Spectral CT — Value, use cases and implementation

Spectral CT — Value, use cases and implementation

September 10, 2019
CT X-Ray
From the September 2019 issue of HealthCare Business News magazine

Niche applications
In addition to the broader applications described above, there are several niche applications to be aware of. For one, spectral CT allows characterization of kidney stone composition, which can affect how they may respond to various treatments. This can be valuable information to the urologist, and allow for more expeditious triage to the correct treatment. Additionally, through similar techniques, spectral CT can be used to detect gout tophi. In fact, spectral CT is already included as a criterion for establishing a diagnosis of gout, and can also be used to monitor patients who are on therapy.


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Training and workflow considerations
As with any new technology, its value will not be realized without adequate staff training. Luckily, there is little difference from the technologist’s perspective between scanning a single energy or dual energy scan on the latest systems. In fact, most systems also allow generation of at least some basic spectral reconstructions at the scanner console itself, in automated or semi-automated fashion, which can then be pushed to PACS for review. This avoids the need for the technologist and/or the radiologist to have to use a separate workstation or thin client, saving valuable time and minimizing interruption of the standard routine. The more important task is deciding when and where to leverage the capabilities of spectral CT without overwhelming the radiologist with a sea of images. This requires careful attention to protocol design, as well as radiologist education regarding the new types of images and their use. To this end, there are many workshops and conferences available for this purpose. While it may not be possible for every radiologist to attend, at least a handful of radiologist “champions” should be designated who can take the lead. One of the major concerns from radiologists is the increasing number of images to review. What we have found helpful to encourage adoption in this regard is to begin by introducing virtual monoenergetic images, since these have the “look and feel” of traditional CT images, but with the advantages discussed above. In many cases these can replace the routine image set, resulting in a net-neutral image count.

Nakul Gupta
In summary, there are many ways in which spectral CT can benefit clinical practice and enhance value, whether by unlocking novel CT applications, reducing contrast dose, or reducing radiation dose by eliminating certain non-contrast exams or repeat scans. While the plethora of available images may seem overwhelming at first, taking a stepwise approach to implementation and designating a handful of radiologist champions can help make for a smooth transition.

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