Paul Deak

Multisection CT Protocols: Sex- and Age-specific Conversion Factors Used to Determine Effective Dose from Dose-Length Product

PURPOSE To determine conversion factors for the new International Commission on Radiological Protection (ICRP) publication 103 recommendations for adult and pediatric patients and to compare the effective doses derived from Monte Carlo calculations with those derived from dose-length product (DLP) for different body regions and computed tomographic (CT) scanning protocols. MATERIALS AND METHODS Effective dose values for the Oak Ridge National Laboratory phantom series, including phantoms for newborns; 1-, 5-, and 10-year-old children; and adults were determined by using Monte Carlo methods for a 64-section multidetector CT scanner. For each phantom, five anatomic regions (head, neck, chest, abdomen, and pelvis) were considered. Monte Carlo simulations were performed for spiral scanning protocols with different voltages. Effective dose was computed by using ICRP publication 60 and publication 103 recommendations. The calculated effective doses were compared with those derived from the DLP by using previously published conversion factors. RESULTS In general, conversion factors determined on the basis of Monte Carlo calculations led to lower values for adults with both ICRP publications. Values up to 33% and 32% lower than previously published data were found for ICRP publication 60 and ICRP publication 103, respectively. For pediatric individuals, effective doses based on the Monte Carlo calculations were higher than those obtained from DLP and previously published conversion factors (eg, for chest CT scanning in 5-year-old children, an increase of about 76% would be expected). For children, a variation in conversion factors of up to 15% was observed when the tube voltage was varied. For adult individuals, no dependence on voltage was observed. CONCLUSION Conversion factors from DLP to effective dose should be specified separately for both sexes and should reflect the new ICRP recommendations. For pediatric patients, new conversion factors specific for the spectrum used should be established.

Application- and patient size-dependent optimization of x-ray spectra for CT

Although x-ray computed tomography (CT) has been in clinical use for over 3 decades, spectral optimization has not been a topic of great concern; high voltages around 120 kV have been in use since the beginning of CT. It is the purpose of this study to analyze, in a rigorous manner, the energies at which the patient dose necessary to provide a given contrast-to-noise ratio (CNR) for various diagnostic tasks can be minimized. The authors used cylindrical water phantoms and quasianthropomorphic phantoms of the thorax and the abdomen with inserts of 13 mm diameter mimicking soft tissue, bone, and iodine for simulations and measurements. To provide clearly defined contrasts, these inserts were made of solid water with a 1% difference in density (DD) to represent an energy-independent soft-tissue contrast of 10 Hounsfield units (HU), calcium hydroxyapatite (Ca) representing bone, and iodine (I) representing the typical contrast medium. To evaluate CT of the thorax, an adult thorax phantom (300 x 200 mm2) plus extension rings up to a size of 460 x 300 mm2 to mimic different patient cross sections were used. For CT of the abdomen, we used a phantom of 360 x 200 mm2 and an extension ring of 460 x 300 mm2. The CT scanner that the authors used was a SOMATOM Definition (Siemens Healthcare, Forchheim, Germany) at 80, 100, 120, and 140 kV. Further voltage settings of 60, 75, 90, and 105 kV were available in an experimental mode. The authors determined contrast for the density difference, calcium, and iodine, and noise and 3D dose distributions for the available voltages by measurements. Additional voltage values and monoenergetic sources were evaluated by simulations. The dose-weighted contrast-to-noise ratio (CNRD) was used as the parameter for optimization. Simulations and measurements were in good agreement with respect to absolute values and trends regarding the dependence on energy for the parameters investigated. For soft-tissue imaging, the standard settings of 120-140 kV were found as adequate choices with optimal values increasing for larger cross sections, e.g., for large abdomens voltages higher than 140 kV may be indicated. For bone and iodine imaging the optimum values were generally found at significantly lower voltages of typically below 80 kV. This offers a potential for dose reduction of up to 50%, but demands significantly higher power values in most cases. The authors concluded that voltage settings in CT should be varied more often than is common in practice today and should be chosen not only according to patient size but also according to the substance imaged in order to minimize dose while not compromising image quality. A reduction from 120 to 80 kV, for example, would yield a reduction in patient dose by more than half for coronary CT angiography. The use of lower voltages has to be recommended for contrast medium studies in cardiac and pediatric CT.

