Josua Decker

PD Dr. med. · Radiologist · Augsburg, Germany

Josua Decker

I am a radiologist and clinical scientist working on sex- and gender-sensitive imaging. My research asks whether imaging works equally well for women and men, and what has to change where it does not.

Managing senior consultant (geschäftsführender Oberarzt) in the Department of Diagnostic and Interventional Radiology and Neuroradiology at University Hospital Augsburg, and Assistant Professor (Privatdozent) at the University of Augsburg.

About 100 papers since 2014 · h-index 20 (OpenAlex) · Board member, AGIT (German Roentgen Society)

Portrait of Josua Decker in a blue jacket, leaning on a railing

01 Research

Where imaging treats women and men differently

Most of my projects start in clinical routine, with a protocol or a threshold that everyone uses and nobody has checked by sex. A few of them grow into trials.

Together they form one programme on sex- and gender-sensitive imaging, from the iodine dose of a single scan to the statistics of an entire health system.

1.1

Contrast dose and sex

Iodinated contrast is dosed by body weight, or not adjusted at all. Women have less blood volume per kilogram, so the same protocol leaves more iodine in each millilitre of their blood. In 274 staging CT scans, enhancement of vessels and organs was significantly higher in women, and sex remained a factor after adjustment for body size and blood volume.

Key paper: Eur Radiol 2025
1.2

Photon-counting CT

Photon-counting detectors register single X-ray photons together with their energy. Since the first clinical systems arrived in 2021, our group has tested what this changes in practice: low-dose abdominal CT with less noise, sharper stent lumens, haemoglobin read from a routine contrast scan to detect anaemia, and fewer follow-up tests in a cost model for coronary CT.

Key paper: Radiology 2022
1.3

Nationwide hospital data

Germany's DRG statistics record almost every inpatient stay. I use them to follow how the care of peripheral artery disease, mesenteric ischaemia, diverticulitis or uterine fibroids has shifted over the years. The largest analysis so far covers 166.7 million cases and asks whether standard comorbidity scores predict in-hospital death equally well for women and men.

Key paper: medRxiv 2026, preprint
1.4

AI and structured reporting

Algorithms reach radiology faster than the evidence for them. I care less about the next model than about how it is tested: reader studies under routine conditions, with results broken down by subgroup. As a co-opted board member of AGIT, the working group on information technology of the German Roentgen Society, I also work on reports that machines can read.

Key paper: J Thorac Imaging 2024

02 Projects

Selected projects

Two of them are open as interactive pages. The underlying data is public; the work was in tracing it back to its sources and checking every number.

Randomised trialNCT06965790

Contrast dosing by blood volume

A single-centre randomised trial on a photon-counting CT scanner compares weight-based with blood-volume-based iodine dosing in staging CT. The goal is equal image quality for women and men, with less contrast wherever less is enough. Recruitment closed in 2025 and the results are under review. Funded by the Margarete Ammon Foundation.

400+patients randomised
Interactive catalogue2026

Thresholds that were never checked by sex

Radiology runs on cut-offs: the aortic diameter that triggers repair, the nodule size that triggers follow-up. I traced 1,401 numeric thresholds from current guidelines back to the studies they came from. Of 111 absolute values with a verifiable source, 101 were never analysed separately for women and men.

101/111absolute thresholds without a sex-specific check
Interactive charts2026

Who gets which scan

Women account for 49% of all inpatient procedures in German hospitals, but for only 34% of cardiac MRI scans. The page breaks down 14 imaging and interventional procedures by sex and age group, based on federal statistics for 2024.

34%share of women in inpatient cardiac MRI, 2024
Preprint2026

Comorbidity scores in women and men

Comorbidity scores such as the Charlson index use one formula for everyone. In 166.7 million adult inpatient cases from German hospitals between 2010 and 2024, we tested whether they are equally well calibrated in women and men. The analysis plan was fixed before any aggregated data existed.

166.7 Minpatient cases, 2010 to 2024

03 Publications

Selected publications

About 100 publications since 2014; OpenAlex counts 99 works and an h-index of 20 (October 2026). The list below comes from Europe PMC, which covers PubMed-indexed papers and preprints, and links to every paper. Further profiles: Google Scholar, ORCID.

74 papers listed in Europe PMC, 18 as first author and 20 as last author.

  1. 2026RadioGraphics
  2. 2025
    Are we systematically overdosing women? Revisiting standardized contrast protocols for thoracoabdominal CT scans last authorBecker J, Huber A, Bette S, Rubeck A, Arndt TT, Müller G, Risch F, Canalini L, Wollny C, Schwarz F, Scheurig-Muenkler C, Kroencke T, Decker JA
    Eur Radiol
  3. 2026medRxiv (preprint)
  4. 2022
    Anemia Detection by Hemoglobin Quantification on Contrast-enhanced Photon-counting CT Data Sets first authorDecker JA, Huber A, Senel F, Bette S, Braun F, Risch F, Woźnicki P, Becker J, Popp D, Haerting M, Jehs B, Rippel K, Wollny C, Scheurig-Muenkler C, Kroencke TJ, Schwarz F
    Radiology
  5. 2023
    Stent imaging on a clinical dual-source photon-counting detector CT system-impact of luminal attenuation and sharp kernels on lumen visibility first authorDecker JA, O'Doherty J, Schoepf UJ, Todoran TM, Aquino GJ, Brandt V, Baruah D, Fink N, Zsarnoczay E, Flohr T, Schmidt B, Allmendinger T, Risch F, Varga-Szemes A, Emrich T
    Eur Radiol
  6. 2022
    Low-dose CT of the abdomen: Initial experience on a novel photon-counting detector CT and comparison with energy-integrating detector CT first authorDecker JA, Bette S, Lubina N, Rippel K, Braun F, Risch F, Woźnicki P, Wollny C, Scheurig-Muenkler C, Kroencke TJ, Schwarz F
    Eur J Radiol
  7. 2025
    Cost-effectiveness of ultrahigh-resolution photon-counting detector coronary CT angiography for the evaluation of stable chest pain last authorVecsey-Nagy M, Emrich T, Tremamunno G, Kravchenko D, Taha Hagar M, Laux GS, Schoepf UJ, O'Doherty J, Boussoussou M, Szilveszter B, Maurovich-Horvat P, Kroencke T, Kabakus IM, Spruill Suranyi P, Varga-Szemes A, Decker JA
    J Cardiovasc Comput Tomogr
  8. 2022Dtsch Arztebl Int
  9. 2024
    Deep Learning-Based Automated Labeling of Coronary Segments for Structured Reporting of Coronary Computed Tomography Angiography in Accordance With Society of Cardiovascular Computed Tomography Guidelines last authorBrandt V, Fischer A, Schoepf UJ, Bekeredjian R, Tesche C, Aquino GJ, O'Doherty J, Sharma P, Gülsün MA, Klein P, Ali A, Few WE, Emrich T, Varga-Szemes A, Decker JA
    J Thorac Imaging
All publications 74 entries, newest first

