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.