV. Quantitative image evaluations compared the contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of the liver, portal vein, and pancreas. Qualitative analysis assessed degree of contrast enhancement, lesion or organ conspicuity, image noise, artificiality, and overall image quality. RESULTS Among 318 patients, 112 (median age, 16 years; 56 in each group) were included after propensity score matching. Compared with the SECT group, DECT group with iDose4 demonstrated lower CNRs and SNRs, while VMI at 40 or 65 keV showed no significant difference. In qualitative analysis, iDose4 produced higher scores on artificiality, and VMI at 40 keV demonstrated superior contrast enhancement and lesion conspicuity in the DECT group. Overall image quality was higher with VMI 65 keV among the DECT patients, and there was no significant difference compared to SECT. The volume CT dose index (CTDIvol) did not differ significantly between the two groups (median, 2.8 mGy vs. 2.9 mGy; p = 0.802). The injected contrast volume was reduced by 10 % in the DECT group. CONCLUSION Pediatric abdominal DECT with reduced contrast administration showed no significant differences in image quality and radiation dose compared to SECT.
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Affiliation(s)
- Yeseul Kang
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Yongin Severance Hospital 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do 16995, Republic of Korea
| | - Shin Hye Hwang
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Yongin Severance Hospital 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do 16995, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hyun Joo Shin
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Yongin Severance Hospital 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do 16995, Republic of Korea.
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Srinivas-Rao S, Cao J, Marin D, Kambadakone A. Dual-Energy Computed Tomography to Photon Counting Computed Tomography: Emerging Technological Innovations. Radiol Clin North Am 2023; 61:933-944. [PMID: 37758361 DOI: 10.1016/j.rcl.2023.06.015] [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: 10/03/2023]
Abstract
Computed tomography (CT) has seen remarkable developments in the past several decades, radically transforming the role of imaging in day-to-day clinical practice. Dual-energy CT (DECT), an exciting innovation introduced in the early part of this century, has widened the scope of CT, opening new opportunities due to its ability to provide superior tissue characterization. The introduction of photon-counting CT (PCCT) heralds a paradigm shift in CT scanner technology representing another significant milestone in CT innovation. PCCT offers several advantages over DECT, such as improved spectral resolution, enhanced tissue characterization, reduced image artifacts, and improved image quality.
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Affiliation(s)
- Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114-2696, USA
| | - Jinjin Cao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114-2696, USA
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC 27710, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114-2696, USA.
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Ananthakrishnan L, Kulkarni N, Toshav A. Dual-Energy Computed Tomography: Integration Into Clinical Practice and Cost Considerations. Radiol Clin North Am 2023; 61:963-971. [PMID: 37758363 DOI: 10.1016/j.rcl.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Optimization of dual-energy CT (DECT) workflow is critical for successful integration of DECT into practice. Patient selection strategies differ by scanner type and may be based on patient size, exam indication, or both. All stakeholders involved in patient scheduling and scan acquisition should be involved in patient triage to DECT. Automation of DECT postprocessing frees up technologist and radiologist time, but care must be taken to avoid sending unnecessary reconstructions to PACS. DECT use in the Emergency Department aids in incidentaloma characterization and improves reader diagnostic confidence, and results in quantifiable cost savings by eliminating the need for follow-up exams.
