A novel routine dual-energy computed tomography (DECT) quality control (QC) program was developed to address the current deficiency of routine QC for this technology. The dual-energy quality control (DEQC) program features (1) a practical phantom with clinically relevant materials and concentrations,(2) a clinically relevant acquisition, reconstruction, and postprocessing protocol, and (3) a fully automated analysis software to extract quantitative data for database storage and trend analysis. The phantom, designed for easy set up for standalone or adjacent imaging next to the ACR phantom, was made in collaboration with an industry partner and informed by clinical needs to have four iodine inserts (0.5,1, 2, and 5 mg/ml) and one calcium insert (100 mg/ml) equally spaced in a cylindrical water-equivalent background. The imaging protocol was based on a clinical DECT abdominal protocol capable of producing material specific concentration maps, virtual unenhanced images, and virtual monochromatic images. The QC automated analysis software uses open-source technologies which integrates well with our current automated CT QC database. The QC program was tested on a GE 750 HD scanner and two Siemens SOMATOM FLASH scanners over a 3-month period. The automated algorithm correctly identified the appropriate region of interest (ROI) locations and stores measured values in a database for monitoring and trend analysis. Slight variations in protocol settings were noted based on manufacturer.Overall,the project proved to provide a convenient and dependable clinical tool for routine oversight of DE CT imaging within the clinic.

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This work demonstrates the potential for a deformable mapping technique to relate corresponding lesions in DBT and ABUS images by showing improved lesion correspondence and reduced lesion registration errors with the use of external fiducial markers. The technique should improve radiologists' characterization of breast lesions which can reduce patient callbacks, misdiagnoses and unnecessary biopsies.

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