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Dual energy CT in clinical routine: how it works and how it adds value

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Abstract

Dual energy computed tomography (DECT), also known as spectral CT, refers to advanced CT technology that separately acquires high and low energy X-ray data to enable material characterization applications for substances that exhibit different energy-dependent x-ray absorption behavior. DECT supports a variety of post-processing applications that add value in routine clinical CT imaging, including material selective and virtual non-contrast images using two- and three-material decomposition algorithms, virtual monoenergetic imaging, and other material characterization techniques. Following a review of acquisition and post-processing techniques, we present a case-based approach to highlight the added value of DECT in common clinical scenarios. These scenarios include improved lesion detection, improved lesion characterization, improved ease of interpretation, improved prognostication, inherently more robust imaging protocols to account for unexpected pathology or suboptimal contrast opacification, length of stay reduction, reduced utilization by avoiding unnecessary follow-up examinations, and radiation dose reduction. A brief discussion of post-processing workflow approaches, challenges, and solutions is also included.

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Abbreviations

CT:

Computed tomography

DE:

Dual energy

DECT:

Dual energy CT

HU:

Hounsfield Units

keV:

Kilo-electron volts

kVp:

Peak kilovoltage

VME:

Virtual monoenergetic

VNC:

Virtual non-contrast

VNCa:

Virtual non-calcium

PACS:

Picture archiving and communication system

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Funding

Institutional research grant from Siemens on Dual Energy CT.

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Authors and Affiliations

  1. Division of Emergency Radiology, Brigham and Women’s Hospital Department of Radiology, Boston, MA, USA

    Aaron D. Sodickson, Abhishek Keraliya, Bryan Czakowski & Jennifer W. Uyeda

  2. Harvard Medical School, Boston, MA, USA

    Aaron D. Sodickson, Abhishek Keraliya & Jennifer W. Uyeda

  3. Siemens Healthineers, Malvern, PA, USA

    Andrew Primak

  4. Lahey Hospital and Medical Center, Burlington, MA, USA

    Jeremy Wortman

  5. Tufts University School of Medicine, Boston, MA, USA

    Jeremy Wortman

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  1. Aaron D. Sodickson
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  5. Jeremy Wortman
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  6. Jennifer W. Uyeda
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Correspondence to Aaron D. Sodickson.

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Aaron Sodickson: PI of institutional research grant from Siemens on Dual Energy CT. Travel expenses from Siemens to speak at a Siemens users conference.

Andrew Primak: Research collaborations scientists employed by Siemens

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Sodickson, A.D., Keraliya, A., Czakowski, B. et al. Dual energy CT in clinical routine: how it works and how it adds value. Emerg Radiol 28, 103–117 (2021). https://doi.org/10.1007/s10140-020-01785-2

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