Qi Jing,  Eutsler Eric,  Siegel Marilyn

Final Pr. ID: Poster #: EDU-068

Dual-energy CT (DECT) refers to the acquisition of CT datasets at two different energy spectra, which allows differentiation and classification of tissues. The purpose of this this poster is to describe post-processing algorithms and clinical applications of DECT in children on a dual-source CT system. Read More

Authors:  Qi Jing , Eutsler Eric , Siegel Marilyn

Keywords:  Dual energy CT, Pediatric Radiology, Clinical application

Yacoub Daniel,  Wang Kuan Chung,  Shah Prakeshkumar,  Moineddin Rahim,  Doria Andrea

Final Pr. ID: Poster #: SCI-063

Increased fracture risk is a complication that occurs in the context of primary bone diseases such as osteogenesis imperfecta (OI). Despite being considered as the reference-standard, the use of dual-energy X-ray absorptiometry (DXA) to evaluate fragility fractures in OI has not been validated by prior systemic review. Identifying patients at greatest risk for bone fragility fractures and determining skeletal health markers that can monitor bone mass concerning response to bone-active treatments are important issues for clinicians. In this systematic review we assessed the clinical utility of DXA for evaluating osteoporotic bone in OI pediatric patients according to the U.S. Preventive Services Task Force guidelines. Read More

Authors:  Yacoub Daniel , Wang Kuan Chung , Shah Prakeshkumar , Moineddin Rahim , Doria Andrea

Keywords:  Dual-energy X-ray absorptiometry (DXA), Osteogenesis imperfecta, Systematic review, Fracture, Clinimetric property

Brandt Ryan

Final Pr. ID: Poster #: SCI-056

1. To compare the effective dose of dual energy CT with plain films in the pediatric population.
2. To compare effective dose using Turbo Flash scanning technique with that of standard scanning technique on single energy CT. Read More

Authors:  Brandt Ryan

Keywords:  Pediatric, Dual Energy, Effective Dose

Arceo Salvador,  Christopher Ross,  Milla Sarah,  Riedesel Erica

Final Pr. ID: Paper #: 165

Head trauma is a significant cause of morbidity and mortality in pediatrics. Non-contrast Head CT is the accepted gold standard imaging study to evaluate for suspected acute intracranial hemorrhage (ICH), however small acute extra-axial hemorrhage may be easily missed due to size and similar density to the bony calvarium. In Dual Energy CT (DECT), materials within the body such as bone/calcium and hemorrhage can be more easily discriminated based on differential attenuation at high and low peak voltage image acquisitions. This allows for advanced post-processing including automated bone removal which has been shown to improved visualization of acute ICH in the adult radiology literature, but has not yet been described in pediatrics. We report a retrospective review of DECT with automated bone removal for detection of acute ICH in the pediatric population. Read More

Authors:  Arceo Salvador , Christopher Ross , Milla Sarah , Riedesel Erica

Keywords:  Dual Energy, Trauma, Intracranial Hemorrhage

Rapp Jordan,  Saul David,  Kaplan Summer,  Barrera Christian,  Otero Hansel

Final Pr. ID: Poster #: EDU-099

Background: Dual source dual-energy CT scanners (DECT) has allowed for the collection of two data sets with a single scan, opening the potential for functional data acquisition. The technique combines two energy beams at distinct voltages applied concurrently during a single scanning phase. The source data can be combined to generate a single mixed composite image, or iodine can be subtracted to create a contrast map or a virtual non-contrast image. The result is functional information in the setting of decreased radiation dose when replacing a biphasic scan, or dose neutral when compared to conventional single source CT. Post processing lung perfusion software allows for imaging display (qualification) and quantification of iodinated contrast volumes in the lungs, a surrogate for lung perfusion.
Purpose:
This educational exhibit will demonstrate: 1. How to perform DECT in children, 2. How to use postprocessing software, and 3. How to interpret lung perfusion results through clinical examples of current pediatric clinical indications including pulmonary embolism, lung hypoplasia, pulmonary AV malformation, and pulmonary hypertension.
Conclusion:
Through this exhibit, readers will gain familiarity with technical aspects of DECT of the lungs in children, understand the basics of post processing and recognize focal or regional perfusion defects, segmented perfusion analysis, and focal lesion perfusion characteristics as well as identify future applications. Read More

