{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:21:54Z","timestamp":1790209314158,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"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>Routine CT examinations are crucial in colorectal cancer patients (CCPs); however, the high frequency of radiation exposure is a significant concern. This study investigated the radiation dose, image quality, and diagnostic performance of tin filter-based spectral shaping chest\u2013abdominal\u2013pelvic (CAP) CT for CCPs. We reviewed 44 CCPs who underwent single-phase enhanced tin-filtered 100 kV (TF100kV) and standard 120 kV (ST120kV) CAP CT on separate days. Radiation metrics including the volume CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) were calculated for both protocols. Two radiologists assessed the presence of the following lesions: lung metastasis, liver metastasis, lymph node metastasis, peritoneal dissemination, and bone metastasis. The area under the receiver operating characteristic curve (AUC) was calculated for the diagnostic performance of each protocol. Radiation metrics of the TF100kV protocol were significantly lower than those of the ST120kV protocol (CDTIvol 1.60 \u00b1 0.31 mGy vs. 14.4 \u00b1 2.50, p &lt; 0.0001; DLP 107.1 (95.9\u2013125.5) mGy\u00b7cm vs. 996.7 (886.2\u20131144.3), p &lt; 0.0001; ED 1.93 (1.73\u20132.26) mSv vs. 17.9 (16.0\u201320.6), p &lt; 0.0001, respectively). TF100kV protocol achieved comparable diagnostic performance to that of the ST120kV protocol (AUC for lung metastasis: 1.00 vs. 0.94; liver metastasis: 0.88 vs. 0.83, respectively). TF100kV protocol could substantially reduce the radiation dose by 89% compared to that with the ST120kV protocol while maintaining good diagnostic performance in CCPs.<\/jats:p>","DOI":"10.3390\/tomography8020088","type":"journal-article","created":{"date-parts":[[2022,4,10]],"date-time":"2022-04-10T06:02:54Z","timestamp":1649570574000},"page":"1079-1089","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Dose Reduction and Diagnostic Performance of Tin Filter\u2013Based Spectral Shaping CT in Patients with Colorectal Cancer"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3190-8508","authenticated-orcid":false,"given":"Koichiro","family":"Kimura","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7141-8901","authenticated-orcid":false,"given":"Tomoyuki","family":"Fujioka","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6107-4519","authenticated-orcid":false,"given":"Mio","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1547-9427","authenticated-orcid":false,"given":"Takuya","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takumi","family":"Hiraishi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroto","family":"Hada","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiaki","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Specialized Surgeries, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ukihide","family":"Tateishi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3322\/caac.21262","article-title":"Global cancer statistics, 2012","volume":"65","author":"Torre","year":"2015","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"International Agency for Research on Cancer (2022, January 31). Cancer Fact Sheets Colorectal Cancer Source: Globocan. Available online: https:\/\/gco.iarc.fr\/today\/fact-sheets-cancers."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1093\/annonc\/mdu543","article-title":"Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: A systematic review and meta-analysis","volume":"26","year":"2015","journal-title":"Ann. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.3748\/wjg.v20.i8.1887","article-title":"Colorectal cancer surveillance: What\u2019s new and what\u2019s next","volume":"20","author":"Rose","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3737","DOI":"10.1200\/JCO.2003.04.187","article-title":"Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer","volume":"21","author":"Verwaal","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3284","DOI":"10.1200\/JCO.2004.10.012","article-title":"Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: A multi-institutional study","volume":"22","author":"Glehen","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.athoracsur.2007.02.093","article-title":"Surgical resection of pulmonary metastases from colorectal cancer: A systematic review of published series","volume":"84","author":"Pfannschmidt","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1016\/j.ejso.2007.09.018","article-title":"Resection of pulmonary metastases from colorectal carcinoma","volume":"33","author":"Warwick","year":"2007","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/SLA.0b013e3181b4539b","article-title":"Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: An international multi-institutional analysis of 1669 patients","volume":"250","author":"Pulitano","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1200\/JCO.2009.23.9285","article-title":"Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: Retrospective analysis of 523 patients from a multicentric French study","volume":"28","author":"Elias","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1002\/bjs.8667","article-title":"Systematic review and meta-analysis of follow-up after hepatectomy for colorectal liver metastases","volume":"99","author":"Jones","year":"2012","journal-title":"Br. J. Surg"},{"key":"ref_12","first-page":"862","article-title":"Colorectal cancer prognosis twenty years later","volume":"16","author":"Bujanda","year":"2010","journal-title":"World J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1002\/ijc.31785","article-title":"An overview of 25 years of incidence, treatment and outcome of colorectal cancer patients","volume":"143","author":"Brouwer","year":"2018","journal-title":"Int. J. