An inventory of patient-image based risk/dose, image quality and body habitus/size metrics for adult abdomino-pelvic CT protocol optimisation

PURPOSE

Patient-specific protocol optimisation in abdomino-pelvic Computed Tomography (CT) requires measurement of body habitus/size (BH), sensitivity-specificity (surrogates image quality (IQ) metrics) and risk (surrogates often dose quantities) (RD). This work provides an updated inventory of metrics available for each of these three categories of optimisation variables derivable directly from patient measurements or images. We consider objective IQ metrics mostly in the spatial domain (i.e., those related directly to sharpness, contrast, noise quantity/texture and perceived detectability as these are used by radiologists to assess the acceptability or otherwise of patient images in practice).

MATERIALS AND METHODS

The search engine used was PubMed with the search period being 2010-2024. The key words used were: 'comput* tomography', 'CT', 'abdom*', 'dose', 'risk', 'SSDE', 'image quality', 'water equivalent diameter', 'size', 'body composition', 'habit*', 'BMI', 'obes*', 'overweight'. Since BH is critical for patient specific optimisation, articles correlating RD vs BH, and IQ vs BH were reviewed.

RESULTS

The inventory includes 11 BH, 12 IQ and 6 RD metrics. 25 RD vs BH correlation studies and 9 IQ vs BH correlation studies were identified. 7 articles in the latter group correlated metrics from all three categories concurrently.

CONCLUSIONS

Protocol optimisation should be fine-tuned to the level of the individual patient and particular clinical query. This would require a judicious choice of metrics from each of the three categories. It is suggested that, for increased utility in clinical practice, more future optimisation studies be clinical task based and involve the three categories of metrics concurrently.

Automated Calculation of Water-equivalent Diameter (DW) Based on AAPM Task Group 220

The purpose of this study is to accurately and effectively automate the calculation of the water‐equivalent diameter (DW) from 3D CT images for estimating the size‐specific dose. DW is the metric that characterizes the patient size and attenuation. In this study, DW was calculated for standard CTDI phantoms and patient images. Two types of phantom were used, one representing the head with a diameter of 16 cm and the other representing the body with a diameter of 32 cm. Images of 63 patients were also taken, 32 who had undergone a CT head examination and 31 who had undergone a CT thorax examination. There are three main parts to our algorithm for automated DW calculation. The first part is to read 3D images and convert the CT data into Hounsfield units (HU). The second part is to find the contour of the phantoms or patients automatically. And the third part is to automate the calculation of DW based on the automated contouring for every slice (DW,all). The results of this study show that the automated calculation of DW and the manual calculation are in good agreement for phantoms and patients. The differences between the automated calculation of DW and the manual calculation are less than 0.5%. The results of this study also show that the estimating of DW,all using DW,n=1 (central slice along longitudinal axis) produces percentage differences of −0.92%±3.37% and 6.75%±1.92%, and estimating DW,all using DW,n=9 produces percentage differences of 0.23%±0.16% and 0.87%±0.36%, for thorax and head examinations, respectively. From this study, the percentage differences between normalized size‐specific dose estimate for every slice (nSSDEall) and nSSDEn=1 are 0.74%±2.82% and −4.35%±1.18% for thorax and head examinations, respectively; between nSSDEall and nSSDEn=9 are 0.00%±0.46% and −0.60%±0.24% for thorax and head examinations, respectively.

PACS number(s): 87.57.Q‐, 87.57.uq‐

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.