Optimal Dose Levels in Screening Chest CT for Unimpaired Detection and Volumetry of Lung Nodules,with and without Computer Assisted Detection at Minimal Patient Radiation

Objectives

The aim of this phantom study was to minimize the radiation dose by finding the best combination of low tube current and low voltage that would result in accurate volume measurements when compared to standard CT imaging without significantly decreasing the sensitivity of detecting lung nodules both with and without the assistance of CAD.

Methods

An anthropomorphic chest phantom containing artificial solid and ground glass nodules (GGNs, 5–12 mm) was examined with a 64-row multi-detector CT scanner with three tube currents of 100, 50 and 25 mAs in combination with three tube voltages of 120, 100 and 80 kVp. This resulted in eight different protocols that were then compared to standard CT sensitivity (100 mAs/120 kVp). For each protocol, at least 127 different nodules were scanned in 21–25 phantoms. The nodules were analyzed in two separate sessions by three independent, blinded radiologists and computer-aided detection (CAD) software.

Results

The mean sensitivity of the radiologists for identifying solid lung nodules on a standard CT was 89.7%±4.9%. The sensitivity was not significantly impaired when the tube and current voltage were lowered at the same time, except at the lowest exposure level of 25 mAs/80 kVp [80.6%±4.3% (p = 0.031)]. Compared to the standard CT, the sensitivity for detecting GGNs was significantly lower at all dose levels when the voltage was 80 kVp; this result was independent of the tube current. The CAD significantly increased the radiologists’ sensitivity for detecting solid nodules at all dose levels (5–11%). No significant volume measurement errors (VMEs) were documented for the radiologists or the CAD software at any dose level.

Conclusions

Our results suggest a CT protocol with 25 mAs and 100 kVp is optimal for detecting solid and ground glass nodules in lung cancer screening. The use of CAD software is highly recommended at all dose levels.     

Image quality characteristics for virtual monoenergetic images using dual-layer spectral detector CT: Comparison with conventional tube-voltage images

PurposeTo investigate the image quality characteristics for virtual monoenergetic images compared with conventional tube-voltage image with dual-layer spectral CT (DLCT).MethodsHelical scans were performed using a first-generation DLCT scanner, two different sizes of acrylic cylindrical phantoms, and a Catphan phantom. Three different iodine concentrations were inserted into the phantom center. The single-tube voltage for obtaining virtual monoenergetic images was set to 120 or 140 kVp. Conventional 120- and 140-kVp images and virtual monoenergetic images (40–200-keV images) were reconstructed from slice thicknesses of 1.0 mm. The CT number and image noise were measured for each iodine concentration and water on the 120-kVp images and virtual monoenergetic images. The noise power spectrum (NPS) was also calculated.ResultsThe iodine CT numbers for the iodinated enhancing materials were similar regardless of phantom size and acquisition method. Compared with the iodine CT numbers of the conventional 120-kVp images, those for the monoenergetic 40-, 50-, and 60-keV images increased by approximately 3.0-, 1.9-, and 1.3-fold, respectively. The image noise values for each virtual monoenergetic image were similar (for example, 24.6 HU at 40 keV and 23.3 HU at 200 keV obtained at 120 kVp and 30-cm phantom size). The NPS curves of the 70-keV and 120-kVp images for a 1.0-mm slice thickness over the entire frequency range were similar.ConclusionVirtual monoenergetic images represent stable image noise over the entire energy spectrum and improved the contrast-to-noise ratio than conventional tube voltage using the dual-layer spectral detector CT.     

