Skip to main content


Log in

Single- and dual-energy CT pulmonary angiography using second- and third-generation dual-source CT systems: comparison of radiation dose and image quality

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript



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.


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.


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).


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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others



Advanced modeled iterative reconstruction


Automated attenuation-based tube voltage selection


Body mass index


Contrast-to-noise ratio


Computed tomography

CTDIvol :

Volume CT dose index


Dual-energy computed tomography


Dose-length product


Dual-source computed tomography


Effective dose




Hounsfield units


Region of interest


Sinogram-affirmed iterative reconstruction


Standard deviation


Single-energy computed tomography


  1. Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29:2276–2315

    Article  CAS  PubMed  Google Scholar 

  2. Stein PD, Fowler SE, Goodman LR et al (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327

    Article  CAS  PubMed  Google Scholar 

  3. Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC (2004) CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 24:1219–1238

    Article  PubMed  Google Scholar 

  4. Albrecht MH, Trommer J, Wichmann JL et al (2016) Comprehensive comparison of virtual monoenergetic and linearly blended reconstruction techniques in third-generation dual-source dual-energy computed tomography angiography of the thorax and abdomen. Invest Radiol 51:582–590

    Article  CAS  PubMed  Google Scholar 

  5. Beeres M, Trommer J, Frellesen C et al (2016) Evaluation of different keV-settings in dual-energy CT angiography of the aorta using advanced image-based virtual monoenergetic imaging. Int J Cardiovasc Imaging 32:137–144

    Article  PubMed  Google Scholar 

  6. Weiss J, Notohamiprodjo M, Bongers M et al (2017) Effect of noise-optimized monoenergetic postprocessing on diagnostic accuracy for detecting incidental pulmonary embolism in portal-venous phase dual-energy computed tomography. Invest Radiol 52:142–147

    PubMed  Google Scholar 

  7. Leithner D, Wichmann JL, Vogl TJ et al (2017) Virtual monoenergetic imaging and iodine perfusion maps improve diagnostic accuracy of dual-energy computed tomography pulmonary angiography with suboptimal contrast attenuation. Invest Radiol 52:659–665

    Article  PubMed  Google Scholar 

  8. Schenzle JC, Sommer WH, Neumaier K et al (2010) Dual energy CT of the chest: how about the dose? Invest Radiol 45:347–353

    PubMed  Google Scholar 

  9. Krauss B, Grant KL, Schmidt BT, Flohr TG (2015) The importance of spectral separation: an assessment of dual-energy spectral separation for quantitative ability and dose efficiency. Invest Radiol 50:114–118

    Article  PubMed  Google Scholar 

  10. Wichmann JL, Hardie AD, Schoepf UJ et al (2017) 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 27:642–650

    Article  PubMed  Google Scholar 

  11. De Cecco CN, Darnell A, Macías N et al (2013) Second-generation dual-energy computed tomography of the abdomen: radiation dose comparison with 64- and 128-row single-energy acquisition. J Comput Assist Tomogr 37:543–546

    Article  PubMed  Google Scholar 

  12. Shrimpton PC, Hillier MC, Lewis MA, Dunn M (2006) National survey of doses from CT in the UK: 2003. Br J Radiol 79:968–980

    Article  CAS  PubMed  Google Scholar 

  13. (2007) The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 37:1–332

  14. Christner JA, Kofler JM, McCollough CH (2010) Estimating effective dose for CT using dose-length product compared with using organ doses: consequences of adopting International Commission on Radiological Protection publication 103 or dual-energy scanning. AJR Am J Roentgenol 194:881–889

    Article  PubMed  Google Scholar 

  15. Schindera ST, Nelson RC, Mukundan S Jr et al (2008) Hypervascular liver tumors: low tube voltage, high tube current multi-detector row CT for enhanced detection--phantom study. Radiology 246:125–132

    Article  PubMed  Google Scholar 

  16. Sullivan GM, Artino AR Jr (2013) Analyzing and interpreting data from likert-type scales. J Grad Med Educ 5:541–542

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284–290

  18. Mahmood U, Horvat N, Horvat JV et al (2018) Rapid switching kVp dual energy CT: value of reconstructed dual energy CT images and organ dose assessment in multiphasic liver CT exams. Eur J Radiol 102:102–108

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schmidt D, Söderberg M, Nilsson M, Lindvall H, Christoffersen C, Leander P (2018) Evaluation of image quality and radiation dose of abdominal dual-energy CT. Acta Radiol 59:845–852

    Article  PubMed  Google Scholar 

  20. Primak AN, Giraldo JC, Eusemann CD et al (2010) Dual-source dual-energy CT with additional tin filtration: dose and image quality evaluation in phantoms and in vivo. AJR Am J Roentgenol 195:1164–1174

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bauer RW, Kramer S, Renker M et al (2011) Dose and image quality at CT pulmonary angiography-comparison of first and second generation dual-energy CT and 64-slice CT. Eur Radiol 21:2139–2147

    Article  PubMed  Google Scholar 

  22. Meyer M, Haubenreisser H, Schoepf UJ et al (2014) Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 273:373–382

    Article  PubMed  Google Scholar 

  23. Gordic S, Morsbach F, Schmidt B et al (2014) Ultralow-dose chest computed tomography for pulmonary nodule detection: first performance evaluation of single energy scanning with spectral shaping. Invest Radiol 49:465–473

    Article  PubMed  Google Scholar 

  24. Nam SB, Jeong DW, Choo KS et al (2017) Image quality of CT angiography in young children with congenital heart disease: a comparison between the sinogram-affirmed iterative reconstruction (SAFIRE) and advanced modelled iterative reconstruction (ADMIRE) algorithms. Clin Radiol 72:1060–1065

    Article  CAS  PubMed  Google Scholar 

  25. Schmid AI, Uder M, Lell MM (2017) Reaching for better image quality and lower radiation dose in head and neck CT: advanced modeled and sinogram-affirmed iterative reconstruction in combination with tube voltage adaptation. Dentomaxillofac Radiol 46:20160131

    Article  PubMed  Google Scholar 

  26. Winklehner A, Gordic S, Lauk E et al (2015) Automated attenuation-based tube voltage selection for body CTA: performance evaluation of 192-slice dual-source CT. Eur Radiol 25:2346–2353

    Article  PubMed  Google Scholar 

  27. Graser A, Johnson TR, Hecht EM et al (2009) Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images? Radiology 252:433–440

    Article  PubMed  Google Scholar 

  28. Mangold S, De Cecco CN, Wichmann JL et al (2016) Effect of automated tube voltage selection, integrated circuit detector and advanced iterative reconstruction on radiation dose and image quality of 3rd generation dual-source aortic CT angiography: an intra-individual comparison. Eur J Radiol 85:972–978

    Article  PubMed  Google Scholar 

  29. Mayo-Smith WW, Hara AK, Mahesh M, Sahani DV, Pavlicek W (2014) How I do it: managing radiation dose in CT. Radiology 273:657–672

    Article  PubMed  Google Scholar 

Download references


The authors state that this work has not received any funding.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Lukas Lenga.

Ethics declarations


The scientific guarantor of this publication is Lukas Lenga.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Julian L. Wichmann received speakers’ fees from GE Healthcare and Siemens Healthcare. Moritz H. Albrecht received speakers’ fees from Siemens Healthcare. However, all other authors report no potential conflict of interest. Data was controlled by authors with no potential conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• cross-sectional study

• performed at one institution

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lenga, L., Trapp, F., Albrecht, M.H. et al. 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 29, 4603–4612 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: