Adult Abdominal Photon-Counting CT Protocols: A Multiinstitutional Consensus of the Society of Abdominal Radiology Photon-Counting Detector CT Emerging Technology Commission

Photon-counting CT (PCCT) offers new opportunities for abdominal imaging by enabling higher spatial resolution, improved image quality, and reduced radiation exposure compared with conventional energy-integrating detector CT systems. However, standardized PCCT protocols for abdominal imaging are lacking, which limits clinical adoption, comparability across institutions, and multicenter research studies. The Society of Abdominal Radiology (SAR) Photon-Counting Detector CT Emerging Technology Commission created a survey to achieve consensus on common adult abdominal PCCT protocols for FDA-approved PCCT, including portal venous phase CT, multiphase aortic CTA, and multiphase pancreas CT protocols. The survey included the following items for each protocol: scan mode, tube potential, image quality level, primary viewing virtual monoenergetic imaging (VMI) level, reconstruction kernel, additional VMI or other spectral reconstructions sent to PACS, and details of archiving the special spectral imaging dataset. Consensus statements were generated based on the survey and voted on by nine radiologists from nine institutions using the consensus-minus-one method. Consensus was reached for 20 protocol features, including that 70-keV VMI is recommended for primary interpretation of portal venous and multiphase pancreas PCCT and that, for multiphase aortic CTA, low virtual monoenergetic levels should be viewed. This multiinstitutional consensus endorsed by SAR establishes standardized abdominal PCCT protocols.