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Al-Hayek Y, Ofori-Manteaw B, Frame N, Spuur K, Zheng X, Rose L, Chau M. Localiser radiographs in CT: Current practice, radiation dose, image quality and clinical applications. Radiography (Lond) 2024; 30:1546-1555. [PMID: 39366144 DOI: 10.1016/j.radi.2024.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 09/11/2024] [Accepted: 09/18/2024] [Indexed: 10/06/2024]
Abstract
INTRODUCTION Survey or localiser radiographs are integral to CT imaging. However, the diverse functions and roles of the localiser radiograph are often obscure to radiographers and radiologists. This scoping review reports the full scope of localiser radiograph use and function in contemporary CT imaging. METHODS A scoping review was performed. A systematic literature search was conducted using four databases: MEDLINE, CINAHL, Emcare and Scopus from January 2013 to December 2023. Data extraction was conducted by two review authors and validated by a third reviewer. Thirty-six studies were included in this review. RESULTS Three major themes emerged: radiation dose management, image quality considerations and clinical protocol applications. Specifically, the number, order of selection and directions of localiser radiographs significantly impact patient dose and image quality; which are additionally impacted by off-centre patient positioning, which can influence the accuracy of body size estimates and CT numbers. Finally, the optimal selection of localiser radiographs, including exposure parameters (kVp, mAs), can be a part of clinical task-based imaging protocol optimisation. CONCLUSIONS The utilities of localiser radiographs in CT imaging are varied. It is salient that radiographers and radiologists understand their role and the impacts of poor application to ensure that radiation dose is minimised and image quality maximised through correct use. Radiographers and radiologists should also be aware of the impact of poor patient positioning on ACTM function, dose and image quality. Additionally, localiser radiographs should be used for clinical task-based protocol optimisation. IMPLICATIONS FOR PRACTICE The number, order of selection, direction, patient off-centring, and exposure parameters must be considered when utilising localiser radiographs as they impact dose, image quality, and protocol applications. It is essential for radiographers and radiologists to understand these impacts.
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Affiliation(s)
- Y Al-Hayek
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
| | - B Ofori-Manteaw
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
| | - N Frame
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
| | - K Spuur
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
| | - X Zheng
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
| | - L Rose
- Division of Library Services, Charles Sturt University, Port Macquarie, NSW 2444, Australia.
| | - M Chau
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
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Valentin B, Kamp B, Henke J, Ljimani A, Appel E, Antoch G, Steuwe A. Influence of tube and patient positioning in thoracoabdominal CT examinations on radiation exposure-towards a better patient positioning. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:031512. [PMID: 37619552 DOI: 10.1088/1361-6498/acf384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 08/26/2023]
Abstract
Although iso-centric patient positioning is enormously important in computed tomography (CT), it is complicated in thoracoabdominal imaging by the varying dimensions of the body. Patient positioning can affect the appearance of the patient on the localiser. Positioned too close to the x-ray tube, a patient appears considerably more voluminous. The goal of this study is to assess the difference in radiation exposure of combined chest and abdomen CT scans between scans with prior 0°- and 180°-localisers in conjunction with patient positioning. In this IRB-approved retrospective study, patients who had two routine thoracoabdominal CT scans on the same CT scanner, one with a prior 0°- and one with a prior 180°-localiser, were included. To evaluate the radiation exposure of the thoracoabdominal CT examination regarding the tube position during the localiser, volumetric computed tomography dose index (CTDIvol), size-specific dose estimate (SSDE), patient diameter and positioning within the iso-centre for three positions (heart, abdomen, femur level) were compared with regard to the tube position during the prior localiser. CT examinations of 114 patients were included. Despite similar patient weight and diameter between the two examinations, SSDE and CTDIvolwas significantly larger (up to 73%) with 180°-localisers. Patient offset from the iso-centre ranged between -9 mm at the centre slice (abdomen level) to -43 mm at the most caudal slice at the pelvis (femur level), causing a significant magnification (p < 0.001) on 180°-localisers with a subsequent increase of the apparent attenuation. The results of this study emphasise the use of 0°-localisers in thoracoabdominal CTs, since 180°-localisers caused patient magnification with subsequent increase in radiation exposure. The advantage of 180°-localisers, namely reducing the dose in thyroid and breast, is eliminated if the dose of the CT scan increases significantly in the abdomen and pelvis.
