The potential application of dual-energy subtraction radiography for COVID-19 pneumonia imaging.

Brent Van Der Heyden

doi:10.1259/bjr.20201384

Abstract

X-ray imaging plays a crucial role in the confirmation of COVID-19 pneumonia. Chest X-ray radiography and CT are two major imaging techniques that are currently adopted in the diagnosis of COVID-19 pneumonia. However, dual-energy subtraction radiography is hardly discussed as potential COVID-19 imaging application. More advanced X-ray radiography equipment often supports dual-energy subtraction X-ray radiography. Dual-energy subtraction radiography enables the calculation of pseudo-radiographs, in which bones are removed and only soft-tissues are highlighted. In this commentary, the author would like to draw the attention to the potential use of dual-energy subtraction X-ray radiography (i.e. soft-tissue pseudo-radiography) for the assessment and the longitudinal follow-up of COVID-19 pneumonia.

Highlights

Chest X-ray radiography imaging plays a crucial role in the confirmation of pneumonia in patients with severe respiratory symptoms caused by COVID-19.1 X-ray radiography has already been suggested as first-line imaging modality of patients with suspected COVID-19 pneumonia in a pandemic scenario with a worldwide increasing number of inpatients.[2,3]
Dual-energy radiography is performed at one low X-ray energy spectrum (e.g. 70 kVp) and at one high X-ray energy spectrum (e.g. 130 kVp)
Dual-e nergy subtraction radiography takes advantages of the more pronounced X-ray attenuation changes at lower X-ray energies in calcium-containing human tissues such as cortical bone

Summary

Introduction

Chest X-ray radiography imaging plays a crucial role in the confirmation of pneumonia in patients with severe respiratory symptoms caused by COVID-19.1 X-ray radiography has already been suggested as first-line imaging modality of patients with suspected COVID-19 pneumonia in a pandemic scenario with a worldwide increasing number of inpatients.[2,3] Alternatively, institutes adopted CT imaging as main or complimentary diagnostic tool for the assessment and the evaluation of COVID-19 pneumonia over time.[4,5,6,7] Undoubtedly, CT imaging provides superior three- dimensional diagnostic information in contrast to planar X-ray radiography. The author would like to draw attention to the potential use of dual-energy subtraction chest X-ray radiography in the assessment or evaluation of COVID-19 pneumonia.

Results

Conclusion