Abstract Background Xenon‐enhanced dual‐energy (DE) computed tomography (CT) and hyperpolarized noble‐gas magnetic resonance imaging (MRI) provide maps of lung ventilation that can be used to detect chronic obstructive pulmonary disease (COPD) early in its development and predict respiratory exacerbations. However, xenon‐enhanced DE‐CT requires high radiation doses and hyper‐polarized noble‐gas MRI is expensive and only available at a handful of institutions?globally. Purpose To present xenon‐enhanced dual‐energy tomosynthesis (XeDET) for low‐dose, low‐cost functional imaging of respiratory disease in an experimental phantom?study. Methods We propose using digital tomosynthesis to produce Xe‐enhanced low‐energy (LE) and high‐energy (HE) coronal images. DE subtraction of the LE and HE images is used to suppress soft tissues. We used an imaging phantom to investigate image quality in terms of the area under the reciever operating characteristic curve (AUC) for the Non‐PreWhitening model observer with an Eye filter and internal noise (NPWEi). The phantom simulated anatomic clutter due to lung parenchyma and attenuation due to soft tissue and lung tissue. Aluminum slats were used to simulate rib structures. A stepwedge consisting of an acrylic casing with sealed cylindrical air‐filled cavities was used to simulate ventilation defects with step thicknesses of 0.5, 1, and 2?cm and cylindrical radii of 0.5, 0.75, and 1?cm. The phantom was ventilated with Xe and projection data were acquired using a flat‐panel detector, a tube‐voltage combination of 60/140?kV with 1.2? mm of copper filtration on the HE spectrum and an angular range of ±15°$pm 15^{circ}$ in 1° increments. The AUC of a NPWEi observer that has access only to a single coronal slice was calculated from measurements of the three‐dimensional noise power spectrum and signal template. The AUC was calculated as a function of ventilation defect thickness and radius for total patient entrance air kermas ranging from 1.42 to 2.84?mGy with and without rib‐simulating Al slats. For the AUC analysis, the observer internal noise level was obtained from an ad hoc calibration to a high‐dose data?set. Results XeDET was able to suppress parenchyma‐simulating clutter in coronal images enabling visualization of the simulated ventilation defects, but the limited angle acquisition resulted in residual clutter due to out‐of‐plane bone‐mimmicking structures. The signal power of the defects increased linearly with defect radius and showed a ten‐fold to fifteen‐fold increase in signal power when the defect thickness increased from 0.5 to 2?cm. These trends agreed with theoretical predictions. Along the depth dimension, the power of the defects decreased exponentially with distance from the center of the defects with full‐width half maxima that varied from 1.85?to 2.85?cm depending on the defect thickness and radius. The AUCs of the 1‐cm‐radius defect that was 2?cm in thickness ranged from good (0.8–0.9) to excellent (0.9–1.0) over the range of air kermas?considered. Conclusions Xenon‐enhanced DE tomosynthesis has the potential to enable functional imaging of respiratory disease and should be further investigated as a low‐cost alternative to MRI‐based approaches and a low‐dose alternative to CT‐based?approaches.
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