Giao Nguyen

Radiation Doses from Small-Bowel Follow-Through and Abdominopelvic MDCT in Crohn's Disease

OBJECTIVE The purpose of our study was to compare organ and effective doses for small-bowel follow-through (SBFT) and abdominopelvic MDCT in adults with Crohns disease, to retrospectively evaluate the number of radiographic examinations performed for Crohns disease indications, and to identify those patients undergoing serial examinations to better delineate the use of radiology in the diagnosis and clinical management of Crohns disease. MATERIALS AND METHODS Using an anthropomorphic phantom and metal-oxide semiconductor field-effect transistor (MOSFET) dosimeters, specific organ doses were measured for 5 minutes of continuous fluoroscopy (kVp, 120; mA, 0.6) of each of the following: right lower quadrant, central abdomen, and pelvis. Effective doses were determined based on International Commission on Radiological Protection (ICRP) 60 weighting factors. Organ and effective doses were determined for abdominal and pelvic 16-MDCT: detector configuration, 16 x 0.625 mm; pitch, 1.75; 17.5 mm per rotation; rotation time, 0.5 second; 140 kVp; 340 mA. Electronic records were reviewed to determine the number of patients imaged for Crohns disease indications and the number of studies per patient. RESULTS The highest fluoroscopic organ doses were as follows: in the right lower quadrant, right kidney (0.78 cGy) and marrow (0.66 cGy); in the central abdomen, kidneys (1.5 and 1.6 cGy) and marrow (0.76 cGy); and in the pelvis, marrow (0.67-0.95 cGy). Effective doses for the right lower quadrant, central abdomen, and pelvis were 1.37, 2.02, and 3.83 mSv, respectively. For MDCT, the highest organ doses were to the liver (2.95-3.33 cGy). The effective dose for abdominopelvic MDCT was 16.1 mSv. Three hundred seventy-three patients underwent imaging for Crohns disease. The average number of SBFT and CT examinations was 1.8 and 2.3, respectively. Thirty-four (9%) of 373 patients underwent more than five CT examinations and 11 (3%) had more than 10. CONCLUSION Organ and effective doses are up to five times higher with MDCT than with SBFT. Crohns disease is more frequently imaged with CT. For a subset of patients who undergo numerous CT examinations, efforts should be made to minimize the number of CT examinations, decrease the CT dose, or consider MR enterography.

Radiation Dose Savings for Adult Pulmonary Embolus 64-MDCT Using Bismuth Breast Shields, Lower Peak Kilovoltage, and Automatic Tube Current Modulation

OBJECTIVE The purpose of this study was to assess whether radiation dose savings using a lower peak kilovoltage (kVp) setting, bismuth breast shields, and automatic tube current modulation could be achieved while preserving the image quality of MDCT scans obtained to assess for pulmonary embolus (PE). MATERIALS AND METHODS CT angiography (CTA) examinations were performed to assess for the presence or absence of pulmonary artery emboli using a 64-MDCT scanner with automatic tube current modulation (noise level=10 HU), two kVp settings (120 and 140 kVp), and bismuth breast shields. Absorbed organ doses were measured using anthropomorphic phantoms and metal oxide semiconductor field effect transistor (MOSFET) detectors. Image quality was assessed quantitatively as well as qualitatively in various anatomic sites of the thorax. RESULTS Using a lower kVp (120 vs 140 kVp) and automatic tube current modulation resulted in a dose savings of 27% to the breast and 47% to the lungs. The use of a lower kVp (120 kVp), automatic tube current modulation, and bismuth shields placed directly on the anterior chest wall reduced absorbed breast and lung doses by 55% and 45%, respectively. Qualitative assessment of the images showed no change in image quality of the lungs and mediastinum when using a lower kVp, bismuth shields, or both. CONCLUSION The use of bismuth breast shields together with a lower kVp and automatic tube current modulation will reduce the absorbed radiation dose to the breast and lungs without degradation of image quality to the organs of the thorax for CTA detection of PE.

Pediatric Chest MDCT Using Tube Current Modulation: Effect on Radiation Dose with Breast Shielding