2026

  1. 2026RadioGraphics
  2. 2026Geroscience
  3. 2026Int J Cardiovasc Imaging
  4. 2026J Cardiovasc Magn Reson
  5. 2026medRxiv (preprint)
  6. 2026medRxiv (preprint)
  7. 2026Eur Radiol

2025

  1. 2025Eur J Cardiothorac Surg
  2. 2025Diagnostics
  3. 2025Radiol Case Rep
  4. 2025Eur Radiol
  5. 2025RöFo
  6. 2025BMC Med Imaging
  7. 2025CVIR Endovasc
  8. 2025Sci Rep
  9. 2025Int J Cardiovasc Imaging
  10. 2025J Endovasc Ther
  11. 2025J Cardiovasc Comput Tomogr
  12. 2025J Nucl Med
  13. 2025Cardiovasc Intervent Radiol
  14. 2025Neuroradiology
  15. 2025Eur Radiol

2024

  1. 2024Int J Cardiovasc Imaging
  2. 2024Diagnostics
  3. 2024Diagnostics
  4. 2024Eur J Radiol
  5. 2024Diagnostics
  6. 2024Abdom Radiol (NY)
  7. 2024Acta Radiol
  8. 2024Colorectal Dis
  9. 2024Radiol Med
  10. 2024J Clin Med
  11. 2024Eur Radiol
  12. 2024J Thorac Imaging
  13. 2024JTCVS Tech

2023

  1. 2023BMC Gastroenterol
  2. 2023Eur Radiol
  3. 2023Eur J Radiol
  4. 2023Cancers
  5. 2023Eur J Radiol
  6. 2023Cardiovasc Intervent Radiol
  7. 2023Diagnostics
  8. 2023CVIR Endovasc
  9. 2023Eur J Radiol
  10. 2023Diagnostics
  11. 2023Eur J Paediatr Neurol
  12. 2023Eur Radiol
  13. 2023Invest Radiol
  14. 2023Eur J Radiol

2022

  1. 2022Eur Radiol
  2. 2022Diagnostics
  3. 2022AJR Am J Roentgenol
  4. 2022Dtsch Arztebl Int
  5. 2022
    Spontaneous Iliopsoas Muscle Hemorrhage-Predictors of Associated Mortality first authorDecker JA, Brill LM, Orlowski U, et al.
    Acad Radiol
  6. 2022J Magn Reson Imaging
  7. 2022J Magn Reson Imaging
  8. 2022Eur J Radiol
  9. 2022Br J Radiol
  10. 2022Diagnostics
  11. 2022Eur J Radiol
  12. 2022Eur Radiol
  13. 2022J Clin Med
  14. 2022Eur Radiol
  15. 2022Radiol Cardiothorac Imaging
  16. 2022Invest Radiol
  17. 2022Eur J Radiol
  18. 2022Cardiovasc Intervent Radiol
  19. 2022Diagnostics
  20. 2022Radiology
  21. 2022Eur Radiol

2021

  1. 2021RöFo
  2. 2021CVIR Endovasc
  3. 2021Radiology

2020

  1. 2020RöFo

04 Profile

Profile

I am a board-certified radiologist and completed my habilitation at the University of Augsburg in 2024. My clinical work covers the whole range of a university radiology department, from interventions to on-call duty; my research time goes into the questions above.

My cardiac CT work also draws on a long-standing collaboration with the Division of Cardiovascular Imaging at the Medical University of South Carolina in Charleston.

Position
Managing senior consultant, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg
Academic
Assistant Professor (Privatdozent), Faculty of Medicine, University of Augsburg
Societies

Co-opted board member of AGIT, the working group on information technology of the German Roentgen Society (DRG)

Member of the DRG, the European Society of Radiology (ESR) and the German Society of Gender and Sex-Specific Medicine (DGesGM)

Funding
Margarete Ammon Foundation: randomised trial on blood-volume-based contrast dosing in photon-counting CT
Awards

2023Reviewer of the Year, European Radiology, for reviews in 2022

2022Young Investigator Award, German Roentgen Society

Media
Am Puls: Geschlechtssensible Medizin, augsburg.tv, with Prof. Thomas Kröncke (in German)

05 Contact

Contact

Josua Decker, smiling, in a white coat

For research collaborations, funding and industry partnerships or invitations to speak, write to me directly. I read and answer every message myself.

mail@josuadecker.de

Augsburg, Germany