Spectral CT in practice: insights from an International Atomic Energy Agency survey

Abstract

Introduction: Spectral CT is an advanced imaging technique that distinguishes X-ray energies at the detector level to provide energy-resolved images for enhanced tissue characterization and quantitative capabilities. Despite its increasing availability, there is limited information on global clinical use and quality assurance. To address this gap, the International Atomic Energy Agency conducted a global survey to assess current practices and inform future guidance development. Methods: An online survey was disseminated internationally between October 2024 and June 2025. The questionnaire collected data on the presence and use of spectral CT, quality assurance (QA) and quality control (QC), clinical applications, dosimetry, and training. Responses were analyzed using descriptive statistics. Results: Eighty-three validated responses were received. Only a small fraction of spectral CT systems was photon-counting, nearly all installed from 2024 onward. A wide range of clinical applications was reported, including oncology, urology, cardiology, and neurological imaging. While many institutions reported access to spectral CT, utilization remains limited. Many facilities do not perform dedicated quality control (53%) and retain dosimetry practices (61%). Training gaps—especially among medical physicists—were evident. Respondents cited barriers such as insufficient training, workflow complexity, additional time for image review, limited post-processing tools, and uncertainty about clinical relevance. Conclusions: This preliminary global survey reveals that while spectral CT access is expanding, its clinical integration and QA/QC practices remain inconsistent. Standardized protocols, targeted training—particularly for medical physicists—and international guidance are urgently needed to support safe and effective adoption of spectral imaging in routine clinical care. Critical relevance statement: This global IAEA survey highlights critical gaps in spectral CT implementation and quality assurance, providing foundational insights that support future clinical advances through standardized protocols, targeted training, and globally harmonized guidance for more effective integration into radiology practice. Key Points: Spectral CT adoption outpaces its clinical use and quality assurance integration. The survey shows limited training, quality control, and routine spectral CT use. Standardized guidelines and targeted training are essential for broader implementation.