Optimization of image quality and accuracy of low iodine concentration quantification as function of kVp pairs for abdominal imaging using dual-source CT: A phantom study

PurposeTo determine the suitable kVp pair for optimal image quality of the virtual monochromatic images (VMIs) and iodine quantification accuracy at low concentration, using a third generation dual-source CT (DSCT).Materials and methodsMulti-energy CT phantoms with and without body rings were scanned with a DSCT using four kVp pairs (tube “A”/“B” voltage): 100/Sn150, 90/Sn150, 80/Sn150 and 70/Sn150 kVp. The reference mAs was adjusted to obtain a CTDI_vol close to 11 mGy. HU values accuracy (RMSD_HU), noise (SD) and contrast-to-noise ratio (CNR) of iodine inserts of 0.5, 1, 2 and 5 mg/mL concentrations were assessed on VMIs at 40/50/60/70 keV. Iodine quantification accuracy was assessed using the RMSD_iodine and iodine bias (IB_iodine).ResultsThe RMSD_HU decreased when the tube “A” voltage increased. The mean noise value increased significantly with tube “A” voltage (p < 0.001) but decreased between 80/Sn150 and 90/Sn150 kVp for the small phantom (1.1 ± 0.1%; p = 0.047). The CNR significantly decreased with tube “A” voltage (p < 0.001), except between 80/Sn150 and 90/Sn150 kVp for all inserts and between 90/Sn150 kVp and 100/Sn150 kVp for the 1.0 and 0.5 mg/mL inserts in the large phantom. In the small phantom, no significant difference was found between 80/Sn150 kVp and 90/Sn150 kVp for all inserts and between 80/Sn150, 90/Sn150 and 100/Sn150 kVp for the 1 and 0.5 mg/mL inserts. The RMSD_iodine and IB_iodine decreased as the tube “A” voltage of the kVp pair increased.ConclusionThe kVp pair of 70/Sn150 led to better image quality in VMIs and sufficient iodine accuracy.     

Automatic exposure control at single- and dual-heartbeat CTCA on a 320-MDCT volume scanner: Effect of heart rate,exposure phase window setting,and reconstruction algorithm

PurposeTo investigate whether electrocardiogram (ECG)-gated single- and dual-heartbeat computed tomography coronary angiography (CTCA) with automatic exposure control (AEC) yields images with uniform image noise at reduced radiation doses.Materials and methodsUsing an anthropomorphic chest CT phantom we performed prospectively ECG-gated single- and dual-heartbeat CTCA on a second-generation 320-multidetector CT volume scanner. The exposure phase window was set at 75%, 70–80%, 40–80%, and 0–100% and the heart rate at 60 or 80 or corr80 bpm; images were reconstructed with filtered back projection (FBP) or iterative reconstruction (IR, adaptive iterative dose reduction 3D). We applied AEC and set the image noise level to 20 or 25 HU. For each technique we determined the image noise and the radiation dose to the phantom center.ResultsWith half-scan reconstruction at 60 bpm, a 70–80% phase window- and a 20-HU standard deviation (SD) setting, the imagenoise level and -variation along the z axis manifested similar curves with FBP and IR. With half-scan reconstruction, the radiation dose to the phantom center with 70–80% phase window was 18.89 and 12.34 mGy for FBP and 4.61 and 3.10 mGy for IR at an SD setting SD of 20 and 25 HU, respectively. At 80 bpm with two-segment reconstruction the dose was approximately twice that of 60 bpm at both SD settings. However, increasing radiation dose at corr80 bpm was suppressed to 1.39 times compared to 60 bpm.ConclusionAEC at ECG-gated single- and dual-heartbeat CTCA controls the image noise at different radiation dose.     

Fetal radiation dose in three common CT examinations during pregnancy – Monte Carlo study

