Substantial radiation dose reduction with consistent image quality using a novel low-dose stone composition protocol
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ORIGINAL ARTICLE
Substantial radiation dose reduction with consistent image quality using a novel low‑dose stone composition protocol Georg Apfaltrer1 · Anja Dutschke2 · Pascal A. T. Baltzer2 · Christian Schestak2 · Mehmet Özsoy3 · Christian Seitz3,4 · Julian Veser3 · Elisabeth Petter2 · Thomas H. Helbich2 · Helmut Ringl2 · Paul Apfaltrer2,5 Received: 21 July 2019 / Accepted: 6 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess a novel low-dose CT-protocol, combining a 150 kV spectral filtration unenhanced protocol (Sn150 kVp) and a stone-targeted dual-energy CT (DECT) in patients with urolithiasis. Methods 232 (151 male, 49 ± 16.4 years) patients with urolithiasis received a low-dose non-contrast enhanced CT (NCCT) for suspected urinary stones either on a third-generation dual-source CT system (DSCT) using Sn150 kVp (n = 116, group 1), or on a second-generation DSCT (n = 116 group 2) using single energy (SE) 120 kVp. For group 1, a subsequent dualenergy CT (DECT) with a short stone-targeted scan range was performed. Objective and subjective image qualities were assessed. Radiation metrics were compared. Results 534 stones (group 1: n = 242 stones; group 2: n = 292 stones) were found. In group 1, all 215 stones within the stone-targeted DECT-scan range were identified. DE analysis was able to distinguish between UA and non-UA calculi in all collected stones. 11 calculi (5.12%) were labeled as uric acid (UA) while 204 (94.88%) were labeled as non-UA calculi. There was no significant difference in overall Signal-to-noise-ratio between group 1 and group 2 (p = 0.819). On subjective analysis both protocols achieved a median Likert rating of 2 (p = 0.171). Mean effective dose was significantly lower for combined Sn150 kVp and stone-targeted DECT (3.34 ± 1.84 mSv) compared to single energy 120 kVp NCCT (4.45 ± 2.89 mSv) (p 50% [21] in urolithiasis- suspected ER patients underline the importance of a radiation protection and emphasize the need for a distinct discussion before changing CT-protocols from SECT to DECT for all patients. Consequently the purpose of this study was to assess a novel low-dose CT-protocol, combining a low-dose 150 kV spectral filtration unenhanced protocol (Sn150 kVp) and a stone-targeted DECT in patients with urolithiasis for image quality, radiation dose reduction and ability for stone characterization.
Materials and methods Subject population This retrospective, single-center, institutional review boardapproved study was performed in accordance with the Health Insurance Portability and Accountability Act and the Declaration of Helsinki. The need for written, informed consent was waived due to the retrospective nature of the study. From April to October 2018 a total of 116 consecutive patients (median age 48.1 years; range 20–89 years), including 70 men (median age 44 years; range 20–89 years) and 46
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World Journal of Urology
women (median age 50.5 years; range 23–85 years) with suspected urolithiasis underwent third-generation dual-
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