Defining Dosimetric Reference Levels in Computed Tomography Spectral Scanning

NCT ID: NCT07305103

Last Updated: 2025-12-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Total Enrollment

9600 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-09-01

Study Completion Date

2026-06-30

Brief Summary

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Spectral computed tomography or dual-energy CT imaging can overcome the limitations of conventional CT in differentiating between two materials with equivalent total attenuation. It can generate several types of images, such as virtual monochromatic images, which improve the contrast-to-noise ratio for low energy levels and reduce artifacts for high energy levels. It also allows for quantitative image analysis and thus better characterization of lesions and tissues through material mapping (e.g., iodinated contrast agent mapping). This technique is increasingly used in routine clinical practice thanks to improvements in image flow management and technological advances. It also involves exposing patients to ionizing radiation, as with conventional CT but, unlike conventional CT scans, for which dosimetric reference levels (RLs) are defined for the most common examinations in France (RL decree dated 2019), there are currently no dosimetric reference levels for examinations performed using this technique. Yet RLs are an important and effective tools for optimizing patient exposure to ionizing radiation. Several articles were published between 2012 and 2017 when the first dual-energy scanners arrived in clinics. However, the results presented in these studies are now far removed from recent practices, as they do not take into account the latest technological developments used in dual-energy scanners, which reduce X-ray doses.

The main objective of the study is to define dosimetric reference levels for the most commonly performed spectral computed tomography examinations in France.

Detailed Description

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Spectral computed tomography (CT) (or dual-energy CT) imaging can overcome the limitations of conventional CT in differentiating between two materials with equivalent total attenuation. It can generate several types of images, such as virtual monochromatic images, which improve the contrast-to-noise ratio for low energy levels and reduce artifacts for high energy levels. It also allows for quantitative image analysis and thus better characterization of lesions and tissues through material mapping (e.g., iodinated contrast agent mapping). This technique is increasingly used in routine clinical practice thanks to improvements in image flow management and technological advances. It also involves exposing patients to ionizing radiation, as with conventional CT.

However, unlike conventional CT scans, for which dosimetric reference levels (RLs) are defined for the most common examinations in France (RL decree dated 2019), there are currently no dosimetric reference levels for examinations performed using this technique. Yet the RL is an important and effective tool in optimizing patient exposure to ionizing radiation. In fact, a number of articles were published between 2012 and 2017, when the first dual-energy scanners arrived in clinics. However, the results presented in these studies are now far removed from recent practices, as they do not take into account the latest technological developments used in dual-energy scanners, which reduce X-ray doses.

The main objective of the study is to define dosimetric reference levels for the most frequently performed spectral computed tomography examinations in France:

1. Chest CT for pulmonary embolism
2. Chest CT for other indications
3. Coronary CT with contrast injection and retrospective gating
4. Coronary CT with contrast injection and prospective gating
5. Cranial CT with contrast injection
6. Supra-aortic trunk CT
7. Neck and ear,nose and throat sphere CT with contrast injection
8. Oncological abdomen-pelvis CT scan
9. Abdomen-pelvis CT scan to check for kidney stones
10. Abdomen-pelvis CT scan for non-oncological purposes and to check for kidney stones
11. Oncological chest-abdomen-pelvis CT scan
12. Non-oncological chest-abdomen-pelvis CT scan
13. Oncological chest-abdomen CT scan
14. Non-oncological chest-abdomen CT scan
15. Lower limb angiography
16. Cervical spine CT scan
17. Thoracic spine CT scan
18. Lumbar spine CT scan
19. Pelvis CT scan,
20. Extremities CT scan

The secondary objectives of the study are to evaluate, for each examination performed:

1. the impact of the spectral acquisition/detection technique on the dose delivered to patients.
2. the impact of patients' BMI on the dose delivered to patients.
3. the impact of reconstruction algorithms on the dose delivered to patients.