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Affiliation(s)
- Lakshmi Ananthakrishnan
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Naveen Kulkarni
- Department of Radiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Aran Toshav
- Department of Radiology, Southeast Louisiana Veterans Healthcare System, LSUHSC, New Orleans, LA 70119, USA
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Shirasaka T, Kojima T, Yamane S, Mikayama R, Kawakubo M, Funatsu R, Kato T, Ishigami K, Funama Y. Effect of iodine concentration and body size on iodine subtraction in virtual non-contrast imaging: A phantom study. Radiography (Lond) 2023; 29:557-563. [PMID: 36965243 DOI: 10.1016/j.radi.2023.03.003] [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: 10/23/2022] [Revised: 02/19/2023] [Accepted: 03/05/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION Dual-energy computed tomography (DECT) can generate virtual non-contrast (VNC) images. Herein, we sought to improve the accuracy of VNC images by identifying the optimal slope of contrast media (SCM) for VNC-image generation based on the iodine concentration and subject's body size. METHODS We used DECT to scan a multi-energy phantom including four iodine concentration rods (15, 10, 5, and 2 mg/mL), and 240 VNC images (eight SCM ranging from 0.49 to 0.56 × three body sizes × ten scans) that were generated by three-material decomposition. The CT number of each iodine and solid water rod part was measured in each VNC image. The difference in the CT number between the iodine and the solid water rod part was calculated and compared using paired t-test or repeated measures ANOVA. RESULTS The SCM that achieved an absolute value of the difference in CT number of <5.0 Hounsfield units (HU) for all body sizes simultaneously was greater at lower iodine concentration (SCM of 0.5, 0.51, and 0.53 at 10, 5, and 2 mg/mL iodine, respectively). At an iodine concentration of 15 mg/mL, no SCM achieved an absolute difference of <5.0 HU in CT number for all body sizes simultaneously. At all iodine concentrations, the SCM achieving the minimal difference in the CT number increased with the increase in body size. CONCLUSION By adjusting the SCM according to the iodine concentration and body size, it is possible to generate VNC images with an accuracy of <5.0 HU. IMPLICATIONS FOR PRACTICE Improving the accuracy of VNC images minimizing incomplete iodine subtraction would make it possible to replace true non-contrast (TNC) images with VNC images and reduce the radiation dose.
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Affiliation(s)
- T Shirasaka
- Graduate School of Health Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan; Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
| | - T Kojima
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan; Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
| | - S Yamane
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
| | - R Mikayama
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
| | - M Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
| | - R Funatsu
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
| | - T Kato
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
| | - K Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
| | - Y Funama
- Department of Medical Radiation Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan.
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Pourvaziri A, Mojtahed A, Hahn PF, Gee MS, Kambadakone A, Sahani DV. Renal lesion characterization: clinical utility of single-phase dual-energy CT compared to MRI and dual-phase single-energy CT. Eur Radiol 2023; 33:1318-1328. [PMID: 36074261 DOI: 10.1007/s00330-022-09106-6] [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: 01/27/2022] [Revised: 07/13/2022] [Accepted: 08/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess the impact of dual-energy CT (DECT) utilization in practice by measuring the readers' confidence, the need for additional image requests, and diagnostic performance in renal lesion assessment, compared to single-energy CT (SECT) using contrast-enhanced MRI to establish the reference standard. MATERIALS AND METHODS Sixty-nine patients (M/F = 47/22) who underwent a dual-phase renal SECT (n = 34) or DECT (n = 35) and had a contrast-enhanced MRI within 180 days were retrospectively collected. Three radiologists assessed images on different sessions (SECT, DECT, and MRI) for (1) likely diagnosis (enhancing/non-enhancing); (2) diagnostic confidence (5-point Likert scale); (3) need for additional imaging test (yes/no); and (4) need for follow-up imaging (yes/no). Diagnostic accuracy was compared using AUC; p value < 0.05 was considered significant. RESULTS One hundred fifty-six lesions consisting of 18% enhancing (n = 28/156, mean size: 30.37 mm, range: 9.9-94 mm) and 82% non-enhancing (n = 128/156, mean size: 23.91 mm, range: 5.0-94.2 mm) were included. The confidence level was significantly lower for SECT than their MRI (4.50 vs. 4.80, p value < 0.05) but not significantly different for DECT and the corresponding MRI (4.78 vs. 4.78, p > 0.05). There were significantly more requests for additional imaging in the SECT session than the corresponding MRI (20% vs. 4%), which was not significantly different between DECT and their MRI counterpart session (5.7% vs. 4.9%). Inter-reader agreement was almost perfect for DECT and MRI (kappa: 0.8-1) and substantial in SECT sessions (kappa: 0.6-0.8) with comparable diagnostic accuracy between SECT, DECT, and MRI (p value > 0.05). CONCLUSION Single-phase DECT allows confident and reproducible characterization of renal masses with fewer recommendation for additional and follow-up imaging tests than dual-phase SECT and a performance similar to MRI. KEY POINTS • DECT utilization leads to similar additional image requests to MRI (5.7% vs. 4.9%, p value > 0.05), whereas single-energy CT utilization leads to significantly higher image requests (20% vs. 4%, p value < 0.05). • DECT and MRI utilization bring highly reproducible results with almost perfect inter-reader agreement (kappa: 0.8-1), better than the inter-reader agreement in SECT utilization (kappa: 0.6-0.8). • Readers' confidence was not significantly altered between DECT and their MRI readout session (p value > 0.05). In contrast, confidence in the diagnosis was significantly lower in the SECT session than their MRI readout (p value < 0.05).
