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A scientific review of dual-energy and spectral computed tomography imaging

White Paper
Philips CT Clinical Science Philips Healthcare • USA


Dual-energy computed tomography (CT), sometimes referred to as spectral CT, is an imaging technology that allows clinicians to differentiate the various elements in the body based on their material density and atomic number, providing both anatomical and tissue composition information. Since its inception, dual-energy CT imaging has proven useful in boosting clinical diagnostic confidence when compared to conventional CT scans.

Studies at university hospitals and centers of excellence have demonstrated the clinical and patient benefits of utilizing spectral technology across a range of clinical indications, including cardiac, neurological, musculoskeletal, genitourinary, vascular and oncology. However, the potential of dual-energy CT scanners in mainstream clinical settings has yet to be realized.

Most frequently cited challenges of spectral imaging:
  • Changes in routine clinical workflow
  • Potentially higher than normal dose exposure to patients
  • Reduction in conventional CT image quality for radiologist to diagnose from

The majority of dual-energy imaging systems available in the market today are source-based systems, i.e. they provide the dual energy through X-ray source/s to generate the data required for a spectral CT image. While source-based approaches generate the various data sets required for a spectral image, they require clinicians to prospectively determine the need for a spectral scan. Dose modulation tools that are typically available on conventional CT scanners are limited in source-based spectral modes, and conventional CT image quality suffers from increased noise generated by these approaches.

A significant advancement in spectral imaging from a source-based approach was realized with the introduction of the Philips IQon Spectral CT, a dual-layer, detector-based approach: i.e. the energy required to create a spectral image is separated by the detector, rather than the source.

Benefits experienced with a detector-based approach to spectral imaging:
  • Clinicians may choose to retrospectively view spectral data
  • Dose modulation tools are always available
  • Conventional image quality is not impacted with detector-based spectral data collection

Detector-based spectral CT imaging boosts diagnostic certainty and reduces the number of follow-up exams required for several clinical applications. Using monoenergetic spectral results, clinicians can reduce beam hardening artifacts and metal implant artifacts. Spectral-derived iodine maps, non-contrast images and monochromatic energy attenuation images improve identification of vascular structures and underlying tissue composition, aiding in reducing contrast dose requirements. By basing diagnoses on both anatomical structures as well as tissue characteristics, clinicians are able to more conclusively detect and characterize tumors, assess the hemodynamic significance of pulmonary embolisms, and characterize renal calculi, amongst several other uses.

This monograph presents evidence to demonstrate and support why detector-based spectral imaging should be the method of choice in routine clinical practice in hospitals and CT imaging centers. It reviews the role of spectral CT imaging in clinical diagnosis, the physics behind spectral imaging, the various techniques used to generate spectral data, and presents clinical efficacy and usefulness of a detector-based approach to spectral imaging. Several studies demonstrate how detector-based spectral imaging, exclusive to the Philips IQon Spectral CT, improved diagnostic confidence for clinicians and helped them overcome workflow challenges presented by source-based spectral imaging techniques, with no loss in functionality of dose modulation tools or conventional image quality.

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Jun 4, 2018

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White Paper
IntelliSpace Portal, IQon Spectral CT
abdomen, artifacts, Body, Cardiac, chest, contrast, dose, follow up, Head, image quality, implant, iodine density, iodine no water, iodine overlay, kidney/renal, MonoE, Musculoskeletal, Neck, Neuro, non-contrast, Oncology, PE, Pediatric, Pelvis, renal calculi, spectral CT, tumor, Vascular, virtual non-contrast, workflow

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