Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols

Purpose: To standardize workflow for dual-energy computed tomography (DECT) involving common abdominopelvic exam protocols. Materials and methods: 9 institutions (4 rsDECT, 1 dsDECT, 4 both) with 32 participants [average # years (range) in practice and DECT experience, 12.3 (1–35) and 4.6 (1–14), respectively] filled out a single survey (n = 9). A five-point agreement scale (0, 1, 2, 3, 4—contra-, not, mildly, moderately, strongly indicated, respectively) and utilization scale (0—not performing and shouldn’t; 1—performing but not clinically useful; 2—performing but not sure if clinically useful; 3—not performing it but would like to; 4—performing and clinically useful) were used. Consensus was considered with a score of ≥2.5. Survey results were discussed over three separate live webinar sessions. Results: 5/9 (56%) institutions exclude large patients from DECT. 2 (40%) use weight, 2 (40%) use transverse dimension, and 1 (20%) uses both. 7/9 (78%) use 50 keV for low and 70 keV for medium monochromatic reconstructed images. DECT is indicated for dual liver [agreement score (AS) 3.78; utilization score (US) 3.22] and dual pancreas in the arterial phase (AS 3.78; US 3.11), mesenteric ischemia/gastrointestinal bleeding in both the arterial and venous phases (AS 2.89; US 2.79), RCC exams in the arterial phase (AS 3.33; US 2.78), and CT urography in the nephrographic phase (AS 3.11; US 2.89). DECT for renal stone and certain single-phase exams is indicated (AS 3.00). Conclusions: DECT is indicated during the arterial phase for multiphasic abdominal exams, nephrographic phase for CTU, and for certain single-phase and renal stone exams.