Monte Carlo simulations of adult and pediatric computed tomography exams: validation studies of organ doses with physical phantoms

3D printing of realistic body phantoms: Comparison of measured and simulated organ doses on the example of a CT scan on a pregnant woman

BACKGROUND

Medical examinations or treatment of pregnant women using ionizing radiation are sometimes unavoidable. In such cases, the risk of harm to the embryo and fetus after exposure to ionizing radiation must be carefully estimated. However, no commercially available anthropomorphic body phantoms of pregnant women are available for dose measurements. A promising possibility for the production of body phantoms for patient groups that are not adequately represented by the phantoms of reference persons is 3D printing. However, this approach is still in the evaluation phase.

PURPOSE

To print the abdomen of a woman in the late stage of pregnancy and compare the dose distribution measured using thermoluminescence dosimeters (TLDs) in the printed phantom for two different computed tomography (CT) protocols with the corresponding results of Monte Carlo simulations on voxel models of the pregnant woman.

MATERIALS AND METHODS

The physical phantom was produced through multi-material extrusion printing using different print materials identified in previous studies to simulate homogeneous soft tissues and the mean compositions of maternal and fetal bones. The 3D printed abdomen was combined with a conventionally produced anthropomorphic female phantom to obtain a whole-body phantom of a pregnant woman. Dose values resulting from two different CT scans acquired at tube voltages of 80 and 120 kV were measured using TLDs positioned in the physical phantom and cross-validated with the results of Monte Carlo simulations performed for two different voxel models. The first was a voxelized model of the produced phantom itself and the second a realistic digital model of a pregnant woman. Representative CT values of the materials used in the printed phantom were determined from the acquired CT images.

RESULTS

The CT values of maternal and fetal tissue structures in the phantom are comparable to CT values of real human tissues. The difference between most organ doses measured in the 3D printed phantom and simulated in the voxel models was below 20% and equivalent within the measurement uncertainties. Only the dose to the fetal head was up to 50% higher and not equivalent for the realistic model and the 80 kV-protocol. As expected, the agreement was better for the voxelized than for the realistic model. For both models a slight energy dependence was observed, with larger deviations for the 80-kV protocol especially for organs located in the pelvic region.

CONCLUSION

Individualized physical body phantoms, such as that of a pregnant woman, can be produced using 3D printing. The good agreement between measured and simulated doses to the fetus cross-validates both dosimetric methods. Therefore, this study demonstrates the suitability of 3D printing phantoms for patients not adequately represented by commercially available body phantoms of reference persons.

Digital phantom versus patient-specific radiation dosimetry in adult routine thorax CT examinations

PURPOSE

The aim of this study was to compare the organ doses assessed through a digital phantom-based and a patient specific-based dosimetric tool in adult routine thorax computed tomography (CT) examinations with reference to physical dose measurements performed in anthropomorphic phantoms.

METHODS

Two Monte Carlo based dose calculation tools were used to assess organ doses in routine adult thorax CT examinations. These were a digital phantom-based dosimetry tool (NCICT, National Cancer Institute, USA) and a patient-specific individualized dosimetry tool (ImpactMC, CT Imaging GmbH, Germany). Digital phantoms and patients were classified in four groups according to their water equivalent diameter (Dw). Normalized to volume computed tomography dose index (CTDIvol), organ dose was assessed for lungs, esophagus, heart, breast, active bone marrow, and skin. Organ doses were compared to measurements performed using thermoluminescent detectors (TLDs) in two physical anthropomorphic phantoms that simulate the average adult individual as a male (Alderson Research Labs, USA) and as a female (ATOM Phantoms, USA).

RESULTS

The average percent difference of NCICT to TLD and ImpactMC to TLD dose measurements across all organs in both sexes was 13% and 6%, respectively. The average ± 1 standard deviation in dose values across all organs with NCICT, ImpactMC, and TLDs was ± 0.06 (mGy/mGy), ± 0.19 (mGy/mGy), and ± 0.13 (mGy/mGy), respectively. Organ doses decreased with increasing Dw in both NCICT and ImpactMC.

CONCLUSION

Organ doses estimated with ImpactMC were in closer agreement to TLDs compared to NCICT. This may be attributed to the inherent property of ImpactMC methodology to generate phantoms that resemble the realistic anatomy of the examined patient as opposed to NCICT methodology that incorporates an anatomical discrepancy between phantoms and patients.

Dose length product to effective dose coefficients in adults

OBJECTIVES

The most accurate method for estimating patient effective dose (a principal metric for tracking patient radiation exposure) from computed tomography (CT) requires time-intensive Monte Carlo simulation. A simpler method multiplies a scalar coefficient by the widely available scanner-reported dose length product (DLP) to estimate effective dose. We developed new adult effective dose coefficients using actual patient scans and assessed their agreement with Monte Carlo simulation.

METHODS

A multicenter sample of 216,906 adult CT scans was prospectively assembled in 2015-2020 from the University of California San Francisco International CT Dose Registry and the University of Florida library of computational phantoms. We generated effective dose coefficients for eight body regions, stratified by patient sex, diameter, and scanner manufacturer. We applied the new coefficients to DLPs to calculate effective doses and assess their correlations with Monte Carlo radiation transport-generated effective dose.

RESULTS

Effective dose coefficients varied by body region and decreased in magnitude with increasing patient diameter. Coefficients were approximately twofold higher for torso scans in smallest compared with largest diameter categories. For example, abdomen and pelvis coefficients decreased from 0.027 to 0.013 mSv/mGy-cm between the 16-20 cm and 41+ cm categories. There were modest but consistent differences by sex and manufacturer. Diameter-based coefficients used to estimate effective dose produced strong correlations with the reference standard (Pearson correlations 0.77-0.86). The reported conversion coefficients differ from previous studies, particularly in neck CT.

CONCLUSIONS

New effective dose coefficients derived from empirical clinical scans can be used to easily estimate effective dose using scanner-reported DLP.

CLINICAL RELEVANCE STATEMENT

Scalar coefficients multiplied by DLP offer a simple approximation to effective dose, a key radiation dose metric. New effective dose coefficients from this study strongly correlate with gold standard, Monte Carlo-generated effective dose, and differ somewhat from previous studies.

KEY POINTS

• Previous effective dose coefficients were derived from theoretical models rather than real patient data. • The new coefficients (from a large registry/phantom library) differ from previous studies. • The new coefficients offer reasonably reliable values for estimating effective dose.

Dose length product to effective dose coefficients in children

BACKGROUND

The most accurate method for estimating effective dose (the most widely understood metric for tracking patient radiation exposure) from computed tomography (CT) requires time-intensive Monte Carlo simulation. A simpler method multiplies a scalar coefficient by the widely available scanner-reported dose length product (DLP) to estimate effective dose.

OBJECTIVE

Develop pediatric effective dose coefficients and assess their agreement with Monte Carlo simulation.

MATERIALS AND METHODS

Multicenter, population-based sample of 128,397 pediatric diagnostic CT scans prospectively assembled in 2015-2020 from the University of California San Francisco International CT Dose Registry and the University of Florida library of highly realistic hybrid computational phantoms. We generated effective dose coefficients for seven body regions, stratified by patient age, diameter, and scanner manufacturer. We applied the new coefficients to DLPs to calculate effective doses and assessed their correlations with Monte Carlo radiation transport-generated effective doses.

