The Growth Channel

Game-changer: Why dual-energy CT could be a key to post-reform success

by Matt Morrill and Becca Portman

With increasing utilization scrutiny, dose reduction pressures, and cuts to reimbursement, the world is changing for radiology. It’s time to start thinking creatively about ways to leverage technology to meet new demands on imaging. 

We recently spoke with a few institutions that are doing just that by introducing dual-energy CT (DECT) scanning for regular clinical use. No longer reserved for research purposes, DECT produces high-quality images at reduced radiation levels, an increasingly valuable combination in a post-reform care.

Benefits of dual energy

Dual-energy CT, also known as spectral imaging, is a function of premium CT scanners that utilizes two different energy spectra to create a “blended image.” It can be leveraged for an increasing number of clinical applications, though much of its use thus far has been for cardiac and abdominal imaging. A few examples of its unique advantages:

  • Increased radiologist confidence at lower radiation dose: While up to 25% of traditional CT scans for pulmonary embolisms are non-diagnostic, dual energy produces a consistent diagnostic image. Additionally, DE eliminates the need for a separate non-contrast scan, reducing overall radiation dose.

  • Risk stratification to prevent unnecessary invasive procedures: Dual-energy imaging of kidney stones allows for early differentiation between stones that can be medically dissolved, and those that require invasive treatment. One doctor reported over 99% accuracy in stratifying these populations, reducing costs while improving patient morbidity.

  • Clearer images and more holistic diagnoses: While lesions in the liver can be difficult to identify with traditional CT scanning, DE blends both low-energy and high-energy images to create a clearer picture. In addition, DECT can be used to quantify iron, fibrosis, or fat deposits in the liver, producing a comprehensive scan of the patient’s liver health.

Barriers to adoption

For several reasons, adoption of regular dual-energy scanning has been mostly restricted to AMCs with active research operations. Limitations include:

  • Substantial capital investment: Scanners with DECT functionality generally cost between 1.6 and 2.5 million dollars, a significant cash outlay for any institution.

  • Lack of financial incentive: Despite producing clearer scans in the same amount of time, dual-energy imaging does not garner any additional reimbursement.

  • Boundaries to clinical applications: Spectral imaging is most useful for the analysis of locally concentrated issues rather than diffuse problems such as cancer. In addition, the use of dual-energy scanning for obese patients is limited using the scanners currently on the market.

The right way to introduce DECT

While DECT won’t be for everyone, large institutions that already operate premium CT scanners are particularly well-primed to introduce the technology. A few considerations to keep in mind:

  • Incremental implementation: The physicians we spoke with recommended a piecewise approach to adoption of the technology for clinical purposes. Institutions looking to introduce DECT will need a physician champion and a careful implementation plan before beginning.

  • Automated protocols: In order to maintain efficiency, the radiologists we spoke with worked closely with the CT vendors to embed protocols and timing for each exam type, automating the process for both image capture and post-processing.  

Learn more

For more about Dual Energy and other Premium CT offerings, see the Service Line Strategy Advisor 2-page overview of the technology.