OBJECTIVE The purpose of our study was to assess the effect on radiation dose and image noise during pediatric chest 16-MDCT using automatic tube current modulation and bismuth breast shields. MATERIALS AND METHODS Age-based chest 16-MDCT was performed on an anthropomorphic phantom representing a 5-year-old child. Two scans were obtained in each of four sequences: first, without a shield; second, with a 2-ply bismuth shield; third, using automatic tube current modulation with a scout image obtained after placement of the shield; and fourth, using automatic tube current modulation with a scout image obtained before placement of the shield. Metal oxide semiconductor field effect transistor technology was used to measure the radiation dose in 20 organ locations. Effective dose was estimated using the console dose-length product. Noise was measured by recording the SD of Hounsfield units in identical regions of interest. RESULTS The bismuth breast shield reduced the dose to the breast by 26%. Shielding and automatic tube current modulation reduced the breast dose by 52%. Multiple organ doses were lowest when the shield was placed after the scout radiograph had been obtained. When the shield was placed after the scout image was obtained, the mean noise in the range of shielding increased from 11.4 to 13.1 H (superior mediastinum) and from 10.0 to 12.8 H (heart) (p < 0.01). Increased noise, however, was near the target noise index (measured in SD of Hounsfield units) of 12.0 H (SD). Using automatic tube current modulation, the effective dose was reduced by 35% when the shield was placed after the scout and by 20% when the shield was present in the scout. CONCLUSION The greatest dose reduction is achieved by placing the shield after obtaining the scout image to avoid Auto mA compensation due to density of shield. With this technique, image noise increased but remained close to the target noise index.

Pediatric cardiac-gated CT angiography : Assessment of radiation dose

OBJECTIVE The purpose of our study was to determine a dose range for cardiac-gated CT angiography (CTA) in children. MATERIALS AND METHODS ECG-gated cardiac CTA simulating scanning of the heart was performed on an anthropomorphic phantom of a 5-year-old child on a 16-MDCT scanner using variable parameters (small field of view; 16 x 0.625 mm configuration; 0.5-second gantry cycle time; 0.275 pitch; 120 kVp at 110, 220, and 330 mA; and 80 kVp at 385 mA). Metal oxide semiconductor field effect transistor (MOSFET) technology measured 20 organ doses. Effective dose calculated using the dose-length product (DLP) was compared with effective dose determined from measured absorbed organ doses. RESULTS Highest organ doses included breast (3.5-12.6 cGy), lung (3.3-12.1 cGy), and bone marrow (1.7-7.6 cGy). The 80 kVp/385 mA examination produced lower radiation doses to all organs than the 120 kVp/220 mA examination. MOSFET effective doses (+/- SD) were as follows: 110 mA: 7.4 mSv (+/- 0.6 mSv), 220 mA: 17.2 mSv (+/- 0.3 mSv), 330 mA: 25.7 mSv (+/- 0.3 mSv), 80 kVp/385 mA: 10.6 mSv (+/- 0.2 mSv). DLP effective doses for diagnostic runs were as follows: 110 mA: 8.7 mSv, 220 mA: 19 mSv, 330 mA: 28 mSv, 80 kVp/385 mA: 12 mSv. DLP effective doses exceeded MOSFET effective doses by 9.7-17.2%. CONCLUSION Radiation doses for a 5-year-old during cardiac-gated CTA vary greatly depending on parameters. Organ doses can be high; the effective dose may reach 28.4 mSv. Further work, including determination of size-appropriate mA and image quality, is important before routine use of this technique in children.

Validation of Metal Oxide Semiconductor Field Effect Transistor Technology for Organ Dose Assessment During CT: Comparison with Thermoluminescent Dosimetry

OBJECTIVE The purposes of this study were to apply near-real-time dose-measurement technology with metal oxide semiconductor field effect transistors (MOSFETs) to the assessment of organ dose during CT and to validate the method in comparison with the thermoluminescent dosimeter (TLD) method. MATERIALS AND METHODS Dosimetry measurements were performed in two ways, one with TLDs and the other with MOSFETs. Twenty organ locations were selected in an adult anthropomorphic female phantom. High-sensitivity MOSFET dosimeters were used. For the reference standard, TLDs were placed in the same organ locations as the MOSFETs. Both MOSFET and TLD detectors were calibrated with an X-ray beam equivalent in quality to that of a commercial CT scanner (half-value layer, approximately 7 mm Al at 120 kVp). Organ dose was determined with a scan protocol for pulmonary embolus studies on a 4-MDCT scanner. RESULTS Measurements for selected organ doses and the percentage difference for TLDs and MOSFETs, respectively, were as follows: thyroid (0.34 cGy, 0.31 cGy, -8%), middle lobe of lung (2.4 cGy, 3.0 cGy, +26%), bone marrow of thoracic spine (2.2 cGy, 2.5 cGy, +11%), stomach (1.0 cGy, 0.93 cGy, -6%), liver (2.5 cGy, 2.6 cGy, +6%), and left breast (3.0 cGy, 2.9 cGy, -1%). Bland-Altman analysis showed that the MOSFET results agreed with the TLD results (bias, 0.042). CONCLUSION We found good agreement between the results with the MOSFET and TLD methods. Near-real-time CT organ dose assessment not previously feasible with TLDs was achieved with MOSFETs. MOSFET technology can be used for protocol development in the rapidly changing MDCT scanner environment, in which organ dose data are extremely limited.