RESULTS

The reported effective dose coefficients, generally higher than previous studies, varied by body region and decreased in magnitude with increasing age. Coefficients were approximately 4 to 13-fold higher (across body regions) for patients  <1 year old compared with patients 15-21 years old. For example, head CT (54% of scans) dose coefficients decreased from 0.039 to 0.003 mSv/mGy-cm in patients  <1 year old vs. 15-21 years old. There were minimal differences by manufacturer. Using age-based conversion coefficients to estimate effective dose produced moderate to strong correlations with Monte Carlo results (Pearson correlations 0.52-0.80 across body regions).

CONCLUSIONS

New pediatric effective dose coefficients update existing literature and can be used to easily estimate effective dose using scanner-reported DLP.

Real-time estimation of patient-specific dose distributions for medical CT using the deep dose estimation

PURPOSE

With the rising number of computed tomography (CT) examinations and the trend toward personalized medicine, patient-specific dose estimates are becoming more and more important in CT imaging. However, current approaches are often too slow or too inaccurate to be applied routinely. Therefore, we propose the so-called deep dose estimation (DDE) to provide highly accurate patient dose distributions in real time METHODS: To combine accuracy and computational performance, the DDE algorithm uses a deep convolutional neural network to predict patient dose distributions. To do so, a U-net like architecture is trained to reproduce Monte Carlo simulations from a two-channel input consisting of a CT reconstruction and a first-order dose estimate. Here, the corresponding training data were generated using CT simulations based on 45 whole-body patient scans. For each patient, simulations were performed for different anatomies (pelvis, abdomen, thorax, head), different tube voltages (80 kV, 100 kV, 120 kV), different scan trajectories (circle, spiral), and with and without bowtie filtration and tube current modulation. Similar simulations were performed using a second set of eight whole-body CT scans from the Visual Concept Extraction Challenge in Radiology (Visceral) project to generate testing data. Finally, the DDE algorithm was evaluated with respect to the generalization to different scan parameters and the accuracy of organ dose and effective dose estimates based on an external organ segmentation.

RESULTS

DDE dose distributions were quantified in terms of the mean absolute percentage error (MAPE) and a gamma analysis with respect to the ground truth Monte Carlo simulation. Both measures indicate that DDE generalizes well to different scan parameters and different anatomical regions with a maximum MAPE of 6.3% and a minimum gamma passing rate of 91%. Evaluating the organ dose values for all organs listed in the International Commission on Radiological Protection (ICRP) recommendation, shows an average error of 3.1% and maximum error of 7.2% (bone surface).

CONCLUSIONS

The DDE algorithm provides an efficient approach to determine highly accurate dose distributions. Being able to process a whole-body CT scan in about 1.5 s, it provides a valuable alternative to Monte Carlo simulations on a graphics processing unit (GPU). Here, the main advantage of DDE is that it can be used on top of any existing Monte Carlo code such that real-time performance can be achieved without major adjustments. Thus, DDE opens up new options not only for dosimetry but also for scan and protocol optimization.

Organ dose conversion coefficients in CT scans for Korean adult males and females

Dose monitoring in CT patients requires accurate dose estimation but most of the CT dose calculation tools are based on Caucasian computational phantoms. We established a library of organ dose conversion coefficients for Korean adults by using four Korean adult male and two female voxel phantoms combined with Monte Carlo simulation techniques. We calculated organ dose conversion coefficients for head, chest, abdomen and pelvis, and chest-abdomen-pelvis scans, and compared the results with the existing data calculated from Caucasian phantoms. We derived representative organ doses for Korean adults using Korean CT dose surveys combined with the dose conversion coefficients. The organ dose conversion coefficients from the Korean adult phantoms were slightly greater than those of the ICRP reference phantoms: up to 13% for the brain doses in head scans and up to 10% for the dose to the small intestine wall in abdominal scans. We derived Korean representative doses to major organs in head, chest, and AP scans using mean CTDIvol values extracted from the Korean nationwide surveys conducted in 2008 and 2017. The Korean-specific organ dose conversion coefficients should be useful to readily estimate organ absorbed doses for Korean adult male and female patients undergoing CT scans.

COMPARISON OF ORGAN ABSORBED DOSES IN WHOLE-BODY COMPUTED TOMOGRAPHY SCANS OF PAEDIATRIC AND ADULT PATIENT MODELS ESTIMATED BY DIFFERENT METHODS

This study aimed to identify the uncertainty in estimations of organ absorbed dose using dedicated software by comparing with corresponding doses measured in physical phantoms. The comparison was performed for whole-body computed tomography (CT) obtained as part of positron emission tomography. Whole-body CT scans provide an advantage in terms of comparison because all organs are in the primary beam of the irradiated area. Organ doses estimated by the different software programs (CT-Expo, VirtualDose and NCICT) were compared by thermoluminescent detector measurements in anthropomorphic phantoms in 1-y-old, 5-y-old and adult patients. Differences were within ~15% in 12 major organs. However, differences of ~30% were observed in organs located at slightly different positions in the computational models compared to the physical phantoms. All investigated programs were deemed suitable for accurate estimation of organ absorbed dose.

Radiation dose from computed tomography scans for Korean pediatric and adult patients

Background

In recent events of the Coronavirus Disease 2019 (COVID-19) pandemic, CT scans are being globally used as a complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. It will be important to be aware of major organ dose levels, which are more relevant quantity to derive potential long-term adverse effect, for Korean pediatric and adult patients undergoing CT for COVID-19.

Materials and Methods

We calculated organ dose conversion coefficients for Korean pediatric and adult CT patients directly from Korean pediatric and adult computational phantoms combined with Monte Carlo radiation transport techniques. We then estimated major organ doses delivered to the Korean child and adult patients undergoing CT for COVID-19 combining the dose conversion coefficients and the international survey data. We also compared our Korean dose conversion coefficients with those from Caucasian reference pediatric and adult phantoms.

Results and discussion

Based on the dose conversion coefficients we established in this study and the international survey data of COVID-19-related CT scans, we found that Korean 7-year-old child and adult males may receive about 4 - 32 mGy and 3 - 21 mGy of lung dose, respectively. We learned that the lung dose conversion coefficient for the Korean child phantom was up to 1.5-fold greater than that for the Korean adult phantom. We also found no substantial difference in dose conversion coefficients between Korean and Caucasian phantoms.

Conclusion

We estimated radiation dose delivered to the Korean child and adult phantoms undergoing COVID-19-related CT examinations. The dose conversion coefficients derived for different CT scan types can be also used universally for other dosimetry studies concerning Korean CT scans. We also confirmed that the Caucasian-based CT organ dose calculation tools may be used for the Korean population with reasonable accuracy.

Conversion factors to derive organ doses for canine subjects undergoing CT examinations

Although a large number of CT scans are being conducted on small animals, especially in Western countries, little is known of absorbed dose from veterinary CT scans. In the current retrospective analytical study, we estimated the radiation dose delivered to dogs from CT scans with various scan protocols and compared the results with those of human patients. We adopted a total of three computerized canine models with three sizes combined with a computer simulation model of a CT scanner. The eyes of the dog model received the greatest dose, 1.10 mGy/mGy, in the head scan, followed by a brain dose of 0.85 mGy/mGy. In the chest, abdomen-pelvis (AP), chest-abdomen-pelvis, and head-chest-abdomen-pelvis scans, the heart wall (0.93 mGy/mGy), ovaries (0.99 mGy/mGy), lungs (1.12 mGy/mGy), and thyroid (1.23 mGy/mGy) received the greatest organ doses, respectively. The smallest dog model received up to 1.4-fold greater organ doses than the largest dog in both the chest and AP scans. Overall, the medium-size canine model received organ doses comparable to those of the 1-year-old child model in the head scan, the 5-year-old child in chest scan, and the 10-year-old child in AP scan. The organ dose conversion factors derived from this study should help evaluate absorbed dose for canine patients undergoing CT exams.

