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Comparative intra-patients (each patient will have both types of scanner imaging done), clinical superiority study, evaluating the imaging performances (e.g. image quality and radiation dose) of SPCCT and standard DECT for several body regions/anatomical structures.

For the dual-layer spectral CT scanner (IQon®, Philips, Amsterdam, The Netherlands), the following parameters will be used for the acquisition:

* Tube potential 120 kVp;
* Tube current time product of 150 mAs;
* Gantry revolution time 0.33 s;
* Automatic exposure control (angular and longitudinal) combined xyz-axis;
* Beam collimation geometry 64 x 0.625 mm - scan field-of-view - 22 cm;

Spectral Photon Counting Computed Tomography (SPCCT)

The SPCCT scanner is a prototype spectral photon-counting computed tomography system derived from a modified clinical CT system with a field-of-view (FOV) of 168 mm in-plane, and a z-coverage of 20 mm. It is equipped with energy-sensitive photon-counting detectors relying on the direct conversion high band gap semiconductor of cadmium zinc telluride (CZT). The electronics comprises 5 rate counters with 5 different configurable energy thresholds. The SPCCT scanner has the following parameters:

* Base platform : iCT scanner
* Tube Voltage (kVp) : 120, capability for imaging at 80 and 100 kVp
* Tube current (mA) : 10 - 300
* Spatial Resolution : \> 30 lp/cm, ≤ 250 µm
* Z-coverage isocenter (mm) : 20 mm
* FOV (mm) : 500
* Minimum rotation time : 0.33 s/rotation
* Acquisition modes : Axial, Helical, Step \& Shoot

DECT (Dual Energy CT)

Philippe DOUEK, Pr

Adeline MANSUY

This pilot study wants to determine to which extent SPCCT allows obtaining images with improved quality and diagnostic confidence when compared to standard Dual Energy CT (DECT), both with and without contrast agent injection.

Depending on the anatomical structures/organs to be visualized during CT examinations, different scanning protocols are performed with quite variable ionizing radiation doses. Therefore, in order to obtain the most extensive and representative results of the improvement in image quality between SPCCT and DECT that will be performed CT imaging on several body regions and structures, including diabetic foot, diabetic calcium coronary scoring, adrenal glands, coronary arteries, lung parenchyma, kidney stones, inner ear, brain and joints, earl/temporal bone, colorectal carcinosis.

Comparison of Imaging Quality Between Spectral Photon Counting Computed Tomography (SPCCT) and Dual Energy Computed Tomography (DECT)

A single four-point scale will be used (1: unacceptable, 2: usable under limited conditions, 3: probably acceptable, 4: fully acceptable) based on the European guidelines on quality criteria for computed tomography

The diagnostic confidence grade will be calculated on a four-point scale (1: insufficient, 2: poor, 3: average, 4: good).

It will be calculated on a five-point scale (1: poor, 2: fair, 3: average, 4: good, 5: excellent) for each following criterion: noise, artifacts and sharpness.

To determine the radiation dose delivered to the patients during the DECT and SPCCT imaging procedures.

The CTDI is an estimation of the dose delivered to the organs for each acquired section that is based on acquisition parameters of a water phantom with a 32 cm diameter. The value is expressed in milligray (mGy).

To determine the radiation dose delivered to the patients during the DECT and SPCCT imaging procedures.

The DLP is obtained as follows: CTDI \* length of body explored = value in mGy.cm.

To determine the radiation dose delivered to the patients during the DECT and SPCCT imaging procedures.

The equivalent dose is obtained by multiplying the DLP to the specific organ conversion factor.

The noise by selecting regions of interest (ROI) will calculated.

The density (HU) by selecting regions of interest (ROI) will calculated.

The contrast-to-noise ratio (CNR) by selecting regions of interest (ROI) will calculated.

Depiction of anatomical structures of interest will be graded on a four-point scale (1: visualization just possible, 2: unclear borders but different structures already visible, 3: very good visualization, well-defined anatomy, 4: perfect delineation of anatomy).

An average radiation dose delivered to the patients for each clinical application will be calculated.

Statistical comparison between SPCCT and DECT will be performed over all images and anatomical structures globally and also for each clinical application of interest.

Hospices Civils de Lyon

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