Evaluation of automatic tube current modulation of CT scanners using a dedicated and the CTDI dosimetry phantoms

PURPOSE

To investigate the operation principles of the automatic tube current modulation (ATCM) of a CT scanner, using a dedicated phantom and the CT dosimetry index (CTDI) phantom.

MATERIAL AND METHODS

The Mercury 4.0 phantom and three different configurations of the CTDI dosimetry phantom were employed. A frequently used clinical scanning protocol was employed as a basis for the acquisitions performed with all phantoms, using both scanning directions. Additional acquisitions with different pitch and examination protocols were performed with Mercury phantom, to further explore their effect on ATCM and the resulting image quality. Different software named DICOM Info Extractor, ImageJ, and imQuest, were used to derive CTDI_vol and table position, image noise, and water equivalent diameter (WED) of each phantom CT image, respectively. ImQuest was also used to derive the detectability index (d') of five different materials (air, solid water, polystyrene, iodine, and bone) embedded in the Mercury phantom.

RESULTS

It was exhibited with all four phantoms that the scanning direction greatly affects the modulation curves. The fitting of the dose modulations curves suggested that for each table position what determines the CTDI_vol value is the WED values of the phantom structures laying ahead towards the scanning direction, for a length equal to the effective width of the X-ray beam. Furthermore, it was also exhibited that ATCM does not fully compensate for larger thicknesses, since images of larger WED phantom sections present more noise (larger SD) in all four phantoms and in Mercury 4.0 phantom smaller detectability (d').

CONCLUSION

Mercury 4.0 is a dedicated phantom for a complete and in-depth evaluation of the ATCM operation and the resulting image quality. However, in its absence, different CTDI configurations can be used as an alternative to investigate and comprehend some basic operation principles of the CT scanners' ATCM systems.

Effects of tube potential selection together with computed tomography automatic tube current modulation on CT imaging performance

The effects of tube potential selection with a computed tomography (CT) automatic tube current modulation (ATCM) system on radiation dose and image quality have been investigated on a Canon CT scanner. The use of different values of tube voltage for imaging, and the appropriate settings of the ATCM system, were evaluated. The custom-made phantom consisted of three sections of different sizes with inserts of various materials. It was scanned using tube potentials of 80-140 kV and different image quality ATCM settings. CTDI_voland image quality in terms of noise, contrast, and contrast-to-noise ratio (CNR) for air, polyethylene (PE), acrylic, polyoxymethylene (POM) and polyvinylchloride (PVC) were analysed. A figure of merit (FOM) was estimated by combining CNR and CTDI_vol. CTDI_volvalues were similar for all values of tube voltage and individual image quality ATCM settings when tube current was not restricted by the maximum value. The contrasts were independent of ATCM image quality setting, but CNR increased at the higher image quality level as image noise decreased. Both contrast and CNR decreased with increasing tube voltage for PVC and PE, but increased for POM and acrylic. PVC was the only insert material for which there was a significant improvement in contrast at lower tube potentials. FOM indicated that standard (SD = 10) and low dose (SD = 12.5) ATCM settings might be appropriate. The optimum tube voltage settings for imaging the PVC was 80-100 kV, but not for the lower contrast POM and acrylic, for which the standard tube voltage setting of 120 kV was better. The tube potential should be carefully set to gain radiological protection optimisation and keep the radiation dose as low as possible. Results indicate that 100 kV is likely to be appropriate for imaging small and medium-sized Thai patients when iodine contrast is used.

Technical Note: Evaluating automatic tube current modulation in CT using the standard CTDI dosimetry phantom

PURPOSE

To assess the utility of the standard body CTDI phantom in characterizing the operation scheme of tube current modulation (TCM) systems in CT.