Projected lifetime cancer risk from cone-beam computed tomography for orthodontic treatment

Objective

To estimate the projected cancer risk attributable to diagnostic cone-beam computed tomography (CBCT) performed under different exposure settings for orthodontic purposes in children and adults.

Methods

We collected a list of CBCT machines and their specifications from 38 orthodontists. Organ doses were estimated using median and maximum exposure settings of 105 kVp/156.8 mAs and 130 kVp/200 mAs, respectively. The projected cancer risk attributable to CBCT procedures performed 1-3 times within 2 years was calculated for children (aged 5 and 10 years) and adult (aged 20, 30, and 40 years) male and female patients.

Results

For maximum exposure settings, the mean lifetime fractional ratio (LFR) was 14.28% for children and 0.91% for adults; this indicated that the risk to children was 16 times the risk to adults. For median exposure settings, the mean LFR was 5.25% and 0.58% for children and adults, respectively. The risk of cancer decreased with increasing age. For both median and maximum exposure settings, females showed a higher risk of cancer than did males in all age groups. Cancer risk increased with an increase in the frequency of CBCT procedures within a given period.

Conclusions

The projected dental CBCT-associated cancer risk spans over a wide range depending on the machine parameters and image acquisition settings. Children and female patients are at a higher risk of developing cancer associated with diagnostic CBCT. Therefore, the use of diagnostic CBCT should be justified, and protective measures should be taken to minimize the harmful biological effects of radiation.

Reference dataset for benchmarking fetal doses derived from Monte Carlo simulations of CT exams

PURPOSE

Task Group Report 195 of the American Association of Physicists in Medicine contains reference datasets for the direct comparison of results among different Monte Carlo (MC) simulation tools for various aspects of imaging research that employs ionizing radiation. While useful for comparing and validating MC codes, that effort did not provide the information needed to compare absolute dose estimates from CT exams. Therefore, the purpose of this work is to extend those efforts by providing a reference dataset for benchmarking fetal dose derived from MC simulations of clinical CT exams.

ACQUISITION AND VALIDATION METHODS

The reference dataset contains the four necessary elements for validating MC engines for CT dosimetry: (a) physical characteristics of the CT scanner, (b) patient information, (c) exam specifications, and (d) fetal dose results from previously validated and published MC simulations methods in tabular form. Scanner characteristics include non-proprietary descriptions of equivalent source cumulative distribution function (CDF) spectra and bowtie filtration profiles, as well as scanner geometry information. Additionally, for the MCNPX MC engine, normalization factors are provided to convert raw simulation results to absolute dose in mGy. The patient information is based on a set of publicly available fetal dose models and includes de-identified image data; voxelized MC input files with fetus, uterus, and gestational sac identified; and patient size metrics in the form of water equivalent diameter (D_w ) z-axis distributions from a simulated topogram (D_w,topo ) and from the image data (D_w,image ). Exam characteristics include CT scan start and stop angles and table and patient locations, helical pitch, nominal collimation and measured beam width, and gantry rotation time for each simulation. For simulations involving estimating doses from exams using tube current modulation (TCM), a realistic TCM scheme is presented that is estimated based upon a validated method. (d) Absolute and CTDI_vol -normalized fetal dose results for both TCM and FTC simulations are given for each patient model under each scan scenario.

DATA FORMAT AND USAGE NOTES

Equivalent source CDFs and bowtie filtration profiles are available in text files. Image data are available in DICOM format. Voxelized models are represented by a header followed by a list of integers in a text file representing a three-dimensional model of the patient. Size distribution metrics are also given in text files. Results of absolute and normalized fetal dose with associated MC error estimates are presented in tabular form in an Excel spreadsheet. All data are stored on Zenodo and are publicly accessible using the following link: https://zenodo.org/record/3959512.

POTENTIAL APPLICATIONS

Similar to the work of AAPM Report 195, this work provides a set of reference data for benchmarking fetal dose estimates from clinical CT exams. This provides researchers with an opportunity to compare MC simulation results to a set of published reference data as part of their efforts to validate absolute and normalized fetal dose estimates. This could also be used as a basis for comparison to other non-MC approaches, such as deterministic approaches, or to commercial packages that provide estimates of fetal doses from clinical CT exams.

TO USE OR NOT USE PATIENT SHIELDING ON PREGNANT WOMEN UNDERGOING CT PULMONARY ANGIOGRAPHY: A PHANTOM STUDY

Pregnancy increases the risk of pulmonary embolism. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. CT generates ionising radiation, and thus, abdominal shielding may be used. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. The absorbed dose to the fetus was measured using thermoluminescent dosemeters. Estimated effective doses to the pregnant patient were based on the dose-length products. Shielding increased both the effective dose to the patient by 47% and the mean absorbed dose to the fetus (0.10 vs. 0.12 mGy; p < 0.001) compared with unshielded standard CTPA, as it affected the automatic exposure control. Shielded short CTPA marginally lowered only the mean fetal absorbed dose (0.03 vs. 0.02 mGy; p = 0.018). Shortening the scan reduced the fetal absorbed dose most effectively by 70% (0.10 vs. 0.03 mGy; p = 0.006), compared with the standard unshielded scan. Shielding modestly reduces fetal radiation dose but may compromise automatic exposure control, possibly increasing the maternal and fetal radiation dose. Shortening the scan is beneficial, assuming anatomical coverage is secured.

AUTOMATIC BRAIN DOSE ESTIMATION IN COMPUTED TOMOGRAPHY USING PATIENT DICOM IMAGES

This study aims to develop an Automatic Brain Dose Estimation (ABDE) methodology for head computed tomography examinations. The ABDE is to be applied first to an anthropomorphic Alderson phantom to obtain a Correction factor (Cf) between the ABDE and the direct absorbed brain dose using dosemeters positioned within the anthropomorphic phantom. Then, in order to estimate the correct brain dose for patient, the Cf was multiplied by the mean ABDE values for each patient. Results were compared to those registered with a mathematical simulation phantom using CT-Expo V 2.4 software. Results showed no significant difference between the correct ABDE values and the CT-Expo values with a mean percent difference of 2.54 ± 0.01%. In conclusion, ABDE yields a correct estimation of brain dose, taking into account the size and attenuation of the irradiated region. Thus, it is clinically recommended for accurate patient brain dose assessment.

Adult patient-specific CT organ dose estimations using automated segmentations and Monte Carlo simulations

We aimed to determine feasibility in calculating patient-specific organ doses for abdominal computed tomography (CT) exams using an automated segmentation technique dedicated to abdominal organs combined with Monte Carlo simulation of a clinical CT scanner. We conducted the automated segmentation of five major abdominal organs (left and right kidneys, pancreas, spleen, and liver) for ten adult patients and calculated organ-specific doses for each patient. We observed significant variability (Coefficient of Variation up to 32%) in organ mass across the ten patients, which was up to two-fold greater or smaller than the reference organ mass for the ICRP reference adult male and female. Comparison of patient-specific organ dose per CTDI_vol with those from the ICRP reference phantoms confirmed that reference phantom-based dose reporting programs cannot capture inter-patient dose variability, and dosimetric errors can go up to nearly 40%. We demonstrated an automated method for patient-specific organ dose calculations, which took about 45 min per patient. When the automatic segmentation method is extended to more organs and faster Monte Carlo calculation technique is employed, our method should be useful for patient-specific dose monitoring at the organ level and for epidemiological investigations of health risks in CT patients.