Conditions

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Medical Imaging

Keywords

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Radiation dose Reference levels Radiology Spectral Computed Tomography Imaging

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Patients undergoing a maximum number of 18 spectral CT scans among the examinations mentioned below

Patients undergoing a maximum number of 18 spectral CT scans among the examinations mentioned below:

1. Chest CT for pulmonary embolism
2. Chest CT for other indications
3. Coronary CT with contrast injection and retrospective gating
4. Coronary CT with contrast injection and prospective gating
5. Cranial CT with contrast injection
6. Supra-aortic trunk CT
7. Neck and ear,nose and throat sphere CT with contrast injection
8. Oncological abdomen-pelvis CT scan
9. Abdomen-pelvis CT scan to check for kidney stones
10. Abdomen-pelvis CT scan for non-oncological purposes and to check for kidney stones
11. Oncological chest-abdomen-pelvis CT scan
12. Non-oncological chest-abdomen-pelvis CT scan
13. Oncological chest-abdomen CT scan
14. Non-oncological chest-abdomen CT scan
15. Lower limb angiography
16. Cervical spine CT scan
17. Thoracic spine CT scan
18. Lumbar spine CT scan
19. Pelvis CT scan,
20. Extremities CT scan

Spectral ComputedTomography

Intervention Type RADIATION

Commonly performed spectral computed tomography examinations in France

Interventions

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Spectral ComputedTomography

Commonly performed spectral computed tomography examinations in France

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Adult male/female patient (≥ 18 years old)
* Body Mass Index (BMI) between 18 and 35 kg/m²
* Patients who underwent a spectral CT scan between January 1, 2023, and August 31, 2024, as part of their treatment.

Exclusion Criteria

\- Pregnant women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institut Paoli Calmettes, Marseille

UNKNOWN

Sponsor Role collaborator

Hôpital Necker-Enfants Malades

OTHER

Sponsor Role collaborator

Lille University Hospital

UNKNOWN

Sponsor Role collaborator

CHU Hôpital Lariboisière APHP

UNKNOWN

Sponsor Role collaborator

Centre Hospitalier Universitaire de Saint Etienne

OTHER

Sponsor Role collaborator

Saint-Louis Hospital, Paris, France

OTHER

Sponsor Role collaborator

Bichat Hospital, Paris, France

UNKNOWN

Sponsor Role collaborator

Hôpital Louis Mourier, 92700 Colombes

UNKNOWN

Sponsor Role collaborator

Centre Hospitalier de Valenciennes

NETWORK

Sponsor Role collaborator

Hopital Louis Pradel

OTHER

Sponsor Role collaborator

Centre Léon Bérard, Lyon

UNKNOWN

Sponsor Role collaborator

University Hospital, Bordeaux

OTHER

Sponsor Role collaborator

Centre Hospitalier Lyon Sud

OTHER

Sponsor Role collaborator

Institut Curie

OTHER

Sponsor Role collaborator

Amiens University Hospital

OTHER

Sponsor Role collaborator

Poitiers University Hospital

OTHER

Sponsor Role collaborator

Henri Mondor Hospital, Créteil

UNKNOWN

Sponsor Role collaborator

Saint Antoine University Hospital

OTHER

Sponsor Role collaborator

Nord Ardennes Intercommunal Hospital

UNKNOWN

Sponsor Role collaborator

Centre Antoine Lacassagne, Nice

UNKNOWN

Sponsor Role collaborator

Hôpital Edouard Herriot (GH Centre), Lyon

UNKNOWN

Sponsor Role collaborator

Centre Hospitalier Universitaire de Nīmes

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Joël GREFFIER

Role: STUDY_CHAIR

Nîmes University Hospital

Locations

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Nîmes University Hospital

Nîmes, Gard, France

Site Status

Countries

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France

References

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Si-Mohamed SA, Boccalini S, Villien M, Yagil Y, Erhard K, Boussel L, Douek PC. First Experience With a Whole-Body Spectral Photon-Counting CT Clinical Prototype. Invest Radiol. 2023 Jul 1;58(7):459-471. doi: 10.1097/RLI.0000000000000965. Epub 2023 Feb 22.

Reference Type BACKGROUND
PMID: 36822663 (View on PubMed)

Wortman JR, Shyu JY, Dileo J, Uyeda JW, Sodickson AD. Dual-energy CT for routine imaging of the abdomen and pelvis: radiation dose and image quality. Emerg Radiol. 2020 Feb;27(1):45-50. doi: 10.1007/s10140-019-01733-9. Epub 2019 Nov 1.

