Ultra-low dose whole-body CT for attenuation correction in a dual tracer PET/CT protocol for multiple myeloma
Keywords: 
PET/CT
Radiation dose
Optimization
Multiple myeloma
Issue Date: 
2021
Publisher: 
Elsevier
ISSN: 
1120-1797
Note: 
This is an open access article under the CC BY-NC-ND license
Citation: 
Prieto-Azcárate, E. (Elena); Garcia-Velloso, M.J. (María José); Aquerreta, D. (Dámaso); et al. "Ultra-low dose whole-body CT for attenuation correction in a dual tracer PET/CT protocol for multiple myeloma". Physica Medica. (84), 2021, 1 - 9
Abstract
Purpose: To investigate within phantoms the minimum CT dose allowed for accurate attenuation correction of PET data and to quantify the effective dose reduction when a CT for this purpose is incorporated in the clinical setting. Methods: The NEMA image quality phantom was scanned within a large parallelepiped container. Twenty-one different CT images were acquired to correct attenuation of PET raw data. Radiation dose and image quality were evaluated. Thirty-one patients with proven multiple myeloma who underwent a dual tracer PET/CT scan were retrospec- tively reviewed. 18F-fluorodeoxyglucose PET/CT included a diagnostic whole-body low dose CT (WBLDCT: 120 kV-80mAs) and 11C-Methionine PET/CT included a whole-body ultra-low dose CT (WBULDCT) for attenuation correction (100 kV-40mAs). Effective dose and image quality were analysed. Results: Only the two lowest radiation dose conditions (80 kV-20mAs and 80 kV-10mAs) produced artifacts in CT images that degraded corrected PET images. For all the other conditions (CTDIvol ≥ 0.43 mGy), PET contrast recovery coefficients varied less than ± 1.2%. Patients received a median dose of 6.4 mSv from diagnostic CT and 2.1 mSv from the attenuation correction CT. Despite the worse image quality of this CT, 94.8% of bone lesions were identifiable. Conclusion: Phantom experiments showed that an ultra-low dose CT can be implemented in PET/CT procedures without any noticeable degradation in the attenuation corrected PET scan. The replacement of the standard CT for this ultra-low dose CT in clinical PET/CT scans involves a significant radiation dose reduction

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