Design of a Monte Carlo model based on dual-source computed tomography (DSCT) scanners for dose and image quality assessment using the Monte Carlo N-Particle (MCNP5) code

The purpose of this work was to develop and validate a Monte Carlo model for a Dual Source Computed Tomography (DSCT) scanner based on the Monte Carlo N-particle radiation transport computer code (MCNP5). The geometry of the Siemens Somatom Definition CT scanner was modeled, taking into consideration the x-ray spectrum, bowtie filter, collimator, and detector system. The accuracy of the simulation from the dosimetry point of view was tested by calculating the Computed Tomography Dose Index (CTDI) values. Furthermore, typical quality assurance phantoms were modeled in order to assess the imaging aspects of the simulation. Simulated projection data were processed, using the MATLAB software, in order to reconstruct slices, using a Filtered Back Projection algorithm. CTDI, image noise, CT-number linearity, spatial and low contrast resolution were calculated using the simulated test phantoms. The results were compared using several published values including IMPACT, NIST and actual measurements. Bowtie filter shapes are in agreement with those theoretically expected. Results show that low contrast and spatial resolution are comparable with expected ones, taking into consideration the relatively limited number of events used for the simulation. The differences between simulated and nominal CT-number values were small. The present attempt to simulate a DSCT scanner could provide a powerful tool for dose assessment and support the training of clinical scientists in the imaging performance characteristics of Computed Tomography scanners.

Patient organ and effective dose estimation in CT: comparison of four software applications

Background

Radiation dose in computed tomography (CT) has become a topic of high interest due to the increasing numbers of CT examinations performed worldwide. Hence, dose tracking and organ dose calculation software are increasingly used. We evaluated the organ dose variability associated with the use of different software applications or calculation methods.

Methods

We tested four commercial software applications on CT protocols actually in use in our hospital: CT-Expo, NCICT, NCICTX, and Virtual Dose. We compared dose coefficients, estimated organ doses and effective doses obtained by the four software applications by varying exposure parameters. Our results were also compared with estimates reported by the software authors.

Results

All four software applications showed dependence on tube voltage and volume CT dose index, while only CT-Expo was also dependent on other exposure parameters, in particular scanner model and pitch caused a variability till 50%. We found a disagreement between our results and those reported by the software authors (up to 600%), mainly due to a different extent of examined body regions. The relative range of the comparison of the four software applications was within 35% for most organs inside the scan region, but increased over the 100% for organs partially irradiated and outside the scan region. For effective doses, this variability was less evident (ranging from 9 to 36%).

Conclusions

The two main sources of organ dose variability were the software application used and the scan region set. Dose estimate must be related to the process used for its calculation.

Assessment of uncertainties associated with Monte Carlo-based personalized dosimetry in clinical CT examinations

The clinical value of x-ray computed tomography (CT) has skyrocketed in the last decade while at the same time being the main source of medical exposure to the population. Concerns regarding the potential health hazards associated with the use of ionizing radiation were raised and an appropriate estimation of absorbed dose to patients is highly desired. In this work, we aim to validate our developed Monte Carlo CT simulator using in-phantom dose measurements and further assess the impact of personalized scan-related parameters on dosimetric calculations. We developed a Monte Carlo-based CT simulator for personalized organ level dose calculations, in which the CT source model, patient-specific computational model and personalized scanning protocol were integrated. The CT simulator was benchmarked using an ionization chamber and standard CT Dose Index phantom while the dosimetry methodology was validated through experimental measurements using thermoluminescent dosimeters (TLDs) embedded within an anthropomorphic phantom. Patient-specific scan protocols extracted from CT raw data and DICOM image metadata, respectively, were fed as input into the CT simulator to calculate individualized dose profiles. Thereby, the dosimetric uncertainties associated with using different protocol-related parameters were investigated. The absolute absorbed dose difference between measurements and simulations using the ionization chamber was less than 3%. In the case of the anthropomorphic phantom, the absolute absorbed dose difference between simulations and TLD measurements ranged from  -8.3% to 22%, with a mean absolute difference of 14% while the uncertainties of protocol-related input parameters introduced an extra absolute error of 15% to the simulated results compared with TLD measurements. The developed methodology can be employed for accurate estimation of organ level dose from clinical CT examinations. The validated methodology can be further developed to produce an accurate MC simulation model with a reduced computational burden.

Distribution of radiation exposure in patients with partially stable and unstable pelvic ring fractures: first-time use of highly accurate assessment by Monte Carlo calculations

PURPOSE

Radiological examinations including X-ray and CT play a critical role in the assessment and treatment of trauma patients. The ionizing radiation used is known to be carcinogenic. However, little is known about the total radiation exposure in trauma patients. The objective of this study was to accurately estimate radiation exposure of patients with severe pelvic ring fractures.

METHODS

In this retrospective dynamic cohort study, adult patients with partially stable and unstable pelvic ring fractures were included. For each patient, data concerning demography and injury characteristics were collected. Subsequently, the total effective radiation dose due to all trauma-related X-rays and CT scans during initial assessment, treatment and follow-up was calculated using Monte Carlo software.

RESULTS

A total of 114 patients were included. The median total effective dose was 49.7 millisievert (mSv). 57 patients (50.0%) received more than 50 mSv and 13 patients (11.4%) received more than 100 mSv. 62.4% of the total effective dose was received within the 24 h after admission. The median total effective dose for survivors (n = 95) was 52.0 mSv. Polytrauma patients received a significantly higher total effective dose than non-polytrauma patients.

CONCLUSIONS

This study showed that a substantial number of patients with partially stable and unstable pelvic ring fractures have an increased cancer risk due to trauma-related medical imaging. Physicians should be aware of the amount of radiation their patients are exposed to, and minimize imaging related increase of cancer risks during initial assessment, treatment and follow-up.

Studying the lung dose uncertainty during chest CT scans using phantoms with statistical lung volumes and shapes

In recent years, there has been increasing interest in constructing a series of deformable phantoms which follow the statistical distributions of some anatomical variations, known as 'statistical phantoms'. The main purpose of this study was to develop statistical phantoms by considering the variations in lung volume and shape, in order to evaluate the lung dose uncertainty for individuals undergoing chest computed tomography. Calculations were performed for 100 statistical lung volume phantoms and 70 statistical lung shape phantoms at tube voltages of 80 and 120 kVp, with the use of Monte Carlo MCNP code. The obtained results indicate that dose fluctuations for low tube voltage (80 kVp) are higher than those at 120 kVp. Moreover, it shows that the impact of statistical variations in lung volume on dose discrepancy (5% to 7%) is higher than the impact of statistical lung shape variations (around 2%).

Organ doses evaluation for chest computed tomography procedures with TL dosimeters: Comparison with Monte Carlo simulations

Purpose

To evaluate organ doses in routine and low‐dose chest computed tomography (CT) protocols using an experimental methodology. To compare experimental results with results obtained by the National Cancer Institute dosimetry system for CT (NCICT) organ dose calculator. To address the differences on organ dose measurements using tube current modulation (TCM) and fixed tube current protocols.

Methods

An experimental approach to evaluate organ doses in pediatric and adult anthropomorphic phantoms using thermoluminescent dosimeters (TLDs) was employed in this study. Several analyses were performed in order to establish the best way to achieve the main results in this investigation. The protocols used in this study were selected after an analysis of patient data collected from the Institute of Radiology of the School of Medicine of the University of São Paulo (InRad). The image quality was evaluated by a radiologist from this institution. Six chest adult protocols and four chest pediatric protocols were evaluated. Lung doses were evaluated for the adult phantom and lung and thyroid doses were evaluated for the pediatric phantom. The irradiations were performed using both a GE and a Philips CT scanner. Finally, organ doses measured with dosimeters were compared with Monte Carlo simulations performed with NCICT.