Authors:  Rapp Jordan , Saul David , Kaplan Summer , Barrera Christian , Otero Hansel

Keywords:  dual energy, thoracic, perfusion

Haq Adeel,  Siegel Marilyn,  Awali Mohamed

Final Pr. ID: Poster #: EDU-096

Dual energy CT with material-specific reconstructions including iodine, pulmonary blood volume, and lung vessel images can improve assessment of vascular and associated parenchymal abnormalities.
An understanding of material-specific reconstruction algorithms, clinical applications and potential pitfalls can help in accurate interpretation of dual energy CT examinations.

Purpose of this exhibit is to review:

Basic principles of dual energy CT material-specific reconstructions
● Iodine maps
● Pulmonary blood volume (PBV) images
● Lung vessel images

Specific applications and benefits of material-specific reconstructions in cardiothoracic imaging
● Pulmonary embolism: Vessel and PBV images can improve detection of embolus and infarction
● Congenital cyanotic heart disease: Material-specific reconstructions can have a role in assessing pulmonary artery flow/lung perfusion and adequacy of reconstruction surgery
● Arteriovenous malformations: Material-specific images can increase conspicuity of small malformations and can be used to evaluate the success of embolization
● Pulmonary hypertension: Material-specific images are useful to detect subtle decreases in parenchymal perfusion and pulmonary blood flow
● Airway diseases: Reconstructions can provide information on the downhill effect of bronchial obstruction.

Potential pitfalls and artifacts in interpreting material specific reconstructions
● Beam-hardening artifacts
● Diaphragmatic motion
● Cardiac motion

Radiation Dose: Similar or less than single-energy CT Read More

Authors:  Haq Adeel , Siegel Marilyn , Awali Mohamed

Keywords:  Dual Energy CT, Iodine mapping, Pulmonary Blood Volume

Griffin Walter,  Simmons Curtis,  Southard Richard,  Jorgensen Scott,  Van Tassel Dane

Final Pr. ID: Poster #: SCI-002

Pediatric abdominal trauma can be challenging and often necessitates rapid and accurate identification of injuries for optimal patient care. This study aimed to assess the potential workflow improvements in diagnostic accuracy achieved with semi-automated analysis of Dual Energy CT (DECT) image reconstruction in the setting of abdominal solid organ injury, as compared to conventional Multi-Detector CT (MDCT) images. The data sets from dual energy reconstructions have superior tissue differentiation and can be used to train a simple artificial intelligence (AI) program to recognize these patterns and expedite care. Read More

Authors:  Griffin Walter , Simmons Curtis , Southard Richard , Jorgensen Scott , Van Tassel Dane

Keywords:  Dual Energy, abdominal trauma

Hornsby Richard,  Brady Samuel,  Mccarville Beth,  Nett Elizabeth,  Rupcich Franco,  Blancq Terry,  Artz Nathan

