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Attenuation-based kV pair selection in dual source dual energy computed tomography angiography of the chest: impact on radiation dose and image quality

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Abstract

Objectives

The purpose of this study was to evaluate the impact of attenuation-based kilovoltage (kV) pair selection in dual source dual energy (DSDE)-pulmonary embolism (PE) protocol examinations on radiation dose savings and image quality.

Methods

A prospective study was carried out on 118 patients with suspected PE. In patients in whom attenuation-based kV pair selection selected the 80/140Sn kV pair, the pre-scan 100/140Sn CTDIvol (computed tomography dose index volume) values were compared with the pre-scan 80/140Sn CTDIvol values. Subjective and objective image quality parameters were assessed.

Results

Attenuation-based kV pair selection switched to the 80/140Sn kV pair (“switched” cohort) in 63 out of 118 patients (53%). The mean 100/140Sn pre-scan CTDIvol was 8.8 mGy, while the mean 80/140Sn pre-scan CTDIvol was 7.5 mGy. The average estimated dose reduction for the “switched” cohort was 1.3 mGy (95% CI 1.2, 1.4; p < 0.001), representing a 15% reduction in dose. After adjusting for patient weight, mean attenuation was significantly higher in the “switched” vs. “non-switched” cohorts in all five pulmonary arteries and in all lobes on iodine maps.

Conclusions

This study demonstrates that attenuation-based kV pair selection in DSDE examination is feasible and can offer radiation dose reduction without compromising image quality.

Key Points

• Attenuation-based kV pair selection in dual energy examination is feasible.

• It can offer radiation dose reduction to approximately 50% of patients.

• Approximate 15% reduction in radiation dose was achieved using this technique.

• The image quality is not compromised by use of attenuation-based kV pair selection.

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Acknowledgements

The scientific guarantor of this publication is Rahul Renapurkar. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Ms Jennifer Bullen kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Thoracic Imaging, L10, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Rahul D. Renapurkar, Joseph Azok, Jason Lempel, Wadih Karim & Ruffin Graham

  2. Siemens Medical Solutions, Malvern, PA, USA

    Andrew Primak

  3. Department of Radiology, Case Western Reserve University-Metro Health Medical Center, Cleveland, OH, 44109, USA

    Yasmeen Tandon

  4. Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Jennifer Bullen

  5. Section of Medical Physics, Cleveland Clinic, Cleveland, OH, USA

    Frank Dong

Authors
  1. Rahul D. Renapurkar
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  2. Andrew Primak
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Correspondence to Rahul D. Renapurkar.

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Renapurkar, R.D., Primak, A., Azok, J. et al. Attenuation-based kV pair selection in dual source dual energy computed tomography angiography of the chest: impact on radiation dose and image quality. Eur Radiol 27, 3283–3289 (2017). https://doi.org/10.1007/s00330-016-4714-7

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  • DOI: https://doi.org/10.1007/s00330-016-4714-7

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