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Affiliation(s)
- Ali Pourvaziri
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA.
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
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Diagnostic Management of Gastroenteropancreatic Neuroendocrine Neoplasms: Technique Optimization and Tips and Tricks for Radiologists. Tomography 2023; 9:217-246. [PMID: 36828370 PMCID: PMC9958666 DOI: 10.3390/tomography9010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) comprise a heterogeneous group of neoplasms, which derive from cells of the diffuse neuroendocrine system that specializes in producing hormones and neuropeptides and arise in most cases sporadically and, to a lesser extent, in the context of complex genetic syndromes. Furthermore, they are primarily nonfunctioning, while, in the case of insulinomas, gastrinomas, glucagonomas, vipomas, and somatostatinomas, they produce hormones responsible for clinical syndromes. The GEP-NEN tumor grade and cell differentiation may result in different clinical behaviors and prognoses, with grade one (G1) and grade two (G2) neuroendocrine tumors showing a more favorable outcome than grade three (G3) NET and neuroendocrine carcinoma. Two critical issues should be considered in the NEN diagnostic workup: first, the need to identify the presence of the tumor, and, second, to define the primary site and evaluate regional and distant metastases. Indeed, the primary site, stage, grade, and function are prognostic factors that the radiologist should evaluate to guide prognosis and management. The correct diagnostic management of the patient includes a combination of morphological and functional evaluations. Concerning morphological evaluations, according to the consensus guidelines of the European Neuroendocrine Tumor Society (ENETS), computed tomography (CT) with a contrast medium is recommended. Contrast-enhanced magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), is usually indicated for use to evaluate the liver, pancreas, brain, and bones. Ultrasonography (US) is often helpful in the initial diagnosis of liver metastases, and contrast-enhanced ultrasound (CEUS) can solve problems in characterizing the liver, as this tool can guide the biopsy of liver lesions. In addition, intraoperative ultrasound is an effective tool during surgical procedures. Positron emission tomography (PET-CT) with FDG for nonfunctioning lesions and somatostatin analogs for functional lesions are very useful for identifying and evaluating metabolic receptors. The detection of heterogeneity in somatostatin receptor (SSTR) expression is also crucial for treatment decision making. In this narrative review, we have described the role of morphological and functional imaging tools in the assessment of GEP-NENs according to current major guidelines.
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Toshav A. Economics of Dual-Energy CT: Workflow, Costs, and Benefits. Semin Ultrasound CT MR 2022; 43:352-354. [PMID: 35738820 DOI: 10.1053/j.sult.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dual-energy CT is an emerging technology which is progressively becoming more available for routine clinical applications. As practices and institutions evaluate the business case for purchase of these high-end scanners, the clinical utility and downstream costs must be determined. This article will provide an overview of the technology and will review direct and indirect costs associated with the implementation of dual-energy CT programs.
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Affiliation(s)
- Aran Toshav
- Department of Radiology, Southeast Louisiana Veterans Healthcare System, LSUHSC New Orleans, Louisiana USA.
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Renal Lesion Characterization by Dual-Layer Dual-Energy CT: Comparison of Virtual and True Unenhanced Images. AJR Am J Roentgenol 2022; 219:614-623. [PMID: 35441533 DOI: 10.2214/ajr.21.27272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Prior studies have provided mixed results for the ability to replace true unenhanced (TUE) images with virtual unenhanced (VUE) images when characterizing renal lesions by dual-energy CT. Detector-based dual-layer dual-energy (dlDECT) systems may optimize performance of VUE images for this purpose. Objective: To compare dual-phase dlDECT examinations evaluated using VUE and TUE images in differentiating cystic and solid renal masses. Methods: This retrospective study included 110 patients (mean age, 64.3±11.8 years; 46 women, 64 men) who underwent renal-mass protocol dlDECT between July 2018 and February 2022. TUE, VUE, and nephrographic-phase image sets were reconstructed. Lesions were diagnosed as solid masses by histopathology or MRI. Lesions were diagnosed as cysts by composite criteria reflecting findings from MRI, ultrasound, and the TUE and nephrographic-phase images of the dlDECT examinations. One radiologist measured lesions' attenuation on all dlDECT image sets. Lesion characterization was compared between use of VUE and TUE images, including