{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T01:27:10Z","timestamp":1780104430164,"version":"3.54.0"},"reference-count":27,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Objective: Chest computed tomography (CT) is a key component of the diagnostic assessment of people with cystic fibrosis (PwCF) and is increasingly replacing chest radiography. Due to improvements in life expectancy, radiation exposure has become a growing concern in PwCF. Photon-counting CT (PCCT) has the potential to reduce the risk of radiation-induced malignancies while maintaining diagnostic accuracy. This study aimed to compare the radiation dose and image quality of low-dose high-resolution (LD-HR) and ultra-low-dose high-resolution (ULD-HR) CT protocols using PCCT in PwCF. Methods: This retrospective study included 72 PwCF, with 36 undergoing a LD-HR chest CT protocol and 36 receiving an ULD-HR protocol on a PCCT. The radiation dose and image quality were assessed by comparing the effective dose and signal-to-noise ratio (SNR). Three blinded radiologists evaluated the overall image quality, sharpness, noise, and assessability of the bronchi, bronchial wall thickening, and bronchiolitis using a five-point Likert scale. Results: The ULD-HR PCCT protocol reduced radiation exposure by approximately 65% compared with the LD-HR PCCT protocol (median effective dose: 0.19 vs. 0.55 mSv, p &lt; 0.001). While LD-HR images were consistently rated higher than ULD-HR images (p &lt; 0.001), both protocols maintained diagnostic significance (median image quality rating of \u201c4-good\u201d). The average SNR of the lung parenchyma was significantly lower with ULD-HR PCCT compared to LD-HR PCCT (p &lt; 0.001). Conclusions: ULD-HR PCCT significantly reduced radiation exposure while maintaining good diagnostic image quality in PwCF. The effective dose of ULD-HR PCCT is only twice that of a two-plane chest X-ray, making it a viable low-radiation alternative for routine imaging in PwCF.<\/jats:p>","DOI":"10.3390\/tomography11120134","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T16:31:52Z","timestamp":1764261112000},"page":"134","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Question of Dose? Ultra-Low Dose Chest CT on Photon-Counting CT in People with Cystic Fibrosis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7455-8590","authenticated-orcid":false,"given":"Marcel","family":"Opitz","sequence":"first","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1259-8911","authenticated-orcid":false,"given":"Matthias","family":"Welsner","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University Duisburg-Essen, T\u00fcschener Weg 40, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halil I.","family":"Tazeoglu","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Stehling","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children\u2019s Hospital, University Duisburg-Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivagurunathan","family":"Sutharsan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University Duisburg-Essen, T\u00fcschener Weg 40, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westh\u00f6lter","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University Duisburg-Essen, T\u00fcschener Weg 40, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2300-239X","authenticated-orcid":false,"given":"Erik","family":"B\u00fcscher","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University Duisburg-Essen, T\u00fcschener Weg 40, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3546-1398","authenticated-orcid":false,"given":"Christian","family":"Taube","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University Duisburg-Essen, T\u00fcschener Weg 40, 45239 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nika","family":"Guberina","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"},{"name":"Department of Radiotherapy, University Medicine Essen, University Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9585-9787","authenticated-orcid":false,"given":"Denise","family":"Bos","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Drews","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2776-6604","authenticated-orcid":false,"given":"Daniel","family":"Rosok","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2997-0740","authenticated-orcid":false,"given":"Sebastian","family":"Zensen","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4843-5911","authenticated-orcid":false,"given":"Johannes","family":"Haubold","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lale","family":"Umutlu","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5584-9824","authenticated-orcid":false,"given":"Michael","family":"Forsting","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5250-5751","authenticated-orcid":false,"given":"Marko","family":"Frings","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1007\/s00247-020-04706-0","article-title":"Computed tomography in cystic fibrosis lung disease: A focus on radiation exposure","volume":"51","author":"Joyce","year":"2021","journal-title":"Pediatr. 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