Effective dose determination using an anthropomorphic phantom and metal oxide semiconductor field effect transistor technology for clinical adult body multidetector array computed tomography protocols.

Purpose: To determine the organ doses and total body effective dose (ED) delivered to an anthropomorphic phantom by multidetector array computed tomography (MDCT) when using standard clinical adult body imaging protocols. Materials and Methods: Metal oxide semiconductor field effect transistor (MOSFET) technology was applied during the scanning of a female anthropomorphic phantom to determine 20 organ doses delivered during clinical body computed tomography (CT) imaging protocols. A 16-row MDCT scanner (LightSpeed, General Electric Healthcare, Milwaukee, Wis) was used. Effective dose was calculated as the sum of organ doses multiplied by a weighting factor determinant found in the International Commission on Radiological Protection Publication 60. Volume CT dose index and dose length product (DLP) values were recorded at the same time for the same scan. Results: Effective dose (mSv) for body MDCT imaging protocols were as follows: standard chest CT, 6.80 ± 0.6; pulmonary embolus CT, 13.7 ± 0.4; gated coronary CT angiography, 20.6 ± 0.4; standard abdomen and pelvic CT, 13.3 + 1.0; renal stone CT, 4.51 + 0.45. Effective dose calculated by direct organ measurements in the phantom was 14% to 37% greater than those determined by the DLP method. Conclusions: Effective dose calculated by the DLP method underestimates ED as compared with direct organ measurements for the same CT examination. Organ doses and total body ED are higher than previously reported for MDCT clinical body imaging protocols.

Effect of automatic tube current modulation on radiation dose and image quality for low tube voltage multidetector row CT angiography: phantom study.

RATIONALE AND OBJECTIVES To evaluate the effect of automatic tube current modulation on radiation dose and image quality for low tube voltage computed tomography (CT) angiography. MATERIALS AND METHODS An anthropomorphic phantom was scanned with a 64-section CT scanner using following tube voltages: 140 kVp (Protocol A), 120 kVp (Protocol B), 100 kVp (Protocol C), and 80 kVp (Protocol D). To achieve similar noise, combined z-axis and xy-axes automatic tube current modulation was applied. Effective dose (ED) for the four tube voltages was assessed. Three plastic vials filled with different concentrations of iodinated solution were placed on the phantoms abdomen to obtain attenuation measurements. The signal-to-noise ratio (SNR) was calculated and a figure of merit (FOM) for each iodinated solution was computed as SNR(2)/ED. RESULTS The ED was kept similar for the four different tube voltages: (A) 5.4 mSv +/- 0.3, (B) 4.1 mSv +/- 0.6, (C) 3.9 mSv +/- 0.5, and (D) 4.2 mSv +/- 0.3 (P > .05). As the tube voltage decreased from 140 to 80 kVp, image noise was maintained (range, 13.8-14.9 HU) (P > .05). SNR increased as the tube voltage decreased, with an overall gain of 119% for the 80-kVp compared to the 140-kVp protocol (P < .05). The FOM results indicated that with a reduction of the tube voltage from 140 to 120, 100, and 80 kVp, at constant SNR, ED was reduced by a factor of 2.1, 3.3, and 5.1, respectively, (P < .001). CONCLUSIONS As tube voltage decreases, automatic tube current modulation for CT angiography yields either a significant increase in image quality at constant radiation dose or a significant decrease in radiation dose at a constant image quality.

Early First-Trimester Fetal Radiation Dose Estimation in 16-MDCT Without and With Automated Tube Current Modulation

OBJECTIVE The objective of our study was to correlate the estimated fetal absorbed radiation dose derived by directly measured uterine doses in the early first trimester and the volume CT dose index (CTDI(vol)) for 16-MDCT of the maternal chest, abdomen, and pelvis. MATERIALS AND METHODS Estimated absorbed fetal dose was measured using a metal oxide semiconductor field effect transistor (MOSFET) dosimeter that was placed in the uterus of an adult female anthropomorphic phantom. The phantom was scanned on a 16-MDCT scanner using three protocols. The scanning parameters for protocol A (trauma) were detector configuration, 16 x 0.625 mm; pitch, 1.75:1; rotation time, 0.5 second; 140 kVp; and 340 mA. The scanning parameters for protocol B (CT angiography) were detector configuration, 16 x 1.25 mm; pitch, 1.38:1; rotation time, 0.6 second; 140 kVp; and 300 mA. The scanning parameters for protocol C, which is the automated tube current modulation (ATCM) protocol previously used in the literature, were detector configuration, 16 x 1.25 mm; pitch, 0.938:1; rotation time, 0.5 second; 140 kVp; and 380 mA. The protocols were also modified for the ATCM mode; the CTDI(vol) was documented from the scanners console. Correlation between these data was tested with a goodness-of-fit model. RESULTS Absorbed fetal radiation dose in the early first trimester correlated with the CTDI(vol) via a linear regression equation. For a constant tube current and peak voltage of 140 kVp, fetal dose (mGy) = 1.665 x CTDI(vol) (mGy) - 7.059. For the ATCM mode and a constant kVp of 140, fetal dose (mGy) = 2.151 x CTDI(vol) (mGy) - 2.200. The goodness of fit (R(2)) for the equations is 0.99 and 0.91, respectively. CONCLUSION In both the manual and ATCM modes, absorbed fetal radiation dose can be estimated from the CTDI(vol) obtained at the time of scanning independent of pitch and tube current-time product (mAs).