when considering enhancement ≥20 HU to indicate presence of a solid mass. Results: The analysis included 219 lesions [33 solid masses; 186 cysts (132 simple, 20 septated, 34 hyperattenuating]. TUE and VUE attenuation were significantly different for solid masses (33.4 ± 7.1 HU vs 35.4 ± 8.6 HU, p=.002), simple cysts (10.8±5.6 vs 7.1±8.1 HU, p<.001), and hyperattenuating cysts (56.3±21.0 HU vs 47.6±16.3 HU, p<.001), but not septated cysts (13.6±8.1 HU vs 14.0±6.8 HU, p=.79). Frequency of enhancement ≥20 HU when using TUE and VUE images was 90.9% and 90.9% in solid masses, 0.0% and 9.1% in simple cysts, 15.0% and 10.0% in septated cysts, and 11.8% and 38.2% in hyperattenuating cysts. All solid lesions were concordant in terms of enhancement ≥20 HU when using TUE and VUE images. Twelve simple cysts and nine hyperattenuating cysts showed enhancement ≥20 HU when using VUE but not TUE images. Conclusion: Use of VUE images reliably detected enhancement in solid masses. However, VUE images underestimated attenuation of simple and hyperattenuating cysts, leading to false-positive findings of enhancement by such lesions. Clinical impact: The findings do not support replacement of TUE acquisitions with VUE images when characterizing renal lesions by dlDECT.
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Andersen MB, Ebbesen D, Thygesen J, Kruis M, Gu Q, Dharaiya E, Rasmussen F. Economic impact of spectral body imaging in diagnosis of patients suspected for occult cancer. Insights Imaging 2021; 12:190. [PMID: 34928439 PMCID: PMC8688640 DOI: 10.1186/s13244-021-01116-0] [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: 05/09/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Based on prior studies spectral CT has shown a higher sensitivity for malignant lesions than conventional CT at the cost of lower specificity. For the radiologists, it also offers a higher degree of certainty in the diagnosis of benign lesions. The objective of this study was to evaluate the economic impact of spectral CT in patients suspected of occult cancer in a medical center in Denmark. Methods This study was a secondary analysis using de-identified data from a prospective study of patients receiving a contrast-enhanced spectral CT scan. Based on suggested follow-up examinations on both spectral CT and contrast-enhanced CT, costs from a payer’s perspective were determined using unit costs obtained from national databases. Results The dataset contained 400 patients. Overall, 203 follow-up procedures were eliminated based on spectral data reading. The largest reduction in suggested follow-up procedures was found for the kidney (83%), followed by the liver (66%), adrenal glands (60%), and pancreas (42%). The total estimated costs for suggested follow-up procedures based on spectral data reading were €155,219, 25.2% (€52,384) less than that of conventional CT reading. Conclusion Our results provide support for spectral body imaging as an advanced imaging modality for suspected occult cancer. A substantial number of follow-up diagnostic procedures could be eliminated based on spectral data reading, which would result in significant cost savings. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01116-0.
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Affiliation(s)
- Michael Brun Andersen
- Department of Radiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark. .,Department of Radiology, Zealand University Hospital, Roskilde, Denmark. .,Department of Radiology, Aarhus University Hospital, Skejby, Denmark.
| | - Dyveke Ebbesen
- Department of Radiology, Aarhus University Hospital, Skejby, Denmark
| | - Jesper Thygesen
- Central Denmark Region, Department of Clinical Engineering, Aarhus University Hospital, Skejby, Denmark
| | | | - Qing Gu
- Philips Healthcare, Cleveland, USA
| | | | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Skejby, Denmark
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11
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Kruis MF. Improving radiation physics, tumor visualisation, and treatment quantification in radiotherapy with spectral or dual-energy CT. J Appl Clin Med Phys 2021; 23:e13468. [PMID: 34743405 PMCID: PMC8803285 DOI: 10.1002/acm2.13468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
Over the past decade, spectral or dual‐energy CT has gained relevancy, especially in oncological radiology. Nonetheless, its use in the radiotherapy (RT) clinic remains limited. This review article aims to give an overview of the current state of spectral CT and to explore opportunities for applications in RT. In this article, three groups of benefits of spectral CT over conventional CT in RT are recognized. Firstly, spectral CT provides more information of physical properties of the body, which can improve dose calculation. Furthermore, it improves the visibility of tumors, for a wide variety of malignancies as well as organs‐at‐risk OARs, which could reduce treatment uncertainty. And finally, spectral CT provides quantitative physiological information, which can be used to personalize and quantify treatment.
