Phantom-based quantification of the spectral accuracy in dual-layer spectral CT for pediatric imaging at 100 kVp

BACKGROUND: To determine the spectral accuracy in detector-based dual-energy CT (DECT) at 100 kVp and wide (8 cm) collimation width for dose levels and object sizes relevant to pediatric imaging. METHODS: A spectral CT phantom containing tissue-equivalent materials and iodine inserts of varying concentrations was scanned on the latest generation detector-based DECT system. Two 3D-printed extension rings were used to mimic varying pediatric patient sizes. Scans were performed at 100 and 120 kVp, 4 and 8 cm collimation widths, and progressively reduced radiation dose levels, down to 0.9 mGy CTDI(vol). Virtual mono-energetic, iodine density, effective atomic number, and electron density results were quantified and compared to their expected values for all acquisition settings and phantom sizes. RESULTS: DECT scans at 100 kVp provided highly accurate spectral results; however, a size dependence was observed for iodine quantification. For the medium phantom configuration (15 cm diameter), measurement errors in iodine density, effective atomic number, and electron density (ED) were below 0.3 mg/mL, 0.2 and 1.8 %ED(water), respectively. The average accuracy was slightly different from scans at 120 kVp; however, not statistically significant for all configurations. Collimation width had no substantial impact. Spectral results were accurate and reliable for radiation exposures down to 0.9 mGy CTDI(vol). CONCLUSIONS: Detector-based DECT at 100 kVp can provide on-demand or retrospective spectral information with high accuracy even at extremely low doses, thereby making it an attractive solution for pediatric imaging.