Lifetime Attributable Risk of Cancer From Radiation Exposure During Parathyroid Imaging: Comparison of 4D CT and Parathyroid Scintigraphy.

OBJECTIVE The purpose of this study is to measure the organ doses and effective dose (ED) for parathyroid 4D CT and scintigraphy and to estimate the lifetime attributable risk of cancer incidence associated with imaging. MATERIALS AND METHODS Organ radiation doses for 4D CT and scintigraphy were measured on the basis of imaging with our institutions protocols. An anthropomorphic phantom with metal oxide semiconductor field effect transistor detectors was scanned to measure CT organ dose. Organ doses from the radionuclide were based on International Commission for Radiological Protection report 80. ED was calculated for 4D CT and scintigraphy and was used to estimate the lifetime attributable risk of cancer incidence for patients differing in age and sex with the approach established by the Biologic Effects of Ionizing Radiation VII report. A 55-year-old woman was selected as the standard patient according to the demographics of patients with primary hyperparathyroidism. RESULTS Organs receiving the highest radiation dose from 4D CT were the thyroid (150.6 mGy) and salivary glands (137.8 mGy). For scintigraphy, the highest organ doses were to the colon (41.5 mGy), gallbladder (39.8 mGy), and kidneys (32.3 mGy). The ED was 28 mSv for 4D CT, compared with 12 mSv for scintigraphy. In the exposed standard patient, the lifetime attributable risk for cancer incidence was 193 cancers/100,000 patients for 4D CT and 68 cancers/100,000 patients for scintigraphy. Given a baseline lifetime incidence of cancer of 46,300 cancers/100,000 patients, imaging results in an increase in lifetime incidence of cancer over baseline of 0.52% for 4D CT and 0.19% for scintigraphy. CONCLUSION The ED of 4D CT is more than double that of scintigraphy, but both studies cause negligible increases in lifetime risk of cancer. Clinicians should not allow concern for radiation-induced cancer to influence decisions regarding workup in older patients.

Radiation Dose Estimation for Prospective and Retrospective ECG-Gated Cardiac CT Angiography in Infants and Small Children Using a 320-MDCT Volume Scanner

OBJECTIVE The purpose of this study is to determine patient dose estimates for clinical pediatric cardiac-gated CT angiography (CTA) protocols on a 320-MDCT volume scanner. MATERIALS AND METHODS Organ doses were measured using 20 metal oxide semiconductor field effect transistor (MOSFET) dosimeters. Radiation dose was estimated for volumetrically acquired clinical pediatric prospectively and retrospectively ECG-gated cardiac CTA protocols in 5-year-old and 1-year-old anthropomorphic phantoms on a 320-MDCT scanner. Simulated heart rates of 60 beats/min (5-year-old phantom) and 120 beats/min (1- and 5-year-old phantoms) were used. Effective doses (EDs) were calculated using average measured organ doses and International Commission on Radiological Protection 103 tissue-weighting factors. Dose-length product (DLP) was recorded for each examination and was used to develop dose conversion factors for pediatric cardiac examinations acquired with volume scan mode. DLP was also used to estimate ED according to recently published dose conversion factors for pediatric helical chest examinations. Repeated measures and paired Student t test analyses were performed. RESULTS For the 5-year-old phantom, at 60 beats/min, EDs ranged from 1.2 mSv for a prospectively gated examination to 4.5 mSv for a retrospectively gated examination. For the 5-year-old phantom, at 120 beats/min, EDs ranged from 3.0 mSv for a prospectively gated examination to 4.9 mSv for a retrospectively gated examination. For the 1-year-old phantom, at 120 beats/min, EDs ranged from 2.7 mSv for a prospectively gated examination to 4.5 mSv for a retrospectively gated examination. CONCLUSION EDs for 320-MDCT volumetrically acquired ECG-gated pediatric cardiac CTA are lower than those published for conventional 16- and 64-MDCT scanners.