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Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols

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Abstract

Purpose

To standardize workflow for dual-energy computed tomography (DECT) involving common abdominopelvic exam protocols.

Materials and methods

9 institutions (4 rsDECT, 1 dsDECT, 4 both) with 32 participants [average # years (range) in practice and DECT experience, 12.3 (1–35) and 4.6 (1–14), respectively] filled out a single survey (n = 9). A five-point agreement scale (0, 1, 2, 3, 4—contra-, not, mildly, moderately, strongly indicated, respectively) and utilization scale (0—not performing and shouldn’t; 1—performing but not clinically useful; 2—performing but not sure if clinically useful; 3—not performing it but would like to; 4—performing and clinically useful) were used. Consensus was considered with a score of ≥2.5. Survey results were discussed over three separate live webinar sessions.

Results

5/9 (56%) institutions exclude large patients from DECT. 2 (40%) use weight, 2 (40%) use transverse dimension, and 1 (20%) uses both. 7/9 (78%) use 50 keV for low and 70 keV for medium monochromatic reconstructed images. DECT is indicated for dual liver [agreement score (AS) 3.78; utilization score (US) 3.22] and dual pancreas in the arterial phase (AS 3.78; US 3.11), mesenteric ischemia/gastrointestinal bleeding in both the arterial and venous phases (AS 2.89; US 2.79), RCC exams in the arterial phase (AS 3.33; US 2.78), and CT urography in the nephrographic phase (AS 3.11; US 2.89). DECT for renal stone and certain single-phase exams is indicated (AS 3.00).

Conclusions

DECT is indicated during the arterial phase for multiphasic abdominal exams, nephrographic phase for CTU, and for certain single-phase and renal stone exams.

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Authors and Affiliations

  1. Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC, 27710, USA

    Bhavik N. Patel, Brian Allen, Achille Mileto & Daniele Marin

  2. Department of Radiology, Emory University, Atlanta, USA

    Lauren Alexander & Courtney Moreno

  3. Department of Radiology, University of Alabama Birmingham, Birmingham, USA

    Lincoln Berland & Desiree Morgan

  4. Department of Radiology, University of Pittsburgh, Pittsburgh, USA

    Amir Borhani & Mitchell Tublin

  5. Department of Radiology, Massachusetts General Hospital, Boston, USA

    Dushyant Sahani

  6. Department of Radiology, University of Washington, Seattle, USA

    William Shuman

  7. Department of Radiology, MD Anderson, Houston, USA

    Eric Tamm

  8. Department of Radiology, University of California San Francisco, San Francisco, USA

    Benjamin Yeh

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  1. Bhavik N. Patel
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Corresponding author

Correspondence to Bhavik N. Patel.

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Funding

No funding was received for this study.

Conflict of interest

Bhavik N. Patel, Lauren Alexander, Brian Allen, Lincoln Berland, Amir Borhani, Courtney Moreno, Mitchell Tublin: no relevant financial disclosures; D. Morgan: research support, General Electric Healthcare; Dushyant Sahani: medical consultant and research support, General Electric Healthcare; royalties from Elsevier; William Shuman: research support, General Electric Healthcare; Eric Tamm: research support, General Electric Healthcare; Benjamin Yeh: research support from General Electric Healthcare; shareholder for Nextrast, Inc; royalties from Oxford University Press. D. Marin: research support, Siemens Healthcare. One of the authors (B.P.), who is neither an employee or consultant to industry, had control of the data and the information submitted for publication.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Statement of informed consent was not applicable since the manuscript does not contain any patient data.

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Patel, B.N., Alexander, L., Allen, B. et al. Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols. Abdom Radiol 42, 676–687 (2017). https://doi.org/10.1007/s00261-016-0966-6

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