Results

After analyzing the data collected from all CT examinations performed during a period of 3 yr, the authors identified that adult and pediatric chest CT are among the most applied protocol in patients in that clinical institution, demonstrating the relevance on evaluating organ doses due to these examinations. With regards to the scan parameters adopted, the authors identified that using 80 kV instead of 120 kV for a pediatric chest routine CT, with TCM in both situations, can lead up to a 28.7% decrease on the absorbed dose. Moreover, in comparison to the standard adult protocol, which is performed with fixed mAs, TCM, and ultra low‐dose protocols resulted in dose reductions of up to 35.0% and 90.0%, respectively. Finally, the percent differences found between experimental and Monte Carlo simulated organ doses were within a 20% interval.

Conclusions

The results obtained in this study measured the impact on the absorbed dose in routine chest CT by changing several scan parameters while the image quality could be potentially preserved.

VALIDATION OF MONTE CARLO DOSE CALCULATION FOR PAEDIATRIC CT EXAMINATIONS USING TUBE CURRENT MODULATION BASED ON IN-PHANTOM DOSIMETRY

The aim of this study is to estimate tube current modulation (TCM) profiles in paediatric computed tomography (CT) examinations with a TCM scheme (Volume-EC) and evaluate the estimation accuracy of TCM profiles. Another aim is to validate organ doses calculated using Monte Carlo-based CT dosimetry software and estimated TCM profiles by comparing them with those measured using 5-year-old and 10-year-old anthropomorphic phantoms and radio-photoluminescence glass dosemeters. Dose calculations were performed by inputting detailed descriptions of a CT scanner, scan parameters and CT images of the phantoms into the software. Organ doses were evaluated from the calculated dose distribution images. Average relative differences (RDs) between the estimated and actual TCM profiles ranged from -3.6 to 5.6%. RDs between the calculated and measured organ doses ranged from -4.2 to 13.0% and -18.1 to 4.9% for 5-year-old and 10-year-old phantoms, respectively. These results validate dose calculations for paediatric CT scans using TCM.

Three-Dimensional Printing for Construction of Tissue-Equivalent Anthropomorphic Phantoms and Determination of Conceptus Dose

OBJECTIVE

The purpose of this study was to develop a road map for rapid construction of anthropomorphic phantoms from computational human phantoms for use in diagnostic imaging dosimetry studies. These phantoms are ideal for performing pregnant-patient dosimetry because the phantoms imitate the size and attenuation properties of an average-sized pregnant woman for multiple gestational periods.

MATERIALS AND METHODS

The method was derived from methods and materials previously described but adapted for 3D printing technology. A 3D printer was used to transform computational models into a physical duplicate with small losses in spatial accuracy and to generate tissue-equivalent materials characterized for diagnostic energy x-rays. A series of pregnant abdomens were selected as prototypes because of their large size and complex modeling. The process involved the following steps: segmentation of anatomy used for modeling; transformation of the computational model into a printing file format; preparation, characterization, and introduction of phantom materials; and model removal and phantom assembly.

RESULTS

The density of the homogenized soft tissue-equivalent substitute was optimized by combining 9.0% by weight of urethane filler powder and 91.0% urethane polymer, which resulted in a mean density of 1.041 g/cm³ measured over 20 samples. Density varied among all of the samples by 0.0026 g/cm³. The total variation in density was 0.00261 g/cm³. The half-value layer of the bone material was measured to be 1.7 mm of bone material at 120 kVp and when simulated by use of the density of the bone tissue-equivalent substitute (1.60 g/cm³) was determined to be 1.61 mm of bone tissue. For dosimetry purposes the phantom provided excellent results for evaluating a site's protocol based on scan range.

CONCLUSION

The 3D printing technology is applicable to the fabrication of phantoms used for performing dosimetry. The tissue-equivalent materials used to substitute for the soft tissue were developed to be highly adaptable for optimization based on the dosimetry application. Use of this method resulted in more automated phantom construction with decreased construction time and increased out-of-slice spatial resolution of the phantoms.

Synthetic breast phantoms from patient based eigenbreasts

PURPOSE

The limited number of 3D patient-based breast phantoms available could be augmented by synthetic breast phantoms in order to facilitate virtual clinical trials (VCTs) using model observers for breast imaging optimization and evaluation.

METHODS

These synthetic breast phantoms were developed using Principal Component Analysis (PCA) to reduce the number of dimensions needed to describe a training set of images. PCA decomposed a training set of M breast CT volumes (with millions of voxels each) into an M-1-dimensional space of eigenvectors, which we call eigenbreasts. Each of the training breast phantoms was compactly represented by the mean image plus a weighted sum of eigenbreasts. The distribution of weights observed from training was then sampled to create new synthesized breast phantoms.

RESULTS

The resulting synthesized breast phantoms demonstrated a high degree of realism, as supported by an observer study. Two out of three experienced physicist observers were unable to distinguish between the synthesized breast phantoms and the patient-based phantoms. The fibroglandular density and noise power law exponent of the synthesized breast phantoms agreed well with the training data.

CONCLUSIONS

Our method extends our series of digital breast phantoms based on breast CT data, providing the capability to generate new, statistically varying ensembles consisting of tens of thousands of virtual subjects. This work represents an important step toward conducting future virtual trials for task-based assessment of breast imaging, where it is vital to have a large ensemble of realistic phantoms for statistical power as well as clinical relevance.

Technical Note: spektr 3.0-A computational tool for x-ray spectrum modeling and analysis

PURPOSE

A computational toolkit (spektr 3.0) has been developed to calculate x-ray spectra based on the tungsten anode spectral model using interpolating cubic splines (TASMICS) algorithm, updating previous work based on the tungsten anode spectral model using interpolating polynomials (TASMIP) spectral model. The toolkit includes a matlab (The Mathworks, Natick, MA) function library and improved user interface (UI) along with an optimization algorithm to match calculated beam quality with measurements.

METHODS

The spektr code generates x-ray spectra (photons/mm(2)/mAs at 100 cm from the source) using TASMICS as default (with TASMIP as an option) in 1 keV energy bins over beam energies 20-150 kV, extensible to 640 kV using the TASMICS spectra. An optimization tool was implemented to compute the added filtration (Al and W) that provides a best match between calculated and measured x-ray tube output (mGy/mAs or mR/mAs) for individual x-ray tubes that may differ from that assumed in TASMICS or TASMIP and to account for factors such as anode angle.

RESULTS

The median percent difference in photon counts for a TASMICS and TASMIP spectrum was 4.15% for tube potentials in the range 30-140 kV with the largest percentage difference arising in the low and high energy bins due to measurement errors in the empirically based TASMIP model and inaccurate polynomial fitting. The optimization tool reported a close agreement between measured and calculated spectra with a Pearson coefficient of 0.98.

CONCLUSIONS

The computational toolkit, spektr, has been updated to version 3.0, validated against measurements and existing models, and made available as open source code. Video tutorials for the spektr function library, UI, and optimization tool are available.