PurposeTo determine fetal doses in different stages of pregnancy in three common computed tomography (CT) examinations: pulmonary CT angiography, abdomino-pelvic and trauma scan with Monte Carlo (MC) simulations.MethodsAn adult female anthropomorphic phantom was scanned with a 64-slice CT using pulmonary angiography, abdomino-pelvic and trauma CT scan protocols. Three different sized gelatin boluses placed on the phantom’s abdomen simulated different stages of pregnancy. Intrauterine dose was used as a surrogate to a dose absorbed to the fetus. MC simulations were performed to estimate uterine doses. The simulation dose levels were calibrated with volumetric CT dose index (CTDI_vol) measurements and MC simulations in a cylindrical CTDI body phantom and compared with ten point doses measured with metal-oxide-semiconductor field-effect-transistor dosimeters. Intrauterine volumes and uterine walls were segmented and the respective dose volume histograms were calculated.ResultsThe mean intrauterine doses in different stages of pregnancy varied from 0.04 to 1.04 mGy, from 4.8 to 5.8 mGy, and from 9.8 to 12.6 mGy in the CT scans for pulmonary angiography, abdomino-pelvic and trauma CT scans, respectively. MC simulations showed good correlation with the MOSFET measurement at the measured locations.ConclusionsThe three studied examinations provided highly varying fetal doses increasing from sub-mGy level in pulmonary CT angiography to notably higher levels in abdomino-pelvic and trauma scans where the fetus is in the primary exposure range. Volumetric dose distribution offered by MC simulations in an appropriate anthropomorphic phantom provides a comprehensive dose assessment when applied in adjunct to point-dose measurements.     

Location of radiosensitive organs inside pediatric anthropomorphic phantoms: Data required for dosimetry

PurposeThe aim of this study was to determine the location of radiosensitive organs in the interior of four pediatric anthropomorphic phantoms for dosimetric purposes.MethodsFour pediatric anthropomorphic phantoms representing the average individual as newborn, 1-year-old, 5-year-old and 10-year-old child underwent head, thorax and abdomen CT scans. CT and MRI scans of all children aged 0–16 years performed during a 5-year-period in our hospital were reviewed, and 503 were found to be eligible for normal anatomy. Anterior-posterior and lateral dimensions of twelve of the above children closely matched that of the phantoms' head, thoracic and abdominal region in each four phantoms. The mid-sagittal and mid–coronal planes were drawn on selected matching axial images of patients and phantoms. Multiple points outlining large radiosensitive organs in patient images were identified at each slice level and their orthogonal distances from the mid-sagittal and mid–coronal planes were measured. In small organs, the coordinates of organs' centers were similarly determined. The outlines and centers of all radiosensitive organs were reproduced using the coordinates of each organ on corresponding phantoms’ transverse images.ResultsThe locations of the following radiosensitive organs in the interior of the four phantoms was determined: brain, eye lenses, salivary glands, thyroid, lungs, heart, thymus, esophagus, breasts, adrenals, liver, spleen, kidneys, stomach, gallbladder, small bowel, pancreas, colon, ovaries, bladder, prostate, uterus and rectum.ConclusionsThe production of charts of radiosensitive organs inside pediatric anthropomorphic phantoms was feasible and may provide users reliable data for positioning of dosimeters during direct organ dose measurements.     

Measuring skin dose in CT examinations under complex geometries: Instruments,methods and considerations

ObjectiveTo investigate skin dose in Computed Tomography (CT) and its dependence on scanning geometry.Materials and methodsMeasurements of entrance surface air kerma (ESAK) in free air and entrance skin dose (ESD) on an anthropomorphic phantom were performed in a 64-slice CT scanner, using two different instruments: the Dose Profiler (DP) and the QED skin diode (QEDSD). Using DP and QEDSD, the ESAK rate profiles at the isocenter and at different distances from it, were measured using axial scans. Using DP and helical scans the ESAK rate profile in the Z-axis was acquired. The same profile was acquired with the QEDSD also, using many axial scans and manual table translation. ESD measurements were performed with the DP and QEDSD, in axial and helical scan mode.ResultsESAK measurements with DP and QEDSD were in good agreement, for both point dose and profile measurements. The agreement was also good for ESD measurements but not for helical scans, due to variable X-ray beam overlapping and different tube angular positions at each scan start. It was observed that the ESD values at different Y-axis offsets were comparable to the respective ESAK values recorded at the same Y-axis offset distances without the phantom.ConclusionsBoth DP and QEDSD were proven suitable for performing point ESD measurements. However, calculating the skin dose distribution in CT examinations is a very challenging task. A practical approach would be for CT scanners to provide a conservative estimate of the peak skin dose using the isocenter ESAK value.     