METHODS

The body CDTI phantom was used to characterize two TCM systems: TCM₁ and TCM₂ , implemented in scanners from different vendors. The phantom was aligned at the gantry isocenter in two configurations. In configuration A, the facet planes of the phantom were parallel to the patient table, while in configuration B they were vertical to the patient table and parallel to the patient's long axis. Acquisitions were performed using the routine abdominal examination protocol. mA(z) profiles were recorded from images' DICOM header. The water equivalent diameter (d_w ) and oval ratio (OR) were calculated as a function of z-axis location. Image noise was defined as the standard deviation (SD) of the mean Hounsfield unit value measured in a region of interest at the center of the phantom's image. Regression analysis was performed to modulated mA and SD vs d_w and OR. The spatial concordance between the change in phantom size and change in mA (SC_mA ) was calculated as the percent difference in the slope of mA(z) change between the 1st and 2nd half of the phantom. The corresponding spatial concordance between the change in phantom size and change in image noise (SC_noise ) was calculated.

RESULTS

Modulated mA(z) along the z-axis did not substantially differentiate between configurations A and B. Correlation between ln(mA) and OR was found to be higher compared to correlation between ln(mA) and d_w . SC_mA was 48% for TCM₁ and 33% for TCM₂ . The corresponding SC_noise was 29% for TCM₁ and 16% for TCM₂ .

CONCLUSION

Apart from routine CT dosimetry evaluations, the standard CTDI phantom positioned in configuration A or B may additionally be used by medical physicists to evaluate the performance of TCM operational characteristics.

Evaluating the impact of scan settings on automatic tube current modulation in CT using a novel phantom

OBJECTIVE

The aim of this study was to make a comprehensive evaluation of how variable scan settings can affect the performance of automatic tube current modulation (ATCM) in recent CT scanners from the four major manufacturers.

METHODS

A phantom was designed and manufactured for the purpose of evaluating ATCM. The phantom was scanned with four categories of systematically varied settings (scan projection radiograph, technique and reconstruction parameters and phantom miscentring). The performance of ATCM, in terms of applied tube current and noise uniformity, for the scans with varied settings was compared with a reference scan using subjective and quantitative approaches.

RESULTS

The ATCM implemented by each manufacturer is based on different principles and any affect to the performance of the ATCM, when varying scan settings, will manifest differently among the vendors. The results are summarized in four tables corresponding to the categories of varied settings.

CONCLUSION

The developed phantom proved useful for evaluating the ATCM. It is important to understand how different implementations (vendor specific) of ATCM perform in order to make informed decisions about the selection of scan settings when designing protocols. The resulting tables can serve as a reference for understanding the different implementations of ATCM and highlight settings that should be taken into consideration when adjusting an imaging protocol. Advances in knowledge: The results from this work can serve as a reference for how changes in geometry or scan settings can affect the performance of ATCM, in terms of tube current and noise.

Setting up computed tomography automatic tube current modulation systems

Automatic tube current modulation (ATCM) on CT scanners can yield significant reductions in patient doses. Modulation is based on x-ray beam attenuation in body tissues obtained from scan projection radiographs (SPRs) and aims to maintain the same level of image quality throughout a scan. Noise level is important in judging image quality, but tissues in larger patients exhibit higher contrast resulting from the presence of fat. CT scanner manufacturers use different metrics to assess image quality. Some employ a simple measure of image noise, while others adopt a measure related to a reference image that accepts higher noise levels in more attenuating parts with higher contrast. At the present time there is no standard method for testing ATCM. This paper reviews the operation of different ATCM systems, considers options for testing, and sets out a framework that could be used for optimizing clinical protocols. If dose and image quality can be established for a reference phantom, the modulation performed by ATCM systems can be characterised using anatomical phantoms or geometrical elliptical phantoms which may be conical or include sections of varying dimension. For scanners using a reference image or mAs, selection of the image quality reference determines other factors. However, for scanners using a noise reference, a higher noise level should be selected for larger patients to avoid high doses, and the operator should ensure that appropriate limits are set for mA modulation. Other factors that need to be considered include the SPRs used to plan the ATCM and image thickness. Users should be aware of the mode of operation of the ATCM system on their CT scanner, and be familiar with the effects of changing different protocol parameters. The behaviour of ATCM systems should be established through testing of each CT scanner with suitable phantoms during commissioning.