Validation of a Monte Carlo tool for patient-specific dose simulations in multi-slice computed tomography

Estimating the dose delivered to the patient in X-ray computed tomography (CT) examinations is not a trivial task. Monte Carlo (MC) methods appear to be the method of choice to assess the 3D dose distribution. The purpose of this work was to extend an existing MC-based tool to account for arbitrary scanners and scan protocols such as multi-slice CT (MSCT) scanners and to validate the tool in homogeneous and heterogeneous phantoms. The tool was validated by measurements on MSCT scanners for different scan protocols under known conditions. Quantitative CT Dose Index (CTDI) measurements were performed in cylindrical CTDI phantoms and in anthropomorphic thorax phantoms of various sizes; dose profiles were measured with thermoluminescent dosimeters (TLD) in the CTDI phantoms and compared with the computed dose profiles. The in-plane dose distributions were simulated and compared with TLD measurements in an Alderson-Rando phantom. The calculated dose values were generally within 10% of measurements for all phantoms and all investigated conditions. Three-dimensional dose distributions can be accurately calculated with the MC tool for arbitrary scanners and protocols including tube current modulation schemes. The use of the tool has meanwhile also been extended to further scanners and to flat-detector CT.

High-pitch spiral computed tomography: effect on image quality and radiation dose in pediatric chest computed tomography.

Objectives:Computed tomography (CT) is considered the method of choice in thoracic imaging for a variety of indications. Sedation is usually necessary to enable CT and to avoid deterioration of image quality because of patient movement in small children. We evaluated a new, subsecond high-pitch scan mode (HPM), which obviates the need of sedation and to hold the breath. Material and Methods:A total of 60 patients were included in this study. 30 patients (mean age, 14 ± 17 month; range, 0–55 month) were examined with a dual source CT system in an HPM. Scan parameters were as follows: pitch = 3.0, 128 × 0.6 mm slice acquisition, 0.28 seconds gantry rotation time, ref. mAs adapted to the body weight (50–100 mAs) at 80 kV. Images were reconstructed with a slice thickness of 0.75 mm. None of the children was sedated for the CT examination and no breathing instructions were given. Image quality was assessed focusing on motion artifacts and delineation of the vascular structures and lung parenchyma. Thirty patients (mean age, 15 ± 17 month; range, 0–55 month) were examined under sedation on 2 different CT systems (10-slice CT, n = 18; 64-slice CT, n = 13 patients) in conventional pitch mode (CPM). Dose values were calculated from the dose length product provided in the patient protocol/dose reports, Monte Carlo simulations were performed to assess dose distribution for CPM and HPM. Results:All scans were performed without complications. Image quality was superior with HPM, because of a significant reduction in motion artifacts, as compared to CPM with 10- and 64-slice CT. In the control group, artifacts were encountered at the level of the diaphragm (n = 30; 100%), the borders of the heart (n = 30; 100%), and the ribs (n = 20; 67%) and spine (n = 6; 20%), whereas motion artifacts were detected in the HPM-group only in 6 patients in the lung parenchyma next to the diaphragm or the heart (P < 0,001). Dose values were within the same range in the patient examinations (CPM, 1.9 ± 0.6 mSv; HPM, 1.9 ± 0.5 mSv; P = 0.95), although z-overscanning increased with the increase of detector width and pitch-value. Conclusion:High-pitch chest CT is a robust method to provide highest image quality making sedation or controlled ventilation for the examination of infants, small or uncooperative children unnecessary, whereas maintaining low radiation dose values.

Effects of Adaptive Section Collimation on Patient Radiation Dose in Multisection Spiral CT

PURPOSE To evaluate the potential effectiveness of adaptive collimation in reducing computed tomographic (CT) radiation dose owing to z-overscanning by using dose measurements and Monte Carlo (MC) dose simulations. MATERIALS AND METHODS Institutional review board approval was not necessary. Dose profiles were measured with thermoluminescent dosimeters in CT dose index phantoms and in an Alderson-Rando phantom without and with adaptive section collimation for spiral cardiac and chest CT protocols and were compared with the MC simulated dose profiles. Additional dose measurements were performed with an ionization chamber for scan ranges of 5-50 cm and pitch factors of 0.5-1.5. RESULTS The measured and simulated dose profiles agreed to within 3%. By using adaptive section collimation, a substantial dose reduction of up to 10% was achieved for cardiac and chest CT when measurements were performed free in air and of 7% on average when measurements were performed in phantoms. For scan ranges smaller than 12 cm, ionization chamber measurements and simulations indicated a dose reduction of up to 38%. CONCLUSION Adaptive section collimation allows substantial reduction of unnecessary exposure owing to z-overscanning in spiral CT. It can be combined in synergy with other means of dose reduction, such as spectral optimization and automatic exposure control.

High-pitch electrocardiogram-triggered computed tomography of the chest: initial results.

