title: High Atomic Number Contrast Media Offer Potential for Radiation Dose Reduction in Contrast-Enhanced Computed Tomography.
abstract: OBJECTIVE
  Spectral optimization of x-ray computed tomography (CT) has led to substantial radiation dose reduction in contrast-enhanced CT studies using standard iodinated contrast media. The purpose of this study was to analyze the potential for further dose reduction using high-atomic-number elements such as hafnium and tungsten. As in previous studies, spectra were determined for which the patient dose necessary to provide a given contrast-to-noise ratio (CNR) is minimized.
  
  
  METHODS
  We used 2 different quasi-anthropomorphic phantoms representing the liver cross-section of a normal adult and an obese adult patient with the lateral widths of 360 and 460 mm and anterior-posterior heights of 200 and 300 mm, respectively. We simulated and measured on 2 different scanners with x-ray spectra from 80 to 140 kV and from 70 to 150 kV, respectively. We determined the contrast for iodine-, hafnium-, and tungsten-based contrast media, the noise, and 3-dimensional dose distributions at all available tube voltages by measurements and by simulations. The dose-weighted CNR was determined as optimization parameter.
  
  
  RESULTS
  Simulations and measurements were in good agreement regarding their dependence on energy for all parameters investigated. Hafnium provided the best performance for normal and for obese patient phantoms, indicating a dose reduction potential of 30% for normal and 50% for obese patients at 120 kV compared with iodine; this advantage increased further with higher kV values. Dose-weighted CNR values for tungsten were always slightly below the hafnium results. Iodine proved to be the superior choice at voltage values of 80 kV and below.
  
  
  CONCLUSIONS
  Hafnium and tungsten both seem to be candidates for contrast-medium-enhanced CT of normal and obese adult patients with strongly reduced radiation dose at unimpaired image quality. Computed tomography examinations of obese patients will decrease in dose for higher kV values.
authors.affiliation: From the *Institute of Medical Physics, University Erlangen-Nuremberg, Erlangen; and †Bayer Healthcare, Berlin, Germany.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Roessler
authors.forename: Martin
authors.initials: M
authors.lastname: Hupfer
authors.forename: Daniel
authors.initials: D
authors.lastname: Kolditz
authors.forename: Gregor
authors.initials: G
authors.lastname: Jost
authors.forename: Hubertus
authors.initials: H
authors.lastname: Pietsch
authors.forename: Willi A
authors.initials: WA
authors.lastname: Kalender
mesh_terms: D003287:Contrast Media / Q000737:chemistry*; D006195:Hafnium / Q000737:chemistry; D006801:Humans; D007455:Iodine / Q000737:chemistry; D008099:Liver; D009765:Obesity; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed; D014414:Tungsten / Q000737:chemistry
chemical_list: D003287:Contrast Media; D007455:Iodine; D014414:Tungsten; D006195:Hafnium