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.
• 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.
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Advanced modeled iterative reconstruction
Automated attenuation-based tube voltage selection
Body mass index
- CTDIvol :
Volume CT dose index
Dual-energy computed tomography
Dual-source computed tomography
Region of interest
Sinogram-affirmed iterative reconstruction
Single-energy computed tomography
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The authors state that this work has not received any funding.
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.
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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). https://doi.org/10.1007/s00330-018-5982-1
- Computed tomography angiography
- Pulmonary embolism
- Radiation dosage
- Diagnostic imaging