{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T19:09:59Z","timestamp":1768417799366,"version":"3.49.0"},"reference-count":20,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"RSNA Research &amp; Education Foundation","award":["RSCH2302"],"award-info":[{"award-number":["RSCH2302"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Simultaneous dual-contrast imaging of iodine and bismuth has shown promise in prior phantom and animal studies utilizing spectral CT. However, it is noted that in previous studies, Pepto-Bismol has frequently been employed as the source of bismuth, exceeding the recommended levels for human subjects. This investigation sought to assess the feasibility of visually differentiating and precisely quantifying low-concentration bismuth using clinical dual-source photon-counting CT (PCCT) in a scenario involving both iodinated and bismuth-based contrast materials. Four bismuth samples (0.6, 1.3, 2.5, and 5.1 mg\/mL) were prepared using Pepto-Bismol, alongside three iodine rods (1, 2, and 5 mg\/mL), inserted into multi-energy CT phantoms with three different sizes, and scanned on a PCCT system at three tube potentials (120, 140, and Sn140 kV). A generic image-based three-material decomposition method generated iodine and bismuth maps, with mean mass concentrations and noise levels measured. The root-mean-square errors for iodine and bismuth determined the optimal tube potential. The tube potential of 140 kV demonstrated optimal quantification performance when both iodine and bismuth were considered. Distinct differentiation of iodine rods with all three concentrations and bismuth samples with mass concentrations \u2265 1.3 mg\/mL was observed across all phantom sizes at the optimal kV setting.<\/jats:p>","DOI":"10.3390\/s24113567","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T05:58:00Z","timestamp":1717394280000},"page":"3567","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Visual and Quantitative Evaluation of Low-Concentration Bismuth in Dual-Contrast Imaging of Iodine and Bismuth Using Clinical Photon-Counting CT"],"prefix":"10.3390","volume":"24","author":[{"given":"Afrouz","family":"Ataei","sequence":"first","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA"}]},{"given":"Vasantha","family":"Vasan","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6129-5549","authenticated-orcid":false,"given":"Todd C.","family":"Soesbe","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA"}]},{"given":"Cecelia C.","family":"Brewington","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA"}]},{"given":"Zhongxing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA"}]},{"given":"Lifeng","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7387-7861","authenticated-orcid":false,"given":"Kristina A.","family":"Hallam","sequence":"additional","affiliation":[{"name":"Siemens Medical Solutions USA Inc., Malvern, PA 19355, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3625-5166","authenticated-orcid":false,"given":"Liqiang","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1007\/s00330-010-1768-9","article-title":"Spectroscopic (multi-energy) CT distinguishes iodine and barium contrast material in MICE","volume":"20","author":"Anderson","year":"2010","journal-title":"Eur. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"12119","DOI":"10.1038\/s41598-018-30570-y","article-title":"Assessment of candidate elements for development of spectral photon-counting CT specific contrast agents","volume":"8","author":"Kim","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3318","DOI":"10.1007\/s00330-017-5252-7","article-title":"Experimental feasibility of spectral photon-counting computed tomography with two contrast agents for the detection of endoleaks following endovascular aortic repair","volume":"28","author":"Dangelmaier","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1007\/s10554-017-1104-4","article-title":"Dual-contrast agent photon-counting computed tomography of the heart: Initial experience","volume":"33","author":"Symons","year":"2017","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5120","DOI":"10.1002\/mp.12301","article-title":"Photon-counting CT for simultaneous imaging of multiple contrast agents in the abdomen: An in vivo study","volume":"44","author":"Symons","year":"2017","journal-title":"Med. Phys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s41747-017-0030-5","article-title":"Simultaneous dual-contrast multi-phase liver imaging using spectral photon-counting computed tomography: A proof-of-concept study","volume":"1","author":"Muenzel","year":"2017","journal-title":"Eur. Radiol. Exp."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1148\/radiol.13121267","article-title":"Extravasated contrast material in penetrating abdominopelvic trauma: Dual-contrast dual-energy CT for improved diagnosis\u2014Preliminary results in an animal model","volume":"268","author":"Mongan","year":"2013","journal-title":"Radiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1148\/radiol.12120692","article-title":"In vivo differentiation of complementary contrast media at dual-energy CT","volume":"265","author":"Mongan","year":"2012","journal-title":"Radiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.2214\/AJR.18.20445","article-title":"Comparison of Positive Oral Contrast Agents for Abdominopelvic CT","volume":"212","author":"Winklhofer","year":"2019","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1097\/RLI.0000000000000687","article-title":"Simultaneous Dual-contrast Imaging of Small Bowel with Iodine and Bismuth using Photon-counting-detector CT: A Feasibility Animal Study","volume":"55","author":"Ren","year":"2020","journal-title":"Investig. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1097\/RCT.0b013e3182606baf","article-title":"Toward biphasic computed tomography (CT) enteric contrast: Material classification of luminal bismuth and mural iodine in a small-bowel phantom using dual-energy CT","volume":"36","author":"Qu","year":"2012","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/RLI.0000000000000483","article-title":"Improved Peritoneal Cavity and Abdominal Organ Imaging Using a Biphasic Contrast Agent Protocol and Spectral Photon Counting Computed Tomography K-Edge Imaging","volume":"53","author":"Thivolet","year":"2018","journal-title":"Investig. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1002\/mp.15448","article-title":"Simultaneous dual-contrast imaging using energy-integrating detector multi-energy CT: An in vivo feasibility study","volume":"49","author":"Zhou","year":"2022","journal-title":"Med. Phys."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1148\/radiol.212579","article-title":"First clinical photon-counting detector CT system: Technical evaluation","volume":"303","author":"Rajendran","year":"2022","journal-title":"Radiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1002\/mp.13912","article-title":"Quantitative accuracy and dose efficiency of dual-contrast imaging using dual-energy CT: A phantom study","volume":"47","author":"Ren","year":"2020","journal-title":"Med. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"013503","DOI":"10.1117\/1.JMI.6.1.013503","article-title":"Impact of prior information on material decomposition in dual- and multienergy computed tomography","volume":"6","author":"Ren","year":"2019","journal-title":"J. Med. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4105","DOI":"10.1002\/mp.13668","article-title":"Feasibility of multi-contrast imaging on dual-source photon counting detector (PCD) CT: An initial phantom study","volume":"46","author":"Tao","year":"2019","journal-title":"Med. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Tao, A., Huang, R., Tao, S., Michalak, G.J., McCollough, C.H., and Leng, S. (2019). Dual-source photon counting detector CT with a tin filter: A phantom study on iodine quantification performance. Phys. Med. Biol., 64.","DOI":"10.1088\/1361-6560\/ab1c34"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8060","DOI":"10.1007\/s00330-021-07886-x","article-title":"Investigating new CT contrast agents: A phantom study exploring quantification and differentiation methods for high-Z elements using dual-energy CT","volume":"31","author":"Soesbe","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e231878","DOI":"10.1148\/radiol.231878","article-title":"Bone Marrow Edema at Photon-Counting CT","volume":"310","author":"Surov","year":"2024","journal-title":"Radiology"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/11\/3567\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:52:09Z","timestamp":1760107929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/11\/3567"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,1]]},"references-count":20,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["s24113567"],"URL":"https:\/\/doi.org\/10.3390\/s24113567","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,1]]}}}