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Półtorak-Szymczak G, Budlewski T, Furmanek MI, Wierzba W, Sklinda K, Walecki J, Mruk B. Radiological Imaging of Gastro-Entero-Pancreatic Neuroendocrine Tumors. The Review of Current Literature Emphasizing the Diagnostic Value of Chosen Imaging Methods. Front Oncol 2021; 11:670233. [PMID: 34211845 PMCID: PMC8239281 DOI: 10.3389/fonc.2021.670233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
Despite development of radiologic imaging, detection and follow-up of neuroendocrine neoplasms (NENs) still pose a diagnostic challenge, due to the heterogeneity of NEN, their relatively long-term growth, and small size of primary tumor. A set of information obtained by using different radiological imaging tools simplifies a choice of the most appropriate treatment method. Moreover, radiological imaging plays an important role in the assessment of metastatic lesions, especially in the liver, as well as, tumor response to treatment. This article reviews the current, broadly in use imaging modalities which are applied to the diagnosis of GEP-NETs, (the most common type of NENs) and put emphasis on the strengths and limitations of each modality.
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Affiliation(s)
- Gabriela Półtorak-Szymczak
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Tadeusz Budlewski
- Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland.,Department of Nuclear Medicine, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Mariusz Ireneusz Furmanek
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Waldemar Wierzba
- Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland.,University of Humanities and Economics, Lodz, Poland
| | - Katarzyna Sklinda
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Jerzy Walecki
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Bartosz Mruk
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
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13
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Wang X, Zheng F, Xiao R, Liu Z, Li Y, Li J, Zhang X, Hao X, Zhang X, Guo J, Zhang Y, Xue H, Jin Z. Comparison of image quality and lesion diagnosis in abdominopelvic unenhanced CT between reduced-dose CT using deep learning post-processing and standard-dose CT using iterative reconstruction: A prospective study. Eur J Radiol 2021; 139:109735. [PMID: 33932717 DOI: 10.1016/j.ejrad.2021.109735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare image quality and lesion diagnosis between reduced-dose abdominopelvic unenhanced computed tomography (CT) using deep learning (DL) post-processing and standard-dose CT using iterative reconstruction (IR). METHOD Totally 251 patients underwent two consecutive abdominopelvic unenhanced CT scans of the same range, including standard and reduced doses, respectively. In group A, standard-dose data were reconstructed by (blend 30 %) IR. In group B, reduced-dose data were reconstructed by filtered back projection reconstruction to obtain group B1 images, and post-processed using the DL algorithm (NeuAI denosing, Neusoft medical, Shenyang, China) with 50 % and 100 % weights to obtain group B2 and B3 images, respectively. Then, CT values of the liver, the second lumbar vertebral centrum, the erector spinae and abdominal subcutaneous fat were measured. CT values, noise levels, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), radiation doses and subjective scores of image quality were compared. Subjective evaluations of low-density liver lesions were compared by diagnostic results from enhanced CT or Magnetic Resonance Imaging. RESULTS Groups B3 and B1 showed the lowest and highest noise levels, respectively (P < 0.001). The SNR and CNR in group B3 were highest (P < 0.001). The radiation dose in group B was reduced by 71.5 % on average compared to group A. Subjective scores in groups A and B2 were highest (P < 0.001). Diagnostic sensitivity and confidence for liver metastases in groups A and B2 were highest (P < 0.001). CONCLUSIONS Reduced-dose abdominopelvic unenhanced CT combined with DL post-processing could ensure image quality and satisfy diagnostic needs.
