Prospective evaluation of ultra-low-dose contrast-enhanced 100-kV abdominal computed tomography with tin filter: effect on radiation dose reduction and image quality with a third-generation dual-source CT system

ObjectivesTo investigate the radiation dose exposure, image quality, and diagnostic performance of enhanced 100-kVp abdominopelvic single-energy CT protocol with tin filter (TF).MethodsNinety-three consecutive patients referred for a single-phase enhanced abdominopelvic CT were prospectively included after informed consent. They underwent in addition to a standard protocol (SP) an acquisition with TF. Both examinations were performed on a third-generation dual-source CT system (DSCT), in single energy, using automatic tube current modulation, identical pitch, and identical level of iterative reconstruction. Radiation metrics were compared. Size-specific dose estimates (SSDE), contrast to noise ratio (CNR), and figure of merit (FOM) were calculated. Diagnostic confidence for the assessment of a predetermined list of abdominal lesions was rated by two independent readers.ResultsThe mean dose of the TF protocol was significantly lower (CDTI 1.560.43mGy vs. 8.133.32, p<0.001; SSDE 9.943.08 vs. 1.930.39, p<0.001), with an effective dose close to 1mSv (1.14mSv +/- 0.34; p<0.001). TF group exhibited non-significant lower liver CNR (2.76 vs. 3.03, p=0.56) and was more dose efficient (FOM 10.6 vs. 2.49/mSv, p<0.001) in comparison to SP. The mean diagnostic confidence for visceral, bone, and peritoneal tumors was equivalent between both groups.Conclusions4>Enhanced 100-kVp abdominopelvic CT acquired after spectral shaping with tin filtration can achieve similar diagnostic performance and CNR compared to a standard CT protocol, while reducing the radiation dose by 81%.Key Points5>center dot 100-kVp spectral filtration enables enhanced abdominal CT with high-dose efficiency.6>center dot The radiation dose reaches the 1-mSv range.7>center dot Predetermined abdominopelvic lesions can be assessed without impairing on diagnostic confidence.