| خلاصه مقاله | Introduction
Dual-energy CT (DECT) is one of the most exciting and promising developments in radiology in recent history. Early diagnostic CT approaches exploring multiple energy applications involved two subsequent scans at different tube voltages over the same anatomic position [1]. The application of dual-energy (DE) techniques in CT is rapidly expanding. DECT scanning refers to simultaneous acquisition of low and high peak voltage CT data. There is an increased interest in DE scanning, driven by the recent commercial availability of different DE hardware platforms (eg, dual-source CT and rapid kilovolt switching).DE scanning, in general, offers 2 main advantages: material characterization based on the difference in material and tissue attenuation observed at 2 different photon energies; and non-material-specific image fusion combining low and high peak voltage acquisitions.[2]
Discussion and Methods
In general, considerable caution is warranted when interpreting comparative reports on radiation exposure with different techniques. A multitude of studies have indiscriminately reported radiation doses with various routine techniques and concluded that one or the other method results in “higher” or “lower” radiation. However, no attention is paid to normalization of image quality, signal-to-noise ratio, or dose-length product (DLP).Most recent researches observed no significant difference in image noise and image dose but showed that the contrast-to-noise ratio (CNR) could be doubled with optimized DECT reconstructions. Specifically, Schenzle et al. [4] equipped an anthropomorphic Alderson phantom with thermoluminescent dosimeters (TLDs) and scanned the chest with a first-generation DSCT system in dual-energy mode at 140 and 80 kVp with 14 × 1.2 mm collimation and on a second-generation DSCT system at 140 and 100 kVp with selective photon shielding at 128 × 0.6 mm collimation. For dose comparison with single-energy CT, the investigators obtained reference examinations at 120 kVp with 64 × 0.6 mm collimation at an equivalent CT dose index of 5.4 mGy × cm. In this phantom study, the authors reported effective dose measurements with TLDs that were equal for both DSCT systems in dual-energy mode at 140 and 80 kV and 140 and 100 kV with selective photon shielding when compared with the single-energy 120-kV reference examination: 2.61 mSv for first-generation DSCT in DECT mode; 2.69 mSv for second-generation DSCT in DECT mode; and 2.70 mSv for second-generation DSCT in single-energy mode. Moreover, the image noise was reported to be similar for all three of the different imaging techniques.[5] (Fig1,Fig2).
Conclusion
Of the various methods that have been proposed for acquiring DECT data, image acquisition based on DSCT is the most intensely evaluated approach in the current literature. There is strong evidence that DECT imaging with DSCT is not associated with increased radiation dose levels. Radiation dose data on DECT techniques based on rapid kilovoltage switching to date are inconclusive. Reports on radiation dose with other approaches for DECT data acquisition are scarce or nonexistent, and a conclusive evaluation of the radiation dose associated with these techniques remains elusive. Finally, judicious use of DECT techniques holds the potential of drastically reducing radiation exposure, for example, by the elimination of unnecessary unenhanced CT. |