Our long term goal is to revolutionize the effectiveness of CT imaging for millions of Americans across a broad range of abdominal disease. Dual energy CT (DECT) provides powerful clinical diagnostic potential but remains heavily underutilized despite wide scanner availability. DECT allows materials to be differentiated based on their relative X-ray attenuation at low versus high energy X-ray spectra. Unfortunately, current DECT workflow is highly fragmented: None of the 3rd party Picture Archiving and Communications Systems (PACS) that physicians use to view clinical images can process DECT images; each DECT scanner's images can only be processed by that specific scanner vendor's software. Worse, DECT signal units are scanner-specific and not compatible with historical 120 kVp single energy CT (SECT) Hounsfield Units (HU) which remain the most commonly used CT signal unit today, and the basis of most diagnostic CT threshold criteria. The profound future of multi-contrast DECT, whereby multiple simultaneously imaged contrast agents are separated at DECT to give rich diagnostic information of complex anatomy, also remains unrealized. Commercial DECT software fails in quantitative separation of current iodine contrast from novel high-Z and silicon agents. In our STTR Phase I we developed a novel Contrast Material Extraction Process (CMEP) that vividly separates individual contrast agent signals, including that of calcium, at DECT. We propose to further validate these methods across all commercial clinical DECT scanner types and integrate them into an urgently needed Vendor-Agnostic DECT processing Software (VADS) for wide low-cost distribution and integration into clinical PACS workflow. Our overall hypothesis is that images from each of the four available clinical DECT scanner types can be processed and displayed using a common interface, and this interface can allow quantitative scan comparisons between all DECT and SECT scanners through a Unified 120 kVp SECT-like HU. Once FDA-approved, VADS will enable FDA-approval of many urgently needed DECT contrast agents to fulfill the promise of multi-contrast DECT.
Our Specific Aims are to 1) Construct standardized DECT phantoms spanning the range of human tissues and contrast agents currently available and in development to obtain a comprehensive image library for each of the commercial clinical DECT scanners; 2) Implement and validate VADS on this image library to allow all DECT images to be processed in a common software interface designed to be 510(k) approvable and readily integrated into PACS or other 3rd party viewing workstations; 3) Use the image library to define a ?Unified Hounsfield Unit,? compatible with 120 kVp SECT, to allow all DECT scanner types and SECT, regardless of kVp setting, to be quantitatively compared. At the conclusion of this proposal, we will have developed disruptive 510(k) approvable software to streamline daily clinical DECT workflow and provide necessary infrastructure for future transformative highly diagnostic multi-contrast enhanced DECT.
The clinical implementation of dual energy CT is obstructed by fragmented software interfaces in current clinical radiology workflow and software-imposed limitations on capability. We will interrogate dual energy CT imaging with each of the commercially available clinical scanners to develop disruptive vendor-agnostic software that will streamline dual energy image processing, improve material separation capability, allow quantitative comparison of images from all CT scanners, and allow double contrast-enhanced dual energy CT to give richly detailed co-registered images of complex abdominal anatomy for millions of Americans at a low radiation dose and major cost savings to the healthcare system.