Abdominal imaging dose in radiology and radiotherapy – Phantom point dose measurements,effective dose and secondary cancer risk

PurposeTo compare abdominal imaging dose from 3D imaging in radiology (standard/low-dose/dual-energy CT) and radiotherapy (planning CT, kV cone-beam CT (CBCT)).MethodsDose was measured by thermoluminescent dosimeters (TLD’s) placed at 86 positions in an anthropomorphic phantom. Point, organ and effective dose were assessed, and secondary cancer risk from imaging was estimated.ResultsOverall dose and mean organ dose comparisons yield significantly lower dose for the optimized radiology protocols (dual-source and care kV), with an average dose of 0.34±0.01 mGy and 0.54±0.01 mGy (average ± standard deviation), respectively. Standard abdominal CT and planning CT involve considerably higher dose (13.58 ± 0.18 mGy and 18.78±0.27 mGy, respectively). The CBCT dose show a dose fall-off near the field edges. On average, dose is reduced as compared with the planning or standard CT (3.79 ± 0.21 mGy for 220° rotation and 7.76 ± 0.37 mGy for 360°), unless the high-quality setting is chosen (20.30 ± 0.96 mGy). The mean organ doses show a similar behavior, which translates to the estimated secondary cancer risk. The modelled risk is in the range between 0.4 cases per million patient years (PY) for the radiological scans dual-energy and care kV, and 300 cases per million PY for the high-quality CBCT setting.ConclusionsModern radiotherapy imaging techniques (while much lower in dose than radiotherapy), involve considerably more dose to the patient than modern radiology techniques. Given the frequency of radiotherapy imaging, a further reduction in radiotherapy imaging dose appears to be both desirable and technically feasible.     

Dose profiles for lung and breast regions at prospective and retrospective CT coronary angiography using optically stimulated luminescence dosimeters on a 64-detector CT scanner

PurposeThe purpose of our study was to acquire dose profiles at critical organs of lung and breast regions using optically stimulated luminescence (OSL) dosimeters; assess the actual radiation dose delivered at retrospective and prospective computed tomography coronary angiography (CTCA).Materials and methodsUsing a chest CT phantom we applied a prospectively-gated step-and-shoot- and a retrospectively-gated helical mode on a 64-detector row CT scanner. Retrospective scan mode was used with and without electrocardiogram (ECG) based tube current modulation. OSL dosimeters were used to measure dose profiles. In the both scan modes we acquired dose profiles and determined the mean and maximum dose in left lung and in left breast regions.ResultsIn prospective mode, the mean dose was 21.53 mGy in left lung- and 23.59 mGy in left breast region. With respect to the retrospective mode, the mean dose with tube current modulation was 38.63 mGy for left lung- and 46.02 mGy for left breast region, i.e. 0.56 and 0.55 times lower than the mean dose without modulation.ConclusionThe OSL dosimeter is useful for measurement of the actual radiation dose along z-axis at lung and breast regions in the prospective and the retrospective CTCA.     

Direct action of radiation on mummified cells: modeling of computed tomography by Monte Carlo algorithms

X-ray imaging is a nondestructive and preferred method in paleopathology to reconstruct the history of ancient diseases. Sophisticated imaging technologies such as computed tomography (CT) have become common for the investigation of skeletal disorders in human remains. Researchers have investigated the impact of ionizing radiation on living cells, but never on ancient cells in dry tissue. The effects of CT exposure on ancient cells have not been examined in the past and may be important for subsequent genetic analysis. To remedy this shortcoming, we developed different Monte Carlo models to simulate X-ray irradiation on ancient cells. Effects of mummification were considered by using two sizes of cells and three different phantom tissues, which enclosed the investigated cell cluster. This cluster was positioned at the isocenter of a CT scanner model, where the cell hit probabilities P(0,1,…, n) were calculated according to the Poisson distribution. To study the impact of the dominant physics process, CT scans for X-ray spectra of 80 and 120 kVp were simulated. Comparison between normal and dry tissue phantoms revealed that the probability of unaffected cells increased by 21 % following cell shrinkage for 80 kVp, while for 120 kVp, a further increase of unaffected cells of 23 % was observed. Consequently, cell shrinkage caused by dehydration decreased the impact of X-ray radiation on mummified cells significantly. Moreover, backscattered electrons in cortical bone protected deeper-lying ancient cells from radiation damage at 80 kVp X-rays.     

