An adult and pediatric size-based contrast administration reduction phantom study for single and dual-energy CT through preservation of contrast-to-noise ratio.

Abstract

Global shortages of iodinated contrast media (ICM) during COVID-19 pandemic forced the imaging community to use ICM more strategically in CT exams. The purpose of this work is to provide a quantitative framework for preserving iodine CNR while reducing ICM dosage by either lowering kV in single-energy CT (SECT) or using lower energy virtual monochromatic images (VMI) from dual-energy CT (DECT) in a phantom study. In SECT study, phantoms with effective diameters of 9.7, 15.9, 21.1, and 28.5cm were scanned on SECT scanners of two different manufacturers at a range of tube voltages. Statistical based iterative reconstruction and deep learning reconstruction were used. In DECT study, phantoms with effective diameters of 20, 29.5, 34.6, and 39.7cm were scanned on DECT scanners from three different manufacturers. VMIs were created from 40 to 140keV. ICM reduction by lowering kV levels for SECT or switching from SECT to DECT was calculated based on the linear relationship between iodine CNR and its concentration under different scanning conditions. On SECT scanner A, while matching CNR at 120kV, ICM reductions of 21%, 58%, and 72% were achieved at 100, 80, and 70kV, respectively. On SECT scanner B, 27% and 80% ICM reduction was obtained at 80 and 100kV. On the Fast-kV switch DECT, with CNR matched at 120kV, ICM reductions were 35%, 30%, 23%, and 15% with VMIs at 40, 50, 60, and 68keV, respectively. On the dual-source DECT, ICM reductions were 52%, 48%, 42%, 33%, and 22% with VMIs at 40, 50, 60, 70, and 80keV. On the dual-layer DECT, ICM reductions were 74%, 62%, 45%, and 22% with VMIs at 40, 50, 60, and 70keV. Our work provided a quantitative baseline for other institutions to further optimize their scanning protocols to reduce the use of ICM.