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1016\/S0959-8049(02)00061-8","article-title":"Follow-up of patients with colorectal cancer: Numbers needed to test and treat","volume":"38","author":"Kievit","year":"2002","journal-title":"Eur. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4465","DOI":"10.1200\/JCO.2013.50.7442","article-title":"Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement","volume":"31","author":"Meyerhardt","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_16","unstructured":"(2022, January 31). National Comprehensive Cancer Network [NCCN Guidelines]\u00ae Rectal Cancer, Version 2.2021. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/default.aspx."},{"key":"ref_17","unstructured":"(2022, January 31). National Comprehensive Cancer Network [NCCN Guidelines]\u00ae Colon Cancer, Version 3.2021. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/default.aspx."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.annonc.2020.06.022","article-title":"Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Argiles","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10147-019-01485-z","article-title":"Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer","volume":"25","author":"Hashiguchi","year":"2020","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1001\/jama.2017.7105","article-title":"Effect of First-line chemotherapy combined with cetuximab or bevacizumab on overall survival in patients with KRAS wild-type advanced or metastatic colorectal cancer: A randomized clinical trial","volume":"317","author":"Venook","year":"2017","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1016\/S1470-2045(16)30269-8","article-title":"FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab for metastatic colorectal cancer (FIRE-3): A post-hoc analysis of tumour dynamics in the final RAS wild-type subgroup of this randomised open-label phase 3 trial","volume":"17","author":"Stintzing","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1007\/s00330-014-3559-1","article-title":"Chest CT using spectral filtration: Radiation dose, image quality, and spectrum of clinical utility","volume":"25","author":"Braun","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/RLI.0000000000000037","article-title":"Ultralow-dose chest computed tomography for pulmonary nodule detection: First performance evaluation of single energy scanning with spectral shaping","volume":"49","author":"Gordic","year":"2014","journal-title":"Investig. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.lpm.2015.12.003","article-title":"Ultra-low dose chest CT: The end of chest radiograph?","volume":"45","author":"Ludes","year":"2016","journal-title":"Presse Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1007\/s00330-018-5750-2","article-title":"Prospective evaluation of ultra-low-dose contrast-enhanced 100-kV abdominal computed tomography with tin filter: Effect on radiation dose reduction and image quality with a third-generation dual-source CT system","volume":"29","author":"Leyendecker","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"808","DOI":"10.2214\/AJR.18.20154","article-title":"Comparison of tin filter-based spectral shaping CT and low-dose protocol for detection of urinary calculi","volume":"212","author":"Mozaffary","year":"2019","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Petritsch, B., Kosmala, A., Weng, A.M., and Bley, T.A. (2019). Tin-filtered 100 kV ultra-low-dose CT of the paranasal sinus: Initial clinical results. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0216295"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1093\/rpd\/ncv511","article-title":"Body size-specific effective dose conversion coefficients for Ct scans","volume":"172","author":"Romanyukha","year":"2016","journal-title":"Radiat. Prot. Dosim."},{"key":"ref_29","first-page":"6","article-title":"Use of water equivalent diameter for calculating patient size and Size-Specific Dose Estimates (SSDE) in CT: The report of AAPM task group 220","volume":"2014","author":"McCollough","year":"2014","journal-title":"AAPM Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1056\/NEJMra072149","article-title":"Computed tomography--an increasing source of radiation exposure","volume":"357","author":"Brenner","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1148\/radiol.2019191422","article-title":"State of the art in abdominal CT: The limits of iterative reconstruction algorithms","volume":"293","author":"Mileto","year":"2019","journal-title":"Radiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2273","DOI":"10.1007\/s00330-017-5243-8","article-title":"Whole-body ultra-low dose CT using spectral shaping for detection of osteolytic lesion in multiple myeloma","volume":"28","author":"Suntharalingam","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1148\/radiol.2017161911","article-title":"U.S. Diagnostic reference levels and achievable doses for 10 adult ct examinations","volume":"284","author":"Kanal","year":"2017","journal-title":"Radiology"},{"key":"ref_34","unstructured":"Japan Network for Research and Information on Medical Exposures (2022, January 31). National Diagnostic Reference Levels in Japan. Japan 2020 DRLs., Available online: http:\/\/www.radher.jp\/J-RIME\/report\/DRL2020_Engver.pdf."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/8\/2\/88\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:50:22Z","timestamp":1760136622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/8\/2\/88"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,8]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["tomography8020088"],"URL":"https:\/\/doi.org\/10.3390\/tomography8020088","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,8]]}}}