Reference Type BACKGROUND
PMID: 31673838 (View on PubMed)

Henzler T, Fink C, Schoenberg SO, Schoepf UJ. Dual-energy CT: radiation dose aspects. AJR Am J Roentgenol. 2012 Nov;199(5 Suppl):S16-25. doi: 10.2214/AJR.12.9210.

Reference Type BACKGROUND
PMID: 23097163 (View on PubMed)

Ghasemi Shayan R, Oladghaffari M, Sajjadian F, Fazel Ghaziyani M. Image Quality and Dose Comparison of Single-Energy CT (SECT) and Dual-Energy CT (DECT). Radiol Res Pract. 2020 Apr 20;2020:1403957. doi: 10.1155/2020/1403957. eCollection 2020.

Reference Type BACKGROUND
PMID: 32373363 (View on PubMed)

Greffier J, Villani N, Defez D, Dabli D, Si-Mohamed S. Spectral CT imaging: Technical principles of dual-energy CT and multi-energy photon-counting CT. Diagn Interv Imaging. 2023 Apr;104(4):167-177. doi: 10.1016/j.diii.2022.11.003. Epub 2022 Nov 19.

Reference Type BACKGROUND
PMID: 36414506 (View on PubMed)

Dabli D, Frandon J, Belaouni A, Akessoul P, Addala T, Berny L, Beregi JP, Greffier J. Optimization of image quality and accuracy of low iodine concentration quantification as function of dose level and reconstruction algorithm for abdominal imaging using dual-source CT: A phantom study. Diagn Interv Imaging. 2022 Jan;103(1):31-40. doi: 10.1016/j.diii.2021.08.004. Epub 2021 Oct 6.

Reference Type BACKGROUND
PMID: 34625394 (View on PubMed)

Noda Y, Kawai N, Kawamura T, Kobori A, Miyase R, Iwashima K, Kaga T, Miyoshi T, Hyodo F, Kato H, Matsuo M. Radiation and iodine dose reduced thoraco-abdomino-pelvic dual-energy CT at 40 keV reconstructed with deep learning image reconstruction. Br J Radiol. 2022 Jun 1;95(1134):20211163. doi: 10.1259/bjr.20211163. Epub 2022 Mar 4.

Reference Type BACKGROUND
PMID: 35230135 (View on PubMed)

Etard C, Bigand E, Salvat C, Vidal V, Beregi JP, Hornbeck A, Greffier J. Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France. Eur Radiol. 2017 Oct;27(10):4281-4290. doi: 10.1007/s00330-017-4780-5. Epub 2017 Mar 13.

Reference Type BACKGROUND
PMID: 28289939 (View on PubMed)

Greffier J, Ferretti G, Rousseau J, Andreani O, Alonso E, Rauch A, Gillet R, Le Roy J, Cabrol-Faivre L, Douane F, David A, Henry S, Jacques T, Stefanovic X, Decoux E, Lafay F, Pilleul F, Couzon F, Boutet C, Woerly B, Baur P, Sans N, Faruch M, Moussier-Lherm A, Tselikas L, Jacquier A, Bigand E, Pessis E, Teriitehau C, Magnier F, Cassagnes L, Haberlay M, Boutteau D, De Kerviler E, Majorel-Gouthain C, Defez D, Vuillod A, Rouviere O, Hennequin L, Fohlen A, Alwan R, Malakhia A, Aubry S, Dohan A, Eresue-Bony M, Gautier R, Dal R, Dabli D, Hebert T, Kovacs R, Hadid-Beurrier L, Bousson V, Potel M, Barbotteau Y, Michel C, Habib-Geryes B, Andre M, Arnaud T, Bestion N, Ernst O, Monfraix S, Brillet PY, Guiu B, Boussel L, Demonchy M, Beregi JP, Frandon J. National dose reference levels in computed tomography-guided interventional procedures-a proposal. Eur Radiol. 2020 Oct;30(10):5690-5701. doi: 10.1007/s00330-020-06903-9. Epub 2020 May 2.

Reference Type BACKGROUND
PMID: 32361774 (View on PubMed)

Other Identifiers

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NIMAO/2024-1/DD-01

Identifier Type: -

Identifier Source: org_study_id