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Related Concept Videos

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Radiological investigations, including X-rays and computed tomography (CT) scans, are critical for diagnosing and evaluating various medical conditions. These imaging techniques provide valuable insights into the body's internal structures, aiding in the detection of abnormalities, assessment of disease progression, and development of treatment strategies. This article delves into two primary radiological investigations, chest X-rays and CT scans, outlining their purpose, procedures, and...
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Related Experiment Video

Updated: Jun 26, 2025

Author Spotlight: Enhanced Quantification of Cardiovascular Calcification Progression for Longitudinal Micro PET/CT Studies in Small Research Animals
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Countering Calcium Blooming With Personalized Contrast Media Injection Protocols: The 1-2-3 Rule for Photon-Counting

Michael C McDermott1, Thomas Sartoretti, Lion Stammen

  • 1From the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.C.M., T.S., L.S., B.M., T.G.F., J.E.W.); Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (T.S., H.A.); Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (M.C.M., T.S., L.S., B.M., J.E.W.); Bayer AG, Berlin, Germany (M.C.M., G.J., H.P.); and Computed Tomography Division, Siemens Healthineers AG, Forchheim, Germany (R.G., B.S., T.G.F.).

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Summary
This summary is machine-generated.

Photon-counting detector CT (PCD-CT) allows virtual monoenergetic images (VMIs) to reduce calcium blooming artifacts in coronary CT angiography. A simple 1-2-3 rule for contrast media injection protocols optimizes image quality by adapting to calcification density.

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Area of Science:

  • Medical Imaging
  • Radiology
  • Cardiovascular Imaging

Background:

  • Photon-counting detector computed tomography (PCD-CT) enables spectral data acquisition for CT angiography.
  • Virtual monoenergetic images (VMIs) can reduce blooming artifacts from calcified plaques.
  • Optimizing contrast media (CM) injection protocols is challenging due to inverse effects of VMI energy on calcium blooming and iodine attenuation.

Purpose of the Study:

  • To investigate and propose a pragmatic, simple rule for calcium-dependent CM injection protocols in VMI-based coronary CT angiography using PCD-CT.
  • To establish a general rule for CM injection protocols based on stenosis grading accuracy and blooming artifacts.

Main Methods:

  • A physiological circulation phantom with coronary vessels and calcified lesions was used.
  • Images were acquired using a dual-source PCD-CT and reconstructed at various VMI levels (45–190 keV).
  • Iodine attenuation and blooming artifacts were assessed, and the IDR to achieve 300 HU was calculated at each VMI level.

Main Results:

  • Plaque blooming and iodine attenuation decreased with increasing keV.
  • Stenosis overestimation was significantly reduced with optimized windowing across keV levels.
  • A strong linear correlation (R² = 0.98) was found between required IDR for 300 HU and VMI energy.

Conclusions:

  • A proof-of-concept for a simple, pragmatic adaptation of CM injection protocols using a 1-2-3 rule was demonstrated in a phantom study.
  • The proposed 1-2-3 rule shows potential for reducing calcium blooming artifacts and improving image quality in coronary CT angiography with PCD-CT.