Submillisievert chest dual energy computed tomography: a pilot study.

OBJECTIVE To assess if diagnostic dual energy CT (DECT) of the chest can be achieved at submillisievert (sub-mSv) doses. METHODS Our IRB-approved prospective study included 20 patients who were scanned on dual-source multidector CT(MDCT). All patients gave written informed consent for acquisition of additional image series at reduced radiation dose on a dual-source MDCT (80/140 kV) within 10 s after the standard of care acquisition. Dose reduction was achieved by reducing the quality reference milliampere-second, with combined angular exposure control. Four readers, blinded to all clinical data, evaluated the image sets. Image noise, signal-to-noise and contrast-to-noise ratio were assessed. Volumetric CT dose index (CTDIvol), doselength product (DLP), size specific dose estimate, and effective dose were also recorded. RESULTS The mean age and body mass index of the patients were 71 years ± 9 and 24 kg m-2 ± 3, respectively. Although images became noisier, overall image quality and image sharpness on blended images were considered good or excellent in all cases (20/20). All findings made on the reduced dose images presented with good demarcation. The intraobserver and interobserver agreements were κ = 0.83 and 0.73, respectively. Mean CTDIvol, size specific dose estimate, DLP and effective dose for reduced dose DECT were: 1.3 ± 0.2 mGy, 1.8 ± 0.2 mGy, 51 ± 9.9 mGy.cm and 0.7 ± 0.1 mSv, respectively. CONCLUSION Routine chest DECT can be performed at sub-mSv doses with good image quality and without loss of relevant diagnostic information. Advances in knowledge: (1) Contrast-enhanced DECT of the chest can be performed at sub-mSv doses, down to mean CTDIvol 1.3 mGy and DLP 51 mGy.cm in patients with body mass index <31 kg m-2. (2) To our knowledge, this is the first time that sub-mSv doses have been successfully applied in a patient study using a dual source DECT scanner.