Carsten Thierfelder

Feasibility of dual-source cardiac CT angiography with high-pitch scan protocols

BACKGROUND Cardiac CT angiography (CCTA) has become a frequently used diagnostic tool in clinical practice, but concern remains about the radiation exposure. Because of the second x-ray acquisition system, dual-source CT systems might allow for high-pitch CT data acquisition and thus for examination of the whole heart during a single heart beat, with the potential for radiation dose reduction. OBJECTIVE We assessed the feasibility of a high-pitch scan mode with a dual-source CT system. METHODS High-pitch modes were used in patients undergoing CCTA with a dual-source CT system. Diagnostic image quality for cardiac structures and coronary arteries was assessed. Radiation dose was estimated from the scanner-generated dose-length product (DLP). RESULTS CCTA was performed in 14 patients during a single heart beat applying a pitch value of 3.4. Mean heart rate during examination was 56.4+/-8.1 beats/min. Diagnostic image quality for the assessment of larger cardiac structures was obtained in all patients, whereas diagnostic image quality could be achieved in 82% of all coronary segments. With a mean DLP of 145+/-47 mGy x cm, the resulting estimated radiation dose was 2.0+/-0.7 mSv. CONCLUSIONS This proof-of-concept study shows the ability of dual-source CT scanners to scan the whole heart during one single heart beat at low radiation dose.

4D-Imaging of the Lung: Reproducibility of Lesion Size and Displacement on Helical CT, MRI, and Cone Beam CT in a Ventilated Ex Vivo System

PURPOSE Four-dimensional (4D) imaging is a key to motion-adapted radiotherapy of lung tumors. We evaluated in a ventilated ex vivo system how size and displacement of artificial pulmonary nodules are reproduced with helical 4D-CT, 4D-MRI, and linac-integrated cone beam CT (CBCT). METHODS AND MATERIALS Four porcine lungs with 18 agarose nodules (mean diameters 1.3-1.9 cm), were ventilated inside a chest phantom at 8/min and subject to 4D-CT (collimation 24 x 1.2 mm, pitch 0.1, slice/increment 24 x 10(2)/1.5/0.8 mm, pitch 0.1, temporal resolution 0.5 s), 4D-MRI (echo-shared dynamic three-dimensional-flash; repetition/echo time 2.13/0.72 ms, voxel size 2.7 x 2.7 x 4.0 mm, temporal resolution 1.4 s) and linac-integrated 4D-CBCT (720 projections, 3-min rotation, temporal resolution approximately 1 s). Static CT without respiration served as control. Three observers recorded lesion size (RECIST-diameters x/y/z) and axial displacement. Interobserver- and interphase-variation coefficients (IO/IP VC) of measurements indicated reproducibility. RESULTS Mean x/y/z lesion diameters in cm were equal on static and dynamic CT (1.88/1.87; 1.30/1.39; 1.71/1.73; p > 0.05), but appeared larger on MRI and CBCT (2.06/1.95 [p < 0.05 vs. CT]; 1.47/1.28 [MRI vs. CT/CBCT p < 0.05]; 1.86/1.83 [CT vs. CBCT p < 0.05]). Interobserver-VC for lesion sizes were 2.54-4.47% (CT), 2.29-4.48% (4D-CT); 5.44-6.22% (MRI) and 4.86-6.97% (CBCT). Interphase-VC for lesion sizes ranged from 2.28% (4D-CT) to 10.0% (CBCT). Mean displacement in cm decreased from static CT (1.65) to 4D-CT (1.40), CBCT (1.23) and MRI (1.16). CONCLUSIONS Lesion sizes are exactly reproduced with 4D-CT but overestimated on 4D-MRI and CBCT with a larger variability due to limited temporal and spatial resolution. All 4D-modalities underestimate lesion displacement.

Flash imaging in dual source CT (DSCT)

We present new acquisition modes of a recently introduced dual-source computed tomography (DSCT) system equipped with two X-ray tubes and two corresponding detectors, mounted onto the rotating gantry with an angular offset of typically 90°. Due to the simultaneous acquisition of complementary data, the minimum exposure time is reduced by a factor of two compared to a single-source CT system (SSCT). The correspondingly improved temporal resolution is beneficial for cardiac CT. Also, maximum table feed per rotation in a spiral mode can be increased by a factor of 2 compared to SSCT, which provides benefits both for cardiac CT and non-cardiac CT. In an ECG-triggered mode the entire cardiac volume can be scanned within a fraction of one cardiac RR-cycle. At a rotation time of 0.28s using a detector with 64×0.6 mm beam collimation, the scan time of the entire heart is less than 0.3s at a temporal resolution of 75 ms. It will be shown, that the extremely fast cardiac scan reduces the patient dose to a theoretical lowest limit: for a 120 kV scan the dose level for a typical cardiac CT scan is well below 2 mSv. Using further protocol optimization (scan range adaptation, 100kV), the radiation dose can be reduced below 1mSv.