Validation of calculation algorithms for organ doses in CT by measurements on a 5 year old paediatric phantom

Many organ dose calculation tools for computed tomography (CT) scans rely on the assumptions: (1) organ doses estimated for one CT scanner can be converted into organ doses for another CT scanner using the ratio of the Computed Tomography Dose Index (CTDI) between two CT scanners; and (2) helical scans can be approximated as the summation of axial slices covering the same scan range. The current study aims to validate experimentally these two assumptions. We performed organ dose measurements in a 5 year-old physical anthropomorphic phantom for five different CT scanners from four manufacturers. Absorbed doses to 22 organs were measured using thermoluminescent dosimeters for head-to-torso scans. We then compared the measured organ doses with the values calculated from the National Cancer Institute dosimetry system for CT (NCICT) computer program, developed at the National Cancer Institute. Whereas the measured organ doses showed significant variability (coefficient of variation (CoV) up to 53% at 80 kV) across different scanner models, the CoV of organ doses normalised to CTDIvol substantially decreased (12% CoV on average at 80 kV). For most organs, the difference between measured and simulated organ doses was within  ±20% except for the bone marrow, breasts and ovaries. The discrepancies were further explained by additional Monte Carlo calculations of organ doses using a voxel phantom developed from CT images of the physical phantom. The results demonstrate that organ doses calculated for one CT scanner can be used to assess organ doses from other CT scanners with 20% uncertainty (k  =  1), for the scan settings considered in the study.

Technical Note: Measurement of bow tie profiles in CT scanners using radiochromic film

PURPOSE

To provide a noninvasive technique to measure the intensity profile of the fan beam in a computed tomography (CT) scanner that is cost effective and easily implemented without the need to access proprietary scanner information or service modes.

METHODS

The fabrication of an inexpensive aperture is described, which is used to expose radiochromic film in a rotating CT gantry. A series of exposures is made, each of which is digitized on a personal computer document scanner, and the resulting data set is analyzed to produce a self-consistent calibration of relative radiation exposure. The bow tie profiles were analyzed to determine the precision of the process and were compared to two other measurement techniques, direct measurements from CT gantry detectors and a dynamic dosimeter.

RESULTS

The radiochromic film method presented here can measure radiation exposures with a precision of ∼ 6% root-mean-square relative error. The intensity profiles have a maximum 25% root-mean-square relative error compared with existing techniques.

CONCLUSIONS

The proposed radiochromic film method for measuring bow tie profiles is an inexpensive (∼$100 USD + film costs), noninvasive method to measure the fan beam intensity profile in CT scanners.

Reduction in radiation doses from paediatric CT scans in Great Britain

OBJECTIVE

Although CT scans provide great medical benefits, concerns have been raised about the magnitude of possible associated cancer risk, particularly in children who are more sensitive to radiation than adults. Unnecessary high doses during CT examinations can also be delivered to children, if the scan parameters are not adjusted for patient age and size. We conducted the first survey to directly assess the trends in CT scan parameters and doses for paediatric CT scans performed in Great Britain between 1978 and 2008.

METHODS

We retrieved 1073 CT film sets from 36 hospitals. The patients were 0-19 years old, and CT scans were conducted between 1978 and 2008. We extracted scan parameters from each film including tube current-time product [milliampere seconds (mAs)], tube potential [peak kilovoltage (kVp)] and manufacturer and model of the CT scanner. We estimated the mean mAs for head and trunk (chest and abdomen/pelvis) scans, according to patient age (0-4, 5-9, 10-14 and 15-19 years) and scan year (<1990, 1990-1994, 1995-1999 and ≥2000), and then derived the volumetric CT dose index and estimated organ doses.

RESULTS

For head CT scans, mean mAs decreased by about 47% on average from before 1990 to after 2000, with the decrease starting around 1990. The mean mAs for head CTs did not vary with age before 1990, whereas slightly lower mAs values were used for younger patients after 1990. Similar declines in mAs were observed for trunk CTs: a 46% decline on an average from before 1990 to after 2000. Although mean mAs for trunk CTs did not vary with age before 1990, the value varied markedly by age, from 63 mAs for age 0-4 years compared with 315 mAs for those aged >15 years after 2000. No material changes in kVp were found. Estimated brain-absorbed dose from head CT scans decreased from 62 mGy before 1990 to approximately 30 mGy after 2000. For chest CT scans, the lung dose to children aged 0-4 years decreased from 28 mGy before 1990 to 4 mGy after 2000.

CONCLUSION

We found that mAs for head and trunk CTs was approximately halved starting around 1990, and age-specific mAs was generally used for paediatric scans after this date. These changes will have substantially reduced the radiation exposure to children from CT scans in Great Britain.

ADVANCES IN KNOWLEDGE

The study shows that mAs and major organ doses for paediatric CT scans in Great Britain began to decrease around 1990.

NCICT: a computational solution to estimate organ doses for pediatric and adult patients undergoing CT scans

We developed computational methods and tools to assess organ doses for pediatric and adult patients undergoing computed tomography (CT) examinations. We used the International Commission on Radiological Protection (ICRP) reference pediatric and adult phantoms combined with the Monte Carlo simulation of a reference CT scanner to establish comprehensive organ dose coefficients (DC), organ absorbed dose per unit volumetric CT Dose Index (CTDIvol) (mGy/mGy). We also developed methods to estimate organ doses with tube current modulation techniques and size specific dose estimates. A graphical user interface was designed to obtain user input of patient- and scan-specific parameters, and to calculate and display organ doses. A batch calculation routine was also integrated into the program to automatically calculate organ doses for a large number of patients. We entitled the computer program, National Cancer Institute dosimetry system for CT(NCICT). We compared our dose coefficients with those from CT-Expo, and evaluated the performance of our program using CT patient data. Our pediatric DCs show good agreements of organ dose estimation with those from CT-Expo except for thyroid. Our results support that the adult phantom in CT-Expo seems to represent a pediatric individual between 10 and 15 years rather than an adult. The comparison of CTDIvol values between NCICT and dose pages from 10 selected CT scans shows good agreements less than 12% except for two cases (up to 20%). The organ dose comparison between mean and modulated mAs shows that mean mAs-based calculation significantly overestimates dose (up to 2.4-fold) to the organs in close proximity to lungs in chest and chest-abdomen-pelvis scans. Our program provides more realistic anatomy based on the ICRP reference phantoms, higher age resolution, the most up-to-date bone marrow dosimetry, and several convenient features compared to previous tools. The NCICT will be available for research purpose in the near future.

GMctdospp: Description and validation of a CT dose calculation system

PURPOSE

To develop a Monte Carlo (MC)-based computed tomography (CT) dose estimation method with a graphical user interface with options to define almost arbitrary simulation scenarios, to make calculations sufficiently fast for comfortable handling, and to make the software free of charge for general availability to the scientific community.

METHODS

A framework called GMctdospp was developed to calculate phantom and patient doses with the MC method based on the EGSnrc system. A CT scanner was modeled for testing and was adapted to half-value layer, beam-shaping filter, z-profile, and tube-current modulation (TCM). To validate the implemented variance reduction techniques, depth-dose and cross-profile calculations of a static beam were compared against DOSXYZnrc/EGSnrc. Measurements for beam energies of 80 and 120 kVp at several positions of a CT dose-index (CTDI) standard phantom were compared against calculations of the created CT model. Finally, the efficiency of the adapted code was benchmarked against EGSnrc defaults.

RESULTS

The CT scanner could be modeled accurately. The developed TCM scheme was confirmed by the dose measurement. A comparison of calculations to DOSXYZnrc showed no systematic differences. Measurements in a CTDI phantom could be reproduced within 2% average, with a maximal difference of about 6%. Efficiency improvements of about six orders of magnitude were observed for larger organ structures of a chest-examination protocol in a voxelized phantom. In these cases, simulations took 25 s to achieve a statistical uncertainty of ∼0.5%.

CONCLUSIONS

A fast dose-calculation system for phantoms and patients in a CT examination was developed, successfully validated, and benchmarked. Influences of scan protocols, protection method, and other issues can be easily examined with the developed framework.