Generating and using patient-specific whole-body models for organ dose estimates in CT with increased accuracy: Feasibility and validation

The estimation of patient dose using Monte Carlo (MC) simulations based on the available patient CT images is limited to the length of the scan. Software tools for dose estimation based on standard computational phantoms overcome this problem; however, they are limited with respect to taking individual patient anatomy into account. The purpose of this study was to generate whole-body patient models in order to take scattered radiation and over-scanning effects into account. Thorax examinations were performed on three physical anthropomorphic phantoms at tube voltages of 80 kV and 120 kV; absorbed dose was measured using thermoluminescence dosimeters (TLD). Whole-body voxel models were built as a combination of the acquired CT images appended by data taken from widely used anthropomorphic voxel phantoms. MC simulations were performed both for the CT image volumes alone and for the whole-body models. Measured and calculated dose distributions were compared for each TLD chip position; additionally, organ doses were determined.MC simulations based only on CT data underestimated dose by 8%–15% on average depending on patient size with highest underestimation values of 37% for the adult phantom at the caudal border of the image volume. The use of whole-body models substantially reduced these errors; measured and simulated results consistently agreed to better than 10%.This study demonstrates that combined whole-body models can provide three-dimensional dose distributions with improved accuracy. Using the presented concept should be of high interest for research studies which demand high accuracy, e.g. for dose optimization efforts.     

Pin-photodiode array for the measurement of fan-beam energy and air kerma distributions of X-ray CT scanners

PurposePatient dose estimation in X-ray computed tomography (CT) is generally performed by Monte Carlo simulation of photon interactions within anthropomorphic or cylindrical phantoms. An accurate Monte Carlo simulation requires an understanding of the effects of the bow-tie filter equipped in a CT scanner, i.e. the change of X-ray energy and air kerma along the fan-beam arc of the CT scanner. To measure the effective energy and air kerma distributions, we devised a pin-photodiode array utilizing eight channels of X-ray sensors arranged at regular intervals along the fan-beam arc of the CT scanner.MethodsEach X-ray sensor consisted of two plate type of pin silicon photodiodes in tandem – front and rear photodiodes – and of a lead collimator, which only allowed X-rays to impinge vertically to the silicon surface of the photodiodes. The effective energy of the X-rays was calculated from the ratio of the output voltages of the photodiodes and the dose was calculated from the output voltage of the front photodiode using the energy and dose calibration curves respectively.ResultsThe pin-photodiode array allowed the calculation of X-ray effective energies and relative doses, at eight points simultaneously along the fan-beam arc of a CT scanner during a single rotation of the scanner.ConclusionsThe fan-beam energy and air kerma distributions of CT scanners can be effectively measured using this pin-photodiode array.     

Spatial resolution compensation by adjusting the reconstruction kernels for iterative reconstruction images of computed tomography

PurposeHybrid iterative reconstruction (IR) is useful to reduce noise in computed tomography (CT) images. However, it often decreases the spatial resolution. The ability of high spatial resolution kernels (harder kernels) to compensate for the decrease in the spatial resolution of hybrid IRs was investigated.MethodsAn elliptic cylindrical phantom simulating an adult abdomen was used. Two types of rod-shaped objects with ~330 and ~130 HU were inserted to simulate contrasts of arteries in CT angiography. Two multi-slice CT systems were used to scan the phantoms with 120 kVp and scan doses of 20 and 10 mGy. The task transfer functions (TTFs) were measured from the circular edges of the rod images. The noise power spectrum (NPS) was measured from the images of the water-only section. The CT images were reconstructed using a filtered back projection (FBP) with baseline kernels and two levels of hybrid IRs with harder kernels. The profiles of the clinical images across the aortic dissection flaps were measured to evaluate actual spatial resolutions.ResultsThe TTF degradation of each hybrid IR was recovered by the harder kernels, whereas the noise reduction effect was retained, for both the 20 and 10 mGy. The profiles of the dissection flaps for the FBP were maintained by using the harder kernels. Even with the best combination of hybrid IR and harder kernel, the noise level at 10 mGy was not reduced to the level of FBP at 20 mGy, suggesting no capability of a 50% dose reduction while maintaining noise.     