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Affiliation(s)
- Xiao Wang
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fuling Zheng
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ran Xiao
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhuoheng Liu
- From CT Business Unit, Neusoft Medical System Company, Shenyang, China
| | - Yutong Li
- From CT Business Unit, Neusoft Medical System Company, Shenyang, China
| | - Juan Li
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xi Zhang
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xuemin Hao
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinhu Zhang
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiawu Guo
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huadan Xue
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Zhengyu Jin
- From the Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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14
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Parakh A, An C, Lennartz S, Rajiah P, Yeh BM, Simeone FJ, Sahani DV, Kambadakone AR. Recognizing and Minimizing Artifacts at Dual-Energy CT. Radiographics 2021; 41:509-523. [PMID: 33606565 DOI: 10.1148/rg.2021200049] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dual-energy CT (DECT) is an exciting innovation in CT technology with profound capabilities to improve diagnosis and add value to patient care. Significant advances in this technology over the past decade have improved our ability to successfully adopt DECT into the clinical routine. To enable effective use of DECT, one must be aware of the pitfalls and artifacts related to this technology. Understanding the underlying technical basis of artifacts and the strategies to mitigate them requires optimization of scan protocols and parameters. The ability of radiologists and technologists to anticipate their occurrence and provide recommendations for proper selection of patients, intravenous and oral contrast media, and scan acquisition parameters is key to obtaining good-quality DECT images. In addition, choosing appropriate reconstruction algorithms such as image kernel, postprocessing parameters, and appropriate display settings is critical for preventing quantitative and qualitative interpretive errors. Therefore, knowledge of the appearances of these artifacts is essential to prevent errors and allows maximization of the potential of DECT. In this review article, the authors aim to provide a comprehensive and practical overview of possible artifacts that may be encountered at DECT across all currently available commercial clinical platforms. They also provide a pictorial overview of the diagnostic pitfalls and outline strategies for mitigating or preventing the occurrence of artifacts, when possible. The broadening scope of DECT applications necessitates up-to-date familiarity with these technologies to realize their full diagnostic potential.
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Affiliation(s)
- Anushri Parakh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (C.A., B.M.Y.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Chansik An
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (C.A., B.M.Y.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Simon Lennartz
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (C.A., B.M.Y.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (C.A., B.M.Y.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Benjamin M Yeh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (C.A., B.M.Y.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Frank J Simeone
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (C.A., B.M.Y.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Dushyant V Sahani
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (C.A., B.M.Y.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Avinash R Kambadakone
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (C.A., B.M.Y.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
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15
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Parakh A, Lennartz S, An C, Rajiah P, Yeh BM, Simeone FJ, Sahani DV, Kambadakone AR. Dual-Energy CT Images: Pearls and Pitfalls. Radiographics 2021; 41:98-119. [PMID: 33411614 PMCID: PMC7853765 DOI: 10.1148/rg.2021200102] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 01/10/2023]
Abstract
Dual-energy CT (DECT) is a tremendous innovation in CT technology that allows creation of numerous imaging datasets by enabling discrete acquisitions at more than one energy level. The wide range of images generated from a single DECT acquisition provides several benefits such as improved lesion detection and characterization, superior determination of material composition, reduction in the dose of iodine, and more robust quantification. Technological advances and the proliferation of various processing methods have led to the availability of diverse vendor-based DECT approaches, each with a different acquisition and image reconstruction process. The images generated from various DECT scanners differ from those from conventional single-energy CT because of differences in their acquisition techniques, material decomposition methods, image reconstruction algorithms, and postprocessing methods. DECT images such as virtual monochromatic images, material density images, and virtual unenhanced images have different imaging appearances, texture features, and quantitative capabilities. This heterogeneity creates challenges in their routine interpretation and has certain associated pitfalls. Some artifacts such as residual iodine on virtual unenhanced images and an appearance of pseudopneumatosis in a gas-distended bowel loop on material-density iodine images are specific to DECT, while others such as pseudoenhancement seen on virtual monochromatic images are also observed at single-energy CT. Recognizing the potential pitfalls associated with DECT is necessary for appropriate and accurate interpretation of the results of this increasingly important imaging tool. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Anushri Parakh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Simon Lennartz
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Chansik An
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Benjamin M. Yeh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Frank J. Simeone
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Dushyant V. Sahani
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Avinash R. Kambadakone
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
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16
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Building a dual-energy CT service line in abdominal radiology. Eur Radiol 2020; 31:4330-4339. [PMID: 33210201 DOI: 10.1007/s00330-020-07441-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
As the access of radiology practices to dual-energy CT (DECT) has increased worldwide, seamless integration into clinical workflows and optimized use of this technology are desirable. In this article, we provide basic concepts of commercially available DECT hardware implementations, discuss financial and logistical aspects, provide tips for protocol building and image routing strategies, and review radiation dose considerations to establish a DECT service line in abdominal imaging. KEY POINTS: • Tube-based and detector-based DECT implementations with varying features and strengths are available on the imaging market. • Thorough assessment of financial and logistical aspects is key to successful implementation of a DECT service line. • Optimized protocol building and image routing strategies are of critical importance for effective use and seamless inception of DECT in routine clinical workflows.
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