Objectives:Chest pain is one of the most frequent symptoms in the emergency department. A variety of different diseases, some of them acutely life threatening, can be the underlying cause. Electrocardiogram (ECG)-gated computed tomography angiography of the thorax has been proposed as a cost and time effective imaging technique for these patients. We describe a new high-pitch scan mode, which has been developed specifically for low-dose ECG-triggered computed tomography angiography using dual source computed tomography (CT). Material and Methods:Twenty-four patients were examined with this technique on a second generation dual source CT system. The scan mode uses a pitch of 3.2 to acquire a spiral CT data set of the complete thorax in less than 1 second with a temporal resolution of 75 ms (scan parameters: 128 × 0.6 mm collimation, 0.28 seconds gantry rotation time, 370 mAs at 100 kV [15 patients] and 320 mAs at 120 kV [9 patients], reconstructed slice thickness 0.6 mm, increment 0.4 mm). Data acquisition was prospectively triggered at 50% to 60% of the RR interval to cover the range over the heart in diastole. A triple phase contrast injection protocol (total volume: 80 mL) was used to optimize enhancement of the pulmonary and systemic arterial vessels. Image quality was evaluated using a 4-point scale (1 = absence of motion artifacts; 2 = slight motion artifacts, fully evaluable; 3 = motion artifacts, but evaluable; 4 = unevaluable) on a per-segment basis. Results:The patients had an average heart rate of 68 ± 15 bpm (range: 43–111 bpm) during data acquisition. Motion artifact free visualization of the aorta and pulmonary vessels was possible in each case, of 344 coronary artery segments, 242 (70%) had an image quality score of 1, 60 segments (17%) a score of 2, 28 segments (8%) a score of 3, and 14 segments (4%) were rated as “unevaluable.” In 17 patients (10 patients with a heart rate ≤60 bpm) all segments were evaluable. The average dose length product was 113 ± 11 mGy × cm per scan (mean effective dose 1.6 ± 0.2 mSv) at 100 kV and 229 ± 31 mGy × cm per scan (mean effective dose 3.2 ± 0.4 mSv) at 120 kV. Conclusion:Our initial results indicate that this high-pitch scan mode allows motion artifact free and accurate visualization of the thoracic vessels, and diagnostic image quality of the coronary arteries in patients with low and stable heart rates at a very low radiation exposure.

The effect of angular and longitudinal tube current modulations on the estimation of organ and effective doses in x-ray computed tomography

PURPOSE Tube current modulation (TCM) is one of the recent developments in multislice CT that has proven to reduce the patient radiation dose without affecting the image quality. Presently established methods and published coefficients for estimating organ doses from the dose measured free in air on the axis of rotation or in the CT dose index (CTDI) dosimetry phantoms do not take into account this relatively new development in CT scanner design and technology. Based on these organ dose coefficients effective dose estimates can be made. The estimates are not strictly valid for CT scanning protocols utilizing TCM. In this study, the authors investigated the need to take TCM into account when estimating organ and effective dose values. METHODS A whole-body adult anthropomorphic phantom (Alderson Rando) was scanned with a multislice CT scanner (Somatom Definition, Siemens, Forchheim, Germany) utilizing TCM (CareDose4D). Tube voltage was 120 kV, beam collimation 19.2 mm, and pitch 1. A voxelized patient model was used to define the tissues and organs in the phantom. Tube current values as a function of tube angle were obtained from the raw data for each individual tube rotation of the scan. These values were used together with the Monte Carlo dosimetry tool IMPACTMC (VAMP GmbH, Erlangen, Germany) to calculate organ dose values both with and without account of TCM. Angular and longitudinal modulations were investigated separately. Finally, corresponding effective dose conversion coefficients were determined for both cases according to the updated 2007 recommendations of the ICRP. RESULTS TCM amplitude was greatest in the shoulder and pelvic regions. Consequently, dose distributions and organ dose values for particular cross sections changed considerably when taking angular modulation into account. The effective dose conversion coefficients were up to 11% lower for a single rotation in the shoulder region and 17% lower in the pelvis when taking angular TCM into account. In the head, neck, thorax, and upper abdominal regions, conversion coefficients changed similarly by only 5% or less. Conversion coefficients for estimating effective doses for scans of complete regions, e.g., chest or abdomen, were approximately 8% lower when taking angular and longitudinal TCMs into account. CONCLUSIONS The authors conclude that for accurate organ and effective dose estimates in individual cross sections in the shoulder or pelvic regions, the angular tube current modulation should be taken into account. In general, using the average of the modulated tube current causes an overestimation of the effective dose.

