Greta Toncheva

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.

Radiation Dose to the Female Breast from 16-MDCT Body Protocols

OBJECTIVE The objective of our study was to determine the radiation dose to the female breast from current 16-MDCT body examinations. MATERIALS AND METHODS Metal oxide semiconductor field effect transistor (MOSFET) detectors were placed in four quadrants of the breast of a female-configured anthropomorphic phantom to determine radiation dose to the breast. Imaging was performed on a 16-MDCT scanner (LightSpeed, GE Healthcare) using current clinical protocols designed to assess pulmonary embolus (PE) (140 kVp, 380 mA, 0.8-sec rotation, 16 x 1.25 mm collimation), appendicitis (140 kVp, 340 mA, 0.5-sec rotation, 16 x 0.625 mm collimation), and renal calculus (140 kVp, 160 mA, 0.5-sec rotation, 16 x 0.625 mm collimation). RESULTS Radiation dose to the breast ranged from 4 to 6 cGy for the PE protocol and up to 1-2 cGy in the inferior aspect of the right breast and lateral aspect of the left breast for the appendicitis protocol. The renal calculus protocol yielded less than 150 microGy absorbed breast dose. CONCLUSION Current clinical chest and abdomen protocols result in vairable radiation doses to the breast. The magnitude of exposure may have implications for imaging strategies.

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.

Effect of patient size on radiation dose for abdominal MDCT with automatic tube current modulation: phantom study

OBJECTIVE The purpose of this study was to evaluate in a phantom study the effect of patient size on radiation dose for abdominal MDCT with automatic tube current modulation. MATERIALS AND METHODS One or two 4-cm-thick circumferential layers of fat-equivalent material were added to the abdomen of an anthropomorphic phantom to simulate patients of three sizes: small (cross-sectional dimensions, 18 x 22 cm), average size (26 x 30 cm), and oversize (34 x 38 cm). Imaging was performed with a 64-MDCT scanner with combined z-axis and xy-axis tube current modulation according to two protocols: protocol A had a noise index of 12.5 H, and protocol B, 15.0 H. Radiation doses to three abdominal organs and the skin were assessed. Image noise also was measured. RESULTS Despite increasing patient size, the image noise measured was similar for protocol A (range, 11.7-12.2 H) and protocol B (range, 13.9-14.8 H) (p > 0.05). With the two protocols, in comparison with the dose of the small patient, the abdominal organ doses of the average-sized patient and the oversized patient increased 161.5-190.6%and 426.9-528.1%, respectively (p < 0.001). The skin dose increased as much as 268.6% for the average-sized patient and 816.3% for the oversized patient compared with the small patient (p < 0.001). CONCLUSION Oversized patients undergoing abdominal MDCT with tube current modulation receive significantly higher doses than do small patients. The noise index needs to be adjusted to the body habitus to ensure dose efficiency.

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.

Patient-specific radiation dose and cancer risk estimation in CT: Part I. Development and validation of a Monte Carlo program

PURPOSE Radiation-dose awareness and optimization in CT can greatly benefit from a dose-reporting system that provides dose and risk estimates specific to each patient and each CT examination. As the first step toward patient-specific dose and risk estimation, this article aimed to develop a method for accurately assessing radiation dose from CT examinations. METHODS A Monte Carlo program was developed to model a CT system (LightSpeed VCT, GE Healthcare). The geometry of the system, the energy spectra of the x-ray source, the three-dimensional geometry of the bowtie filters, and the trajectories of source motions during axial and helical scans were explicitly modeled. To validate the accuracy of the program, a cylindrical phantom was built to enable dose measurements at seven different radial distances from its central axis. Simulated radial dose distributions in the cylindrical phantom were validated against ion chamber measurements for single axial scans at all combinations of tube potential and bowtie filter settings. The accuracy of the program was further validated using two anthropomorphic phantoms (a pediatric one-year-old phantom and an adult female phantom). Computer models of the two phantoms were created based on their CT data and were voxelized for input into the Monte Carlo program. Simulated dose at various organ locations was compared against measurements made with thermoluminescent dosimetry chips for both single axial and helical scans. RESULTS For the cylindrical phantom, simulations differed from measurements by -4.8% to 2.2%. For the two anthropomorphic phantoms, the discrepancies between simulations and measurements ranged between (-8.1%, 8.1%) and (-17.2%, 13.0%) for the single axial scans and the helical scans, respectively. CONCLUSIONS The authors developed an accurate Monte Carlo program for assessing radiation dose from CT examinations. When combined with computer models of actual patients, the program can provide accurate dose estimates for specific patients.

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.

Dual energy versus single energy MDCT: measurement of radiation dose using adult abdominal imaging protocols

RATIONALE AND OBJECTIVES The aim of this study was to measure the radiation dose of dual-energy and single-energy multidetector computed tomographic (CT) imaging using adult liver, renal, and aortic imaging protocols. MATERIALS AND METHODS Dual-energy CT (DECT) imaging was performed on a conventional 64-detector CT scanner using a software upgrade (Volume Dual Energy) at tube voltages of 140 and 80 kVp (with tube currents of 385 and 675 mA, respectively), with a 0.8-second gantry revolution time in axial mode. Parameters for single-energy CT (SECT) imaging were a tube voltage of 140 kVp, a tube current of 385 mA, a 0.5-second gantry revolution time, helical mode, and pitch of 1.375:1. The volume CT dose index (CTDI(vol)) value displayed on the console for each scan was recorded. Organ doses were measured using metal oxide semiconductor field-effect transistor technology. Effective dose was calculated as the sum of 20 organ doses multiplied by a weighting factor found in International Commission on Radiological Protection Publication 60. Radiation dose saving with virtual noncontrast imaging reconstruction was also determined. RESULTS The CTDI(vol) values were 49.4 mGy for DECT imaging and 16.2 mGy for SECT imaging. Effective dose ranged from 22.5 to 36.4 mSv for DECT imaging and from 9.4 to 13.8 mSv for SECT imaging. Virtual noncontrast imaging reconstruction reduced the total effective dose of multiphase DECT imaging by 19% to 28%. CONCLUSION Using the current Volume Dual Energy software, radiation doses with DECT imaging were higher than those with SECT imaging. Substantial radiation dose savings are possible with DECT imaging if virtual noncontrast imaging reconstruction replaces precontrast imaging.