Simultaneous achievement of accurate CT number and image quality improvement for myocardial perfusion CT at 320-MDCT volume scanning

PurposeTo investigate differences in image-to-image variations between full- and half-scan reconstruction on myocardial CT perfusion (CTP) study.MethodsUsing a cardiac phantom we performed ECG-gated myocardial CTP on a second-generation 320-multidetector CT volume scanner. The heart rate was set at 60 bpm; once per second for a total of 24 s were performed. CT images were acquired at 80- and 120 kVp and subjected to full- and half-scan reconstruction. On images acquired at the same slice level we then measured image-to-image variations, coefficients of variance (CV), and image noise.ResultsThe image-to-image variations with full- and half-scan reconstruction were 1.3 HU vs. 27.2 HU at 80 kVp (p < 0.001) and 0.70 HU vs. 9.3 HU at 120 kVp (p < 0.001) even though the mean HU value was almost the same for both reconstruction methods. The CV of 80- and 120-kVp images of the left ventricular cavity decreased by 0.16% and 0.17%, respectively, with full-scan reconstruction; with half-scan reconstruction it decreased by 3.34% and 2.30%, respectively. Compared with half-scan reconstruction, the image noise was reduced by 27.2% at 80 kVp and by 28.0% at 120 kVp with full-scan reconstruction.ConclusionMyocardial CTP with full-scan reconstruction substantially decreased image-to-image variations and provided accurate CT attenuation.     

An empirical artifact correction for proton computed tomography

Purpose: To reduce image artifacts of proton computed tomography (pCT) from a preclinical scanner, for imaging of the relative stopping power (RSP) needed for particle therapy treatment planning using a simple empirical artifact correction method.Methods: We adapted and employed a correction method previously used for beam-hardening correction in x-ray CT which makes use of a single scan of a custom-built homogeneous phantom with known RSP. Exploiting the linearity of the filtered backprojection operation, a function was found which corrects water-equivalent path lengths (RSP line integrals) in experimental scans using a prototype pCT scanner. The correction function was applied to projection values of subsequent scans of a homogeneous water phantom, a sensitometric phantom with various inserts and an anthropomorphic head phantom. Data were acquired at two different incident proton energies to test the robustness of the method.Results: Inaccuracies in the detection process caused an offset and known ring artifacts in the water phantom which were considerably reduced using the proposed method. The mean absolute percentage error (MAPE) of mean RSP values of all inserts of the sensitometric phantom and the water phantom was reduced from 0.87% to 0.44% and from 0.86% to 0.48% for the two incident energies respectively. In the head phantom a clear reduction of artifacts was observed.Conclusions: Image artifacts of experimental pCT scans with a prototype scanner could substantially be reduced both in homogeneous, heterogeneous and anthropomorphic phantoms. RSP accuracy was also improved.     

Impact of miscentering on patient dose and image noise in x-ray CT imaging: Phantom and clinical studies

