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The purpose of this study was to assess the diagnostic accuracy of computed tomography pulmonary angiogram (CTPA) including dual energy and reconstruction of iodine maps for diagnosing CTEPH. This method for detecting embolisms and perfusion failures was compared with V/Q-SPECT. An additional purpose was to compare the applied radiation dose of both techniques. 71 patients (49 women) with suspected CTEPH were included in this prospective study. The patients received a V/Q-SPECT and a dual-energy CTPA. Iodine maps were reconstructed from the data set. CTPA and the iodine maps were read by an experienced radiologist unaware of the clinical information as well as the results of the V/Q-SPECT. Results were compared to the V/Q-SPECT. DLP and the applied amount of radionuclides (MAA, Technegas) were obtained for comparison of radiation dose. For the diagnosis of CTEPH, the sensitivity of DECT was 1.000, specificity 0.966, PPV 0.867 and NPV 1.000, respectively. There was not a considerable difference in the x-ray exposure between the DECT examination and the V/Q-SPECT (1.892 mSv vs. 1.911 mSv; p = 0.6115). Both examination modalities were highly consistent regarding the classification of pathological segments (1177/1278 segments, 92,09 %, κ = 0,5938). This study presents the DECT, in combination with reconstructed iodine maps, as a potential alternative to the current imaging technique of first choice, V/Q-SPECT. For creating future prospective diagnostic algorithms, the implementation of DECT screening with iodine maps should be considered.· DECT correctly identified all CTEPH patients.. · There is substantial agreement between DECT and V/Q-SPECT in the classification of pathological segments.. · There is no significant difference in radiation exposure during DECT examination and V/Q-SPECT examination.. · Reduced radiation dose does not negatively impact image quality..· Schüßler A, Richter M, Tello K et al. Evaluation der diagnostischen Genauigkeit und der Strahlendosis der Dual-Energy-Computertomografie (DECT) bei chronisch thromboembolischer pulmonaler Hypertonie (CTEPH). Fortschr Röntgenstr 2021; 193: 1318 - 1326.ZIEL: Ziel der Studie war es herauszufinden, wie exakt die diagnostische Genauigkeit der computertomografischen Pulmonalisangiografie (CTPA) unter Hinzunahme von Dual-Energy und Rekonstruktionen von Jodkarten bei der Diagnosestellung einer CTEPH ist. Zudem wurde die Übereinstimmung der CTPA mit der Ventilations-/Perfusionsszintigrafie (V/Q-SPECT) bei der Detektion von Embolien und Perfusionsausfällen untersucht. Ein weiteres Ziel war es, die applizierte Strahlenexposition beider Techniken miteinander zu vergleichen. 71 Patienten (49 Frauen) mit dem Verdacht auf eine CTEPH wurden in diese prospektive Studie eingeschlossen. Die Patienten erhielten eine V/Q-SPECT und eine Dual-Energy-CTPA und hieraus rekonstruierte Jodkarten. Die Analyse der CTPA und der Jodkarten erfolgte durch einen erfahrenen Radiologen, verblindet zu den klinischen Angaben und in Unkenntnis des V/Q-SPECT-Befundes. Die Ergebnisse wurden mit dem Befund der V/Q-SPECT verglichen. DLP und die applizierten Radionuklidmengen (MAA, Technegas) wurden zur Ermittlung der Strahlenexposition erfasst. Die DECT erzielte eine Sensitivität von 1,000, eine Spezifität von 0,966, einen PPV von 0,867 und einen NPV von 1,000. Zwischen den beiden Untersuchungsmodalitäten gab es, in Bezug auf die Strahlenexposition, nahezu keinen Unterschied (1,911 mSv vs. 1,892 mSv). Die Untersuchungsmodalitäten zeigten im Hinblick auf Perfusionsdefizite eine hohe Übereinstimmung (1177/1278 Segmente, 92,09 %; κ = 0,5938). Die DECT präsentierte sich, in Kombination mit den Jodkarten, als potenzielle Alternative zum gegenwärtigen bildgebenden Verfahren der ersten Wahl, der V/Q-SPECT. Bei der Erstellung zukünftiger diagnostischer CTEPH-Untersuchungsalgorithmen sollte die Implementierung der DECT erwogen werden. · Die DECT stufte alle CTEPH-Patienten als richtig positiv ein.. · Hohe Übereinstimmung zwischen DECT und V/Q-SPECT bei der Einteilung pathologischer Segmente.. · Strahlenexposition DECT-Untersuchung und V/Q SPECT kein signifikanter Unterschied.. · Trotz eingesparter Strahlendosis keine Einbußen der Bildqualität..· Schüßler A, Richter M, Tello K et al. Evaluation of Diagnostic Accuracy and X-Ray Exposure of Dual-Energy Computed Tomography (DECT) in the Course of Chronic Thromboembolic Pulmonary Hypertension (CTEPH). Fortschr Röntgenstr 2021; 193: 1318 – 1326.

On 31 December 2018, the new Radiation Protection Regulation came into effect in Germany and made the new Radiation Protection Act more concrete. The old Radiation Protection Regulation and X‑ray Regulation have thereby been replaced.The substantial modifications regarding the practical daily routine in radiology are summarized.Modifications and innovations of the New Radiation Protection Act and Regulation compared to the old Radiation Protection Regulation and X‑ray Regulation and accordances were evaluated. Thereby the main focus was in the relevance for workflow in clinical routine.The new legislation contains a number of regulations that provide crucial tools for implementation of radiation protection, quality assurance, and dose optimization. However, this also requires additional time and personnel.

The entry of the new Radiation Protection Act and new Radiation Protection Regulation into force in Germany created many changes for radiology with regard to the old Radiation Protection Regulation and X‑ray Regulation.The substantial modifications in radiology regarding the areas of approval and notification procedures, teleradiology, screening, research and radon in the workplace are summarized.Changes in the new Radiation Protection Act and Regulation compared to the old Radiation Protection Regulation and X‑ray Regulation were evaluated. Thereby, the focus was on areas beyond the workflow in clinical routine.The requirements for the approval and notification procedure have increased. For example, proof must be provided that a medical physics expert can be consulted. The establishment of deadlines for the process by the responsible authorities may accelerate the procedure and create planning certainty.

PURPOSE In this study we assessed the effect of an interactive breath-hold control system on procedure time and technical success in transthoracic CT-guided lung biopsies. MATERIALS AND METHODS In 36 patients (4 female, 32 male, mean age 65 years; range 33 - 88) with a pulmonary nodule, we performed CT-guided biopsy using a 18G Tru-cut needle (Cardinal Health, Dublin, UK) in a 64 row dual-source CT scanner (Somatom Definition, Siemens, Forchheim, Germany) using intermittent imaging of the needle. In half of the patients (2 female, 16 male, mean age 67 years), an interactive breath-hold control system (IBC) (Mayo Clinic Medical Devices, USA) was applied. No additional device was used in the control group. RESULTS The biopsy was visually successful in all patients. The diameter of the target lesion was comparable in both groups (IBC: 30 +/- 19 mm; control: 28 +/- 15 mm). The number of imaging steps was significantly smaller (p < 0.05) and the intervention time was significantly shorter (p < 0.05) in the IBC group (IBC: 9 +/- 5 steps 17 +/- 10 min; control: 13 +/- 5 steps 26 +/- 12 min). CONCLUSION Application of the IBC unit reduced the intervention time and radiation exposure in CT-guided Tru-cut biopsy of pulmonary nodules.