title: Technical prerequisites and imaging protocols for CT perfusion imaging in oncology.
abstract: The aim of this review article is to define the technical prerequisites of modern state-of-the-art CT perfusion imaging in oncology at reasonable dose levels. The focus is mainly on abdominal and thoracic tumor imaging, as they pose the largest challenges with respect to attenuation and patient motion. We will show that low kV dynamic scanning in conjunction with detection technology optimized for low photon fluxes has the highest impact on reducing dose independently of other choices made in the protocol selection. We discuss, derived from relatively simple first principles, on what appropriate temporal sampling and total scan duration depend on and why optimized contrast medium injection protocols are also essential in limiting dose. Finally we will examine the possibility of simultaneously extracting standard morphological and functional information from one single 4D examination as a potential enabler for a more widespread use of dynamic contrast enhanced CT in oncology.
authors.affiliation: Siemens Healthcare, Computed Tomography and Radiation Oncology, Forchheim, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Klotz
authors.affiliation: Siemens Healthcare, Computed Tomography and Radiation Oncology, Forchheim, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Haberland
authors.affiliation: Medical Radiation Physics/Radiation Protection, Medical Faculty Mannheim, Heidelberg University, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Glatting
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Germany.
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.affiliation: Department of Radiology, General Hospital Celle, Celle, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Attenberger
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Germany. Electronic address: thomas.henzler@medma.uni-heidelberg.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
mesh_terms: D003287:Contrast Media; D006801:Humans; D011856:Radiographic Image Enhancement; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: Dynamic contrast enhanced computed tomography; Functional imaging; Oncology; Perfusion CT