The operation of the bowtie filter in x-ray CT is correct if the object being scanned is properly centered in the scanner’s field-of-view. Otherwise, the dose delivered to the patient and image noise will deviate from optimal setting. We investigate the effect of miscentering on image noise and surface dose on three commercial CT scanners. Six cylindrical phantoms with different size and material were scanned on each scanner. The phantoms were positioned at 0, 2, 4 and 6 cm below the isocenter of the scanner’s field-of-view. Regression models of surface dose and noise were produced as a function of miscentering magnitude and phantom’s size. 480 patients were assessed using the calculated regression models to estimate the influence of patient miscentering on image noise and patient surface dose in seven imaging centers. For the 64-slice CT scanner, the maximum increase of surface dose using the CTDI-32 phantom was 13.5%, 33.3% and 51.1% for miscenterings of 2, 4 and 6 cm, respectively. The analysis of patients’ scout scans showed miscentering of 2.2 cm in average below the isocenter. An average increase of 23% and 7% was observed for patient dose and image noise, respectively. The maximum variation in patient miscentering derived from the comparison of imaging centers using the same scanner was 1.6 cm. Patient miscentering may substantially increase surface dose and image noise. Therefore, technologists are strongly encouraged to pay greater attention to patient centering.     

Investigation of the dose distribution for a cone beam CT system dedicated to breast imaging

Cone-beam breast Computed Tomography (bCT) is an X-ray imaging technique for breast cancer diagnosis, in principle capable of delivering a much more homogeneous dose spatial pattern to the breast volume than conventional mammography, at dose levels comparable to two-view mammography. We present an investigation of the three-dimensional dose distribution for a cone-beam CT system dedicated to breast imaging. We employed Monte Carlo simulations for estimating the dose deposited within a breast phantom having a hemiellipsoidal shape placed on a cylinder of 3.5 cm thickness that simulates the chest wall. This phantom represents a pendulant breast in a bCT exam with the average diameter at chest wall, assumed to correspond to a 5-cm-thick compressed breast in mammography. The phantom is irradiated in a circular orbit with an X-ray cone beam selected from four different techniques: 50, 60, 70, and 80 kVp from a tube with tungsten anode, 1.8 mm Al inherent filtration and additional filtration of 0.2 mm Cu. Using the Monte Carlo code GEANT4 we simulated a system similar to the experimental apparatus available in our lab. Simulations were performed at a constant free-in-air air kerma at the isocenter (1 μGy); the corresponding total number of photon histories per scan was 288 million at 80 kVp. We found that the more energetic beams provide a more uniform dose distribution than at low energy: the 50 kVp beam presents a frequency distribution of absorbed dose values with a coefficient of variation almost double than that for the 80 kVp beam. This is confirmed by the analysis of the relative dose profiles along the radial (i.e. parallel to the “chest wall”) and longitudinal (i.e. from “chest wall” to “nipple”) directions. Maximum radial deviations are on the order of 25% for the 80 kVp beam, whereas for the 50 kVp beam variations around 43% were observed, with the lowest dose values being found along the central longitudinal axis of the phantom.     

Dependency of prescribed CT dose on table height,patient size,and localizer acquisition for one clinical MDCT

PurposeThe purpose of this study was to quantify the effect that table height, patient size, and localizer acquisition order may have on AEC prescribed dose.Method and materialsThree phantoms were used for this study: the Mercury Phantom, acrylic sheets, and an anthropomorphic phantom. A lateral (LAT) and a posterior-anterior (PA) localizer was acquired for each phantom at different table heights on a MDCT scanner (GE Discovery CT750 HD). AEC scan acquisitions were prescribed for each combination of phantom, localizer orientation, and table height ±4 cm with the center position; the displayed CTDI_vol was recorded. Based on the institutional dose monitoring program, the relationship between change in CTDI_vol and change in table height were studied for LAT and AP localizers for clinical exams.ResultsFor all phantom scans based on the PA localizer, the percent change in ranged between −18% and 42% for table heights 4 cm below and above proper centering; while for the LAT localizer, the percent change in CTDI_vol from ideal were no greater than 12% different for ±4 cm differences in table height. Change in CTDI_vol and change in table height displayed a strong linear relationship for AP localizer exams (P = 0.002), and weak correlation for LAT localizer exams (P = 0.12).ConclusionsSince uncertainty in vertical patient positioning is inherently greater than lateral positioning, the LAT localizer should be utilized to precisely and reproducibly deliver the intended amount of radiation prescribed by CT protocols.