Medical physics · 2026
Iodine and bismuth dual-contrast imaging on photon-counting CT with noise-optimized virtual monoenergetic imaging: Phantom and patient studies.
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Roth Sophia, Thapa Diwash, Ataei Afrouz, Vasan Vasantha, Ahn Richard W, Yu Lifeng, Xi Yin, Ren Liqiang
Аннотация
BACKGROUND: Dual-contrast imaging of iodine and bismuth has shown promise in previous phantom and animal studies utilizing spectral CT. However, these studies often employed Pepto-Bismol containing bismuth subsalicylate with dosages exceeding the recommended limits for human consumption, limiting their clinical applicability.
PURPOSE: The purpose of this study was to improve iodine-bismuth dual-contrast imaging on a clinical photon-counting CT (PCCT) system using a noise-optimized virtual monoenergetic imaging (VMI) approach.
METHODS: Four bismuth samples (0.6, 1.3, 2.5, and 5.1 mg/mL) and three iodine rods (1.0, 2.0, and 5.0 mg/mL) were inserted into a multi-energy CT phantom and scanned on a PCCT system at 140 kV. VMIs were generated from 40 to 190 keV in 10 keV increments. Iodine and bismuth maps were computed for all possible keV pairs using a generic image-based three-material decomposition method and compared with maps generated from the original low-/high-energy PCCT images. Mass concentrations, noise levels, and individual as well as joint root-mean-square error (RMSE) for iodine and bismuth were measured to determine the optimal keV pair. The contrast-to-noise ratios (CNRs) of low concentration samples (bismuth: 0.6 and 1.3 mg/mL; iodine: 1.0 mg/mL) were calculated at the optimal keV pair and compared to the values determined with the original PCCT images. In an IRB-approved feasibility study, a research patient was administered two doses of Pepto-Bismol prior to a routine abdomen-pelvis CT scan. Material decomposition was performed using both the original low-/high-energy images and the optimal VMI pair identified in the phantom study. Bismuth signals in the stomach and proximal small bowel were assessed qualitatively and quantitatively.
RESULTS: The VMI pair of 110 and 190 keV was determined to be optimal, achieving the lowest joint RMSE of 0.49 mg/mL, compared to 1.42 mg/mL for the original low-/high-energy pair. It also yielded the highest CNR, representing a 190-318% improvement over the original low/high-energy decomposition. Qualitatively, both phantom and patient studies demonstrated improved iodine-bismuth separation and reduced noise using the optimized VMI pair.
CONCLUSIONS: These findings suggest that noise-optimized VMI selection can enhance dual-contrast material decomposition performance on clinical PCCT, supporting its potential for translation into gastrointestinal imaging applications.
PURPOSE: The purpose of this study was to improve iodine-bismuth dual-contrast imaging on a clinical photon-counting CT (PCCT) system using a noise-optimized virtual monoenergetic imaging (VMI) approach.
METHODS: Four bismuth samples (0.6, 1.3, 2.5, and 5.1 mg/mL) and three iodine rods (1.0, 2.0, and 5.0 mg/mL) were inserted into a multi-energy CT phantom and scanned on a PCCT system at 140 kV. VMIs were generated from 40 to 190 keV in 10 keV increments. Iodine and bismuth maps were computed for all possible keV pairs using a generic image-based three-material decomposition method and compared with maps generated from the original low-/high-energy PCCT images. Mass concentrations, noise levels, and individual as well as joint root-mean-square error (RMSE) for iodine and bismuth were measured to determine the optimal keV pair. The contrast-to-noise ratios (CNRs) of low concentration samples (bismuth: 0.6 and 1.3 mg/mL; iodine: 1.0 mg/mL) were calculated at the optimal keV pair and compared to the values determined with the original PCCT images. In an IRB-approved feasibility study, a research patient was administered two doses of Pepto-Bismol prior to a routine abdomen-pelvis CT scan. Material decomposition was performed using both the original low-/high-energy images and the optimal VMI pair identified in the phantom study. Bismuth signals in the stomach and proximal small bowel were assessed qualitatively and quantitatively.
RESULTS: The VMI pair of 110 and 190 keV was determined to be optimal, achieving the lowest joint RMSE of 0.49 mg/mL, compared to 1.42 mg/mL for the original low-/high-energy pair. It also yielded the highest CNR, representing a 190-318% improvement over the original low/high-energy decomposition. Qualitatively, both phantom and patient studies demonstrated improved iodine-bismuth separation and reduced noise using the optimized VMI pair.
CONCLUSIONS: These findings suggest that noise-optimized VMI selection can enhance dual-contrast material decomposition performance on clinical PCCT, supporting its potential for translation into gastrointestinal imaging applications.