Evaluation of organ doses in adult and paediatric CT examinations based on Monte Carlo simulations and in-phantom dosimetry

The aim of this study was to validate the computed tomography dose index (CTDI) and organ doses evaluated by Monte Carlo simulations through comparisons with doses evaluated by in-phantom dosimetry. Organ doses were measured with radio-photoluminescence glass dosemeter (RGD) set at various organ positions within adult and 1-y-old anthropomorphic phantoms. For the dose simulations, the X-ray spectrum and bow-tie filter shape of a CT scanner were estimated and 3D voxelised data of the CTDI and anthropomorphic phantoms from the acquired CT images were derived. Organ dose simulations and measurements were performed with chest and abdomen-pelvis CT examination scan parameters. Relative differences between the simulated and measured doses were within 5 % for the volume CTDI and 13 % for organ doses for organs within the scan range in adult and paediatric CT examinations. The simulation results were considered to be in good agreement with the measured doses.

Validation of a Monte Carlo model used for simulating tube current modulation in computed tomography over a wide range of phantom conditions/challenges

PURPOSE

Monte Carlo (MC) simulation methods have been widely used in patient dosimetry in computed tomography (CT), including estimating patient organ doses. However, most simulation methods have undergone a limited set of validations, often using homogeneous phantoms with simple geometries. As clinical scanning has become more complex and the use of tube current modulation (TCM) has become pervasive in the clinic, MC simulations should include these techniques in their methodologies and therefore should also be validated using a variety of phantoms with different shapes and material compositions to result in a variety of differently modulated tube current profiles. The purpose of this work is to perform the measurements and simulations to validate a Monte Carlo model under a variety of test conditions where fixed tube current (FTC) and TCM were used.

METHODS

A previously developed MC model for estimating dose from CT scans that models TCM, built using the platform of mcnpx, was used for CT dose quantification. In order to validate the suitability of this model to accurately simulate patient dose from FTC and TCM CT scan, measurements and simulations were compared over a wide range of conditions. Phantoms used for testing range from simple geometries with homogeneous composition (16 and 32 cm computed tomography dose index phantoms) to more complex phantoms including a rectangular homogeneous water equivalent phantom, an elliptical shaped phantom with three sections (where each section was a homogeneous, but different material), and a heterogeneous, complex geometry anthropomorphic phantom. Each phantom requires varying levels of x-, y- and z-modulation. Each phantom was scanned on a multidetector row CT (Sensation 64) scanner under the conditions of both FTC and TCM. Dose measurements were made at various surface and depth positions within each phantom. Simulations using each phantom were performed for FTC, detailed x-y-z TCM, and z-axis-only TCM to obtain dose estimates. This allowed direct comparisons between measured and simulated dose values under each condition of phantom, location, and scan to be made.

RESULTS

For FTC scans, the percent root mean square (RMS) difference between measurements and simulations was within 5% across all phantoms. For TCM scans, the percent RMS of the difference between measured and simulated values when using detailed TCM and z-axis-only TCM simulations was 4.5% and 13.2%, respectively. For the anthropomorphic phantom, the difference between TCM measurements and detailed TCM and z-axis-only TCM simulations was 1.2% and 8.9%, respectively. For FTC measurements and simulations, the percent RMS of the difference was 5.0%.

CONCLUSIONS

This work demonstrated that the Monte Carlo model developed provided good agreement between measured and simulated values under both simple and complex geometries including an anthropomorphic phantom. This work also showed the increased dose differences for z-axis-only TCM simulations, where considerable modulation in the x-y plane was present due to the shape of the rectangular water phantom. Results from this investigation highlight details that need to be included in Monte Carlo simulations of TCM CT scans in order to yield accurate, clinically viable assessments of patient dosimetry.

In vitro dose measurements in a human cadaver with abdomen/pelvis CT scans

PURPOSE

To present a study of radiation dose measurements with a human cadaver scanned on a clinical CT scanner.

METHODS

Multiple point dose measurements were obtained with high-accuracy Thimble ionization chambers placed inside the stomach, liver, paravertebral gutter, ascending colon, left kidney, and urinary bladder of a human cadaver (183 cm in height and 67.5 kg in weight) whose abdomen/pelvis region was scanned repeatedly with a multidetector row CT. The flat energy response and precision of the dosimeters were verified, and the slight differences in each dosimeter's response were evaluated and corrected to attain high accuracy. In addition, skin doses were measured for radiosensitive organs outside the scanned region with OSL dosimeters: the right eye, thyroid, both nipples, and the right testicle. Three scan protocols were used, which shared most scan parameters but had different kVp and mA settings: 120-kVp automA, 120-kVp 300 mA, and 100-kVp 300 mA. For each protocol three repeated scans were performed.

RESULTS

The tube starting angle (TSA) was found to randomly vary around two major conditions, which caused large fluctuations in the repeated point dose measurements: for the 120-kVp 300 mA protocol this angle changed from approximately 110° to 290°, and caused 8%-25% difference in the point dose measured at the stomach, liver, colon, and urinary bladder. When the fluctuations of the TSA were small (within 5°), the maximum coefficient of variance was approximately 3.3%. The soft tissue absorbed doses averaged from four locations near the center of the scanned region were 27.2±3.3 and 16.5±2.7 mGy for the 120 and 100-kVp fixed-mA scans, respectively. These values were consistent with the corresponding size specific dose estimates within 4%. The comparison of the per-100-mAs tissue doses from the three protocols revealed that: (1) dose levels at nonsuperficial locations in the TCM scans could not be accurately deduced by simply scaling the fix-mA doses with local mA values; (2) the general power law relationship between dose and kVp varied from location to location, with the power index ranged between 2.7 and 3.5. The averaged dose measurements at both nipples, which were about 0.6 cm outside the prescribed scan region, ranged from 23 to 27 mGy at the left nipple, and varied from 3 to 20 mGy at the right nipple over the three scan protocols. Large fluctuations over repeated scans were also observed, as a combined result of helical scans of large pitch (1.375) and small active areas of the skin dosimeters. In addition, the averaged skin dose fell off drastically with the distance to the nearest boundary of the scanned region.

CONCLUSIONS

This study revealed the complexity of CT dose fluctuation and variation with a human cadaver.

New absorbed dose measurement with cylindrical water phantoms for multidetector CT

The aim of this study was to develop new dosimetry with cylindrical water phantoms for multidetector computed tomography (MDCT). The ionization measurement was performed with a Farmer ionization chamber at the center and four peripheral points in the body-type and head-type cylindrical water phantoms. The ionization was converted to the absorbed dose using a (60)Co absorbed-dose-to-water calibration factor and Monte Carlo (MC) -calculated correction factors. The correction factors were calculated from MDCT (Brilliance iCT, 64-slice, Philips Electronics) modeled with GMctdospp (IMPS, Germany) software based on the EGSnrc MC code. The spectrum of incident x-ray beams and the configuration of a bowtie filter for MDCT were determined so that calculated photon intensity attenuation curves for aluminum (Al) and calculated off-center ratio (OCR) profiles in air coincided with those measured. The MC-calculated doses were calibrated by the absorbed dose measured at the center in both cylindrical water phantoms. Calculated doses were compared with measured doses at four peripheral points and the center in the phantom for various beam pitches and beam collimations. The calibration factors and the uncertainty of the absorbed dose determined using this method were also compared with those obtained by CTDIair (CT dose index in air). Calculated Al half-value layers and OCRs in air were within 0.3% and 3% agreement with the measured values, respectively. Calculated doses at four peripheral points and the centers for various beam pitches and beam collimations were within 5% and 2% agreement with measured values, respectively. The MC-calibration factors by our method were 44-50% lower than values by CTDIair due to the overbeaming effect. However, the calibration factors for CTDIair agreed within 5% with those of our method after correction for the overbeaming effect. Our method makes it possible to directly measure the absorbed dose for MDCT and is more robust and accurate than the CTDIair measurement.