A routine quality assurance test for CT automatic exposure control systems

The study purpose was to develop and validate a quality assurance test for CT automatic exposure control (AEC) systems based on a set of nested polymethylmethacrylate CTDI phantoms. The test phantom was created by offsetting the 16 cm head phantom within the 32 cm body annulus, thus creating a three part phantom. This was scanned at all acceptance, routine, and some nonroutine quality assurance visits over a period of 45 months, resulting in 115 separate AEC tests on scanners from four manufacturers. For each scan the longitudinal mA modulation pattern was generated and measurements of image noise were made in two annular regions of interest. The scanner displayed CTDIvol and DLP were also recorded. The impact of a range of AEC configurations on dose and image quality were assessed at acceptance testing. For systems that were tested more than once, the percentage of CTDIvol values exceeding 5%, 10%, and 15% deviation from baseline was 23.4%, 12.6%, and 8.1% respectively. Similarly, for the image noise data, deviations greater than 2%, 5%, and 10% from baseline were 26.5%, 5.9%, and 2%, respectively. The majority of CTDIvol and noise deviations greater than 15% and 5%, respectively, could be explained by incorrect phantom setup or protocol selection. Barring these results, CTDIvol deviations of greater than 15% from baseline were found in 0.9% of tests and noise deviations greater than 5% from baseline were found in 1% of tests. The phantom was shown to be sensitive to changes in AEC setup, including the use of 3D, longitudinal or rotational tube current modulation. This test methodology allows for continuing performance assessment of CT AEC systems, and we recommend that this test should become part of routine CT quality assurance programs. Tolerances of ±15% for CTDIvol and ±5% for image noise relative to baseline values should be used.

PACS number(s): 87.57.Q‐

INFLUENCE OF LOCALIZER AND SCAN DIRECTION ON THE DOSE-REDUCING EFFECT OF AUTOMATIC TUBE CURRENT MODULATION IN COMPUTED TOMOGRAPHY

The purpose of this study was to investigate the influence of the localizer and scan direction on the dose-reducing efficacy of the automatic tube current modulation (ATCM) in computed tomography (CT). Craniocaudal and caudocranial chest CT scans, based on anterior-posterior (AP), posterior-anterior (PA), lateral (LAT) or dual AP/LAT localizers, of an anthropomorphic phantom containing thermoluminescent dosimeters (TLDs), were made on three Siemens systems. TLD readings were converted to lung and thyroid doses. A second dose estimation was performed based on Monte Carlo simulations. In addition, the ATCM behaviour of GE and Toshiba was evaluated based on AP, PA and LAT localizers. Compared with AP, tube currents of PA and AP/LAT scans were on average 20 % higher and 40 % lower, respectively, for the Siemens systems. Consequently, thyroid and lung doses increased with 60 % with a PA instead of an AP/LAT scan, with significant differences in image noise. Moreover, the thyroid dose halves by taking the scan in caudocranial direction. Noise values were not significantly different when changing scan direction.

Effective dose and organ doses estimation taking tube current modulation into account with a commercial software package

PURPOSE

To evaluate the effect of including tube current modulation (TCM) versus using the average mAs in estimating organ and effective dose (E) using commercial software.

METHOD

Forty adult patients (24 females, 16 males) with normal BMI underwent chest/abdomen computed tomography (CT) performed with TCM at 120 kVp, reference mAs of 110 (chest) and 200 (abdomen). Doses to fully irradiated organs (breasts, lungs, stomach, liver and ovaries) and E were calculated using two versions of a dosimetry software: v.2.0, which uses the average mAs, and v.2.2, which accounts for TCM by implementing a gender-specific mAs profile. Student's t-test was used to assess statistically significant differences between organ doses calculated with the two versions.

RESULTS

A statistically significant difference (p < 0.001) was found for E on chest and abdomen CT, with E being lower by 4.2% when TCM is considered. Similarly, organ doses were also significantly lower (p < 0.001): 13.7% for breasts, 7.3% for lungs, 9.1% for the liver and 8.5% for the stomach. Only the dose to the ovaries was higher with TCM (11.5%).

CONCLUSION

When TCM is used, for the stylized phantom, the doses to lungs, breasts, stomach and liver decreased while the dose to the ovaries increased.

KEY POINTS

• Estimated dose to the ovaries increased with TCM. • Estimated dose to lungs, breasts, stomach and liver decreased with TCM. • A unique but gender-specific mAs profile resulted in a radiation dose shift. • Even for normal size patients there is a variety in mAs profiles.