Final Pr. ID: Poster #: EDU-054

This educational exhibit will review 1) challenges of CT imaging near metal, 2) current acquisition and reconstruction methods for reducing metallic artifacts, and 3) our initial experience using a GE Revolution CT system for Dual-energy scanning combined with metal artifact reduction (MAR) image reconstruction. Artifacts caused by metallic implants have limited clinical diagnoses for decades using single-energy CT (single kVp, polyenergetic beam) with standard image reconstruction. Low-energy photons in the beam are absorbed by metal, leaving only high-energy photons passing through (ie. beam hardening). Beam hardening due to metal, along with photon starvation and scatter, result in dark shading and bright/dark streaking, as well as lower signal-to-noise levels. Dual-energy CT (DECT) has demonstrated promise for beam hardening reduction because it enables reconstruction of a monoenergetic image, similar in theory to acquiring data with a monoenergetic beam. Recent developments in CT data reconstruction have also achieved better image quality near metal by mitigating shading and streaking artifacts. On our Revolution CT, MAR reconstruction is available solely in dual-energy mode. For our patients with metallic prostheses, we perform DECT and review monoenergetic images with and without MAR. MAR images typically show markedly reduced artifacts from metal and thereby improved image quality. Fig 1 displays 70 keV monoenergetic images both with and without MAR for a patient with a pacemaker. Streaking artifacts arising from the pacemaker were apparent throughout anatomy without MAR, while significantly reduced streaking and improved visualization of the aortic bifurcation is observed in the MAR reconstructed image. Images from a patient with pedicle screws and metallic rods in the spine are shown in Fig 2. Although present, shading and streaking was noticeably reduced with MAR allowing better visibility of the paraspinal soft-tissue structures and the main portal vein. On occasion, however, MAR yielded more severe artifacts for certain slices, such as in the thigh for a patient with a metallic femoral rod just above a total knee replacement (Fig 3). In summary, recent technical advancements incorporated into the Revolution CT system have improved image quality for many of our patients with metallic implants. Predicting a priori when MAR will be worse is not yet possible, so viewing monoenergetic images with and without MAR is recommended. Read More

Authors:  Hornsby Richard , Brady Samuel , Mccarville Beth , Nett Elizabeth , Rupcich Franco , Blancq Terry , Artz Nathan

Keywords:  metal artifact reduction, Dual-energy CT

Siegel Marilyn,  Ramirez Giraldo Juan Carlos

Final Pr. ID: Paper #: 037

To develop diagnostic reference ranges (DRRs) for pediatric contrast-enhanced dual-energy CT (DECT) examinations as a function of patient size and radiation output of the CT scanner with comparison to conventional single energy CT (SECT). Read More

Authors:  Siegel Marilyn , Ramirez Giraldo Juan Carlos

Keywords:  Dual-Energy CT, Chest CT, Dose Reduction

Alizadeh Houman,  Siegel Marilyn,  Ramirez Giraldo Juan Carlos

Final Pr. ID: Poster #: EDU-075

Dual-energy computed tomography (DECT) decomposition software has expanded the scope of CT post-processing. It is an efficient method in pediatric thoracic imaging to define both vascular and parenchymal abnormalities. Read More

Authors:  Alizadeh Houman , Siegel Marilyn , Ramirez Giraldo Juan Carlos

Keywords:  Dual Energy CT, chest, pediatric

Groth Nicholas,  Williams Avery,  Southard Richard

Final Pr. ID: Poster #: EDU-023

PURPOSE: Trauma is a leading cause of death and disability in children ages 1-18, with abdominal trauma accounting for a significant patient population. Prompt identification of bowel and mesenteric injury in the setting of blunt trauma and penetrating injuries is important to avoid significant complications that may arise from delayed diagnosis. Spectral Dual-Energy Computed Tomography (DECT) obtains raw data at two energy spectra which by virtue of material decomposition can identify, isolate and or quantify iodine, pure calcium, and uric acid. Multiple image sets can be generated from a single scan allowing both anatomic and material-specific analysis. The use of DECT can improve detection and accurate grading of solid organ injury, aid in defining active hemorrhage, and increase visibility of altered bowel wall enhancement, ischemia, necrosis, and inflammation which provides critical information to inform the course of treatment in emergent settings. Read More

Authors:  Groth Nicholas , Williams Avery , Southard Richard

Keywords:  Dual Energy, Computed Tomography, Bowel Injury

Alizadeh Houman,  Siegel Marilyn,  Cullinane Mike

Final Pr. ID: Paper #: 146

Mediastinal tumors comprise a range of congenital, neoplastic and inflammatory tumors. While many benign and malignant lesions can be differentiated by CT appearance and attenuation values, many cannot be reliably separated. The purpose of this paper is to evaluate the feasibility of dual-energy computed tomography (DECT) in differentiating a spectrum of mediastinal tumors in children Read More

Authors:  Alizadeh Houman , Siegel Marilyn , Cullinane Mike

Keywords:  Dual Energy CT, Mediastinal Tumors, children