Photon Counting Computed Tomography with the Radiation Dose of a Chest X-Ray: Feasibility and Diagnostic Yield

Abstract

Introduction: Photon counting (PC) detectors allow a reduction of the radiation dose in CT. Chest X-ray (CXR) is known to have a low sensitivity and specificity for detection of pneumonic infiltrates. The aims were to establish an ultra-low-dose CT (ULD-CT) protocol at a PC-CT with the radiation dose comparable to the dose of a CXR and to evaluate its clinical yield in patients with suspicion of pneumonia.

Methods: A ULD-CT protocol was established with the aim to meet the radiation dose of a CXR. In this retrospective study, all adult patients who received a ULD-CT of the chest with suspected pneumonia were included. Radiation exposure of ULD-CT and CXR was calculated. The clinical significance (new diagnosis, change of therapy, additional findings) and limitations were evaluated by a radiologist and a pulmonologist considering previous CXR and clinical data.

Results: Twenty-seven patients (70% male, mean age 68 years) were included. With our ULD-CT protocol, the radiation dose of a CXR could be reached (mean radiation exposure 0.11 mSv). With ULD-CT, the diagnosis changed in 11 patients (41%), there were relevant additional findings in 4 patients (15%), an infiltrate (particularly fungal infiltrate under immunosuppression) could be ruled out with certainty in 10 patients (37%), and the therapy changed in 10 patients (37%). Two patients required an additional CT with contrast medium to rule out a pulmonary embolism or pleural empyema.

Conclusions: With ULD-CT, the radiation dose of a CXR could be reached while the clinical impact is higher with change in diagnosis in 41%.

Keywords: Community-acquired pneumonia; Photon counting computed tomography; Ultra-low-dose computed tomography.

Fig. 1.

Comparison of CXR and ULD-CT in 6 patients of our study cohort demonstrating the clinical significance and the limitations of ULD-CT. a, b Consolidation in the right lower lobe, occult in the CXR hidden behind the right diaphragm. c, d Bilateral opacities, occult in the CXR due to the low density. e, f Bilateral opacities in the CXR; the ULD-CT shows the pattern of an organizing pneumonia as additional information. g, h Bilateral opacities in the CXR; the ULD-CT shows the pattern of sarcoidosis as additional information. i, j Bilateral opacities in the CXR; the ULD-CT shows pleural masses. k, l Basal opacities in CXR and consolidation and pleural effusion in ULD-CT; for the diagnosis of a pleural empyema, the ULD-CT was not sufficient and a standard CT with contrast was needed.