Effect of ROI filtering in 3D cone-beam rotational angiography on organ dose and effective dose in cerebral investigations

The assessment of intracranial aneurysms is increasingly performed using three-dimensional cone-beam rotational angiography (3D CBRA). To reduce the dose to the patient during 3D CBRA procedures, filtered region-of-interest imaging (FROI) is presented in literature to be an effective technique as the dose in regions of low interest is reduced, while high image quality is preserved in the ROI. The purpose of this study was to quantify the benefit of FROI imaging during a typical 3D CBRA procedure in a patient's head region. A cone-beam rotational angiography unit (Infinix) was modeled in GMctdospp, an EGSnrc-based Monte Carlo software, which calculates patient dose distributions in rotational computed tomography. Kodak Lanex, a gadolinium compound, was chosen to be the ROI filter material. The adult female ICRP reference phantom was integrated in GMctdospp to calculate organ and effective doses in simulations of FROI-CBRA examinations. During the Monte Carlo simulations, different parameters as the ROI filter thickness, the ROI opening size, the tube voltage, and the isocenter position were varied. The results showed that the reduction in dose clearly depends on these parameters. Comparing the reduction in organ dose in standard 3D CBRA and FROI-CBRA, a maximum reduction of about 60%-80% could be achieved with a small sized ROI filter and about 40%-70% of the dose could be saved using a ROI filter with a large opening. Further we could show that dose reduction strongly depends on filter thickness, the location of the organ in the radiated area, and the position of the isocenter. As a consequence, dose reduction partially differs from theoretically calculated values by a factor up to 1.6. The effective dose could be reduced to a minimum of about 40%. Due to the fact that standard 3D CBRA is only used for the assessment of aneurysms at present and, thus, most of the patient dose originates from the aneurysm treatment (with 2D techniques) itself, the dose reduction effect of ROI filtering in 3D CBRA tends to be much smaller, if the patient dose of a whole aneurysm treatment procedure is considered.

Size-specific dose estimate (SSDE) provides a simple method to calculate organ dose for pediatric CT examinations

PURPOSE

To investigate the correlation of size-specific dose estimate (SSDE) with absorbed organ dose, and to develop a simple methodology for estimating patient organ dose in a pediatric population (5-55 kg).

METHODS

Four physical anthropomorphic phantoms representing a range of pediatric body habitus were scanned with metal oxide semiconductor field effect transistor (MOSFET) dosimeters placed at 23 organ locations to determine absolute organ dose. Phantom absolute organ dose was divided by phantom SSDE to determine correlation between organ dose and SSDE. Organ dose correlation factors (CF(organ)(SSDE)) were then multiplied by patient-specific SSDE to estimate patient organ dose. The [CF(organ)(SSDE)) were used to retrospectively estimate individual organ doses from 352 chest and 241 abdominopelvic pediatric CT examinations, where mean patient weight was 22 kg ± 15 (range 5-55 kg), and mean patient age was 6 yrs ± 5 (range 4 months to 23 yrs). Patient organ dose estimates were compared to published pediatric Monte Carlo study results.

RESULTS

Phantom effective diameters were matched with patient population effective diameters to within 4 cm; thus, showing appropriate scalability of the phantoms across the entire pediatric population in this study. Individual CF(organ)(SSDE) were determined for a total of 23 organs in the chest and abdominopelvic region across nine weight subcategories. For organs fully covered by the scan volume, correlation in the chest (average 1.1; range 0.7-1.4) and abdominopelvic region (average 0.9; range 0.7-1.3) was near unity. For organ/tissue that extended beyond the scan volume (i.e., skin, bone marrow, and bone surface), correlation was determined to be poor (average 0.3; range: 0.1-0.4) for both the chest and abdominopelvic regions, respectively. A means to estimate patient organ dose was demonstrated. Calculated patient organ dose, using patient SSDE and CF(organ)(SSDE), was compared to previously published pediatric patient doses that accounted for patient size in their dose calculation, and was found to agree in the chest to better than an average of 5% (27.6/26.2) and in the abdominopelvic region to better than 2% (73.4/75.0).

CONCLUSIONS

For organs fully covered within the scan volume, the average correlation of SSDE and organ absolute dose was found to be better than ± 10%. In addition, this study provides a complete list of organ dose correlation factors (CF(organ)(SSDE)) for the chest and abdominopelvic regions, and describes a simple methodology to estimate individual pediatric patient organ dose based on patient SSDE.

Accuracy of Monte Carlo simulations compared to in-vivo MDCT dosimetry

PURPOSE

The purpose of this study was to assess the accuracy of a Monte Carlo simulation-based method for estimating radiation dose from multidetector computed tomography (MDCT) by comparing simulated doses in ten patients to in-vivo dose measurements.

METHODS

MD Anderson Cancer Center Institutional Review Board approved the acquisition of in-vivo rectal dose measurements in a pilot study of ten patients undergoing virtual colonoscopy. The dose measurements were obtained by affixing TLD capsules to the inner lumen of rectal catheters. Voxelized patient models were generated from the MDCT images of the ten patients, and the dose to the TLD for all exposures was estimated using Monte Carlo based simulations. The Monte Carlo simulation results were compared to the in-vivo dose measurements to determine accuracy.

RESULTS

The calculated mean percent difference between TLD measurements and Monte Carlo simulations was -4.9% with standard deviation of 8.7% and a range of -22.7% to 5.7%.

CONCLUSIONS

The results of this study demonstrate very good agreement between simulated and measured doses in-vivo. Taken together with previous validation efforts, this work demonstrates that the Monte Carlo simulation methods can provide accurate estimates of radiation dose in patients undergoing CT examinations.

Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in France

BACKGROUND

Recent epidemiological results suggested an increase of cancer risk after receiving computed tomography (CT) scans in childhood or adolescence. Their interpretation is questioned due to the lack of information about the reasons for examination. Our objective was to estimate the cancer risk related to childhood CT scans, and examine how cancer-predisposing factors (PFs) affect assessment of the radiation-related risk.

METHODS

The cohort included 67,274 children who had a first scan before the age of 10 years from 2000 to 2010 in 23 French departments. Cumulative X-rays doses were estimated from radiology protocols. Cancer incidence was retrieved through the national registry of childhood cancers; PF from discharge diagnoses.

RESULTS

During a mean follow-up of 4 years, 27 cases of tumours of the central nervous system, 25 of leukaemia and 21 of lymphoma were diagnosed; 32% of them among children with PF. Specific patterns of CT exposures were observed according to PFs. Adjustment for PF reduced the excess risk estimates related to cumulative doses from CT scans. No significant excess risk was observed in relation to CT exposures.

CONCLUSIONS

This study suggests that the indication for examinations, whether suspected cancer or PF management, should be considered to avoid overestimation of the cancer risks associated with CT scans.

Computed tomography radiation dosimetry: from the indicators to the indications

The technological advances in computed tomography (CT) scanners and their continuously increased use have raised concern about the patient-induced risks from the CT procedures. In the present review, all available dose metrics used in CT dosimetry are described, evaluated, and compared. The various models and methodologies currently existing for the estimation of the effective dose and, by extension, the carcinogenesis probability as well as the way that this is derived from dose descriptors are also considered.