Concepts for dose determination in flat-detector CT

Flat-detector computed tomography (FD-CT) scanners provide large irradiation fields of typically 200 mm in the cranio-caudal direction. In consequence, dose assessment according to the current definition of the computed tomography dose index CTDI(L=100 mm), where L is the integration length, would demand larger ionization chambers and phantoms which do not appear practical. We investigated the usefulness of the CTDI concept and practical dosimetry approaches for FD-CT by measurements and Monte Carlo (MC) simulations. An MC simulation tool (ImpactMC, VAMP GmbH, Erlangen, Germany) was used to assess the dose characteristics and was calibrated with measurements of air kerma. For validation purposes measurements were performed on an Axiom Artis C-arm system (Siemens Medical Solutions, Forchheim, Germany) equipped with a flat detector of 40 cm x 30 cm. The dose was assessed for 70 kV and 125 kV in cylindrical PMMA phantoms of 160 mm and 320 mm diameter with a varying phantom length from 150 to 900 mm. MC simulation results were compared to the values obtained with a calibrated ionization chambers of 100 mm and 250 mm length and to thermoluminesence (TLD) dose profiles. The MCs simulations were used to calculate the efficiency of the CTDI(L) determination with respect to the desired CTDI(infinity). Both the MC simulation results and the dose distributions obtained by MC simulation were in very good agreement with the CTDI measurements and with the reference TLD profiles, respectively, to within 5%. Standard CTDI phantoms which have a z-extent of 150 mm underestimate the dose at the center by up to 55%, whereas a z-extent of 600 mm appears to be sufficient for FD-CT; the baseline value of the respective profile was within 1% to the reference baseline. As expected, the measurements with ionization chambers of 100 mm and 250 mm offer a limited accuracy, whereas an increased integration length of 600 mm appeared to be necessary to approximate CTDI(infinity) in within 1%. MC simulations appear to offer a practical and accurate way of assessing conversion factors for arbitrary dosimetry setups using a standard pencil chamber to provide estimates of CTDI(infinity). This would eliminate the need for extra-long phantoms and ionization chambers or excessive amounts of TLDs.

X-Ray and X-Ray-CT

Since their discovery in 1895, X-rays have been widely used for imaging humans. Recently, they have also gained an importance in small animal imaging (SAI). Most techniques known from clinical medicine, including single- and dual-energy X-ray imaging, have been successfully ported to SAI and are the subject of this chapter. As trivial as it is, simple X-ray examinations may bring diagnostically valuable information in a variety of applications. Unenhanced radiography reveals skeletal anatomy, contrast-enhanced imaging allows improved visualization of the vasculature and strongly vascularized areas, and dedicated methods such as bone densitometry deliver quantitative information. In analogy to clinical X-ray imaging, we will separately describe standard two-dimensional (2D) projection imaging and the more advanced three-dimensional (3D) computed tomography (CT) imaging techniques. Also in analogy to clinical applications, CT is considered to be of significantly higher importance as it provides more information and possibilities than conventional 2D approaches. It will therefore be covered in much more detail.

TU-C-L100J-10: Combining Measurement and Monte Carlo Methods for Dose Assessment in Flat-Detector CT

Purpose: Dose assessment in flat‐detector CT (FD‐CT) combining measurements and Monte Carlo(MC) simulations. Material and Methods: FD‐CT scanners provide large irradiation fields of typically 100 mm to 250 mm in the longitudinal direction. In consequence dose assessment according to the current definition of the CTDI would demand larger ionization chambers and phantoms which are not practical. We propose a method which includes a measurement in air or in a phantom with an integrating dosimeter to assess the dose at that point and to combine it with MC simulations to assess 3D dose distributions and integral dose for arbitrary objects and geometries. For validation purposes measurements were performed on a C‐arm system (Siemens Medical Solutions, Forchheim, Germany) equipped with a flat‐detector of 40 × 30 cm2. Dose was assessed for various tube voltages in cylindrical PMMA phantoms of 16 cm and 32 cm diameter with a varying z‐extent from 15 to 60 cm. The MC results were compared to the values obtained with calibrated ionization chambers of 100 mm and 250 mm length and to TLD dose profiles along the complete z‐extent of the phantoms. Additionally a comparison to measurements of dose distribution in an anthropomorphic phantom was performed. Results: The MC simulation was in agreement with the reference TLD measurements to within better than 10%. Standard CTDI phantoms with a z‐extent of 15 cm underestimate the dose at the center by up to 20% whereas a z‐extent of 300 mm appears to be sufficient for FD‐CT. The 100 mm chamber underestimates the measured CTDI value by over 40%. The MC tool can be used to calibrate the measurements with the ionization chamber of 100 mm. Conclusion: The combination of measurement and validated MC tool appears to be a flexible solution to assess arbitrary dose characteristics.