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Affiliation(s)
- Birte Valentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf D-40225, Germany
| | - Benedikt Kamp
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf D-40225, Germany
| | - Jan Henke
- University Dusseldorf, Medical Faculty, Department of Nuclear Medicine, Dusseldorf D-40225, Germany
| | - Alexandra Ljimani
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf D-40225, Germany
| | - Elisabeth Appel
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf D-40225, Germany
| | - Gerald Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf D-40225, Germany
| | - Andrea Steuwe
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf D-40225, Germany
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Jiang D, Wang Y, Zhang P, Liu Z. Comparison of image quality and radiation dose of different scanning methods used for computed tomography of the unilateral shoulder. Acta Radiol 2023; 64:1919-1926. [PMID: 36775984 DOI: 10.1177/02841851231153031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND The effect of different computed tomography (CT) scanning methods of the shoulder on image quality is uncertain. PURPOSE To compare the effect of different methods of CT scanning of the right shoulder on image quality and radiation dose. MATERIAL AND METHODS A total of 30 adults were divided into five groups. Group A received scans centered on the body's long axis, a scout direction of 0° + 90°, and automatic tube current modulation (ATCM). The other four groups (B, C, D, E) received isocenter scans centered on the shoulder with different scout directions (B and C: 0° + 90°, D: 0°, E: 0° + 270°) and tube currents (B: 420 mA; C, D, E: ATCM). The volume CT dose index (CTDIvol), dose-length product (DLP), image objective noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared. Three subjective measures were also compared (noise, stripe artifacts, diagnostic confidence). RESULTS The five groups differed significantly in all subjective and objective indexes. The CTDIvol and DLP decreased in the order of groups C, A, B, E, and D; the differences between groups A and B were not significant (P > 0.05). Groups B, C, and E had better SNR and CNR than groups A and D (P < 0.01). Subjective evaluations indicated group D was worse than groups B, C, and E (P < 0.05). CONCLUSION In the ATCM system that uses the last scout view, CT of the shoulder should use isocenter scanning with the lateral scout view when the tube is away from the long axis of the body as the last execution direction.
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Affiliation(s)
- Dongdong Jiang
- Department of Radiology, Wuhan Fourth Hospital, Wuhan, Hubei, PR China
| | - Yanan Wang
- Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Peng Zhang
- Department of Radiology, Wuhan Fourth Hospital, Wuhan, Hubei, PR China
| | - Zhenyu Liu
- Department of Radiology, Wuhan Fourth Hospital, Wuhan, Hubei, PR China
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Al-Hayek Y, Zheng X, Hayre C, Spuur K. The influence of patient positioning on radiation dose in CT imaging: A narrative review. J Med Imaging Radiat Sci 2022; 53:737-747. [PMID: 36280573 DOI: 10.1016/j.jmir.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Although it is fundamental for optimal scanner operation, it is generally accepted that accurate patient centring cannot always be achieved. This review aimed to examine the reported knowledge of the negative impact of patient positioning on radiation dose and image quality during CT imaging. Furthermore, the study evaluated the current optimisation tools and techniques used to improve patient positioning relative to the gantry iso-center. METHODOLOGY A comprehensive search through the databases PubMed, Ovid, and Google Scholar was performed. Keywords included patient off-centring, patient positioning, localiser radiograph orientation, radiation dose, and automatic patient positioning (including synonyms). The search was limited to full-text articles that were written in English. After initial title and abstract screening, a total of 52 articles were identified to address the aim of the review. No limitations were imposed on the year of publication. RESULTS Vertical off-centring was reported in up to 95% of patients undergoing chest and abdominal CT examinations, showing a significant influence on radiation dose. Depending on the scanner model and vendor, localiser orientation, bowtie filter used, and patient size, radiation dose varied from a decrease of 36% to an increase of 91%. A significant dose reduction was demonstrated when utilising an AP localiser, aligning with the trend for radiographers to off-center patients below the gantry iso-centre. Utilizing a 3D camera for body contour detection allowed for more accurate patient positioning and promoted further dose reduction. CONCLUSION Patient positioning has shown significant effects on radiation dose and image quality in CT. Developing a good understanding of the key factors influencing patient dose (off-centring direction, localiser orientation, patient size and bowtie filter selection) is critical in optimising CT scanning practices. Utilising a 3D camera for body contour detection is strongly recommended to improve patient positioning accuracy, image quality and to minimise patient dose.
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Affiliation(s)
- Yazan Al-Hayek
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia; Department of Medical Imaging, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, 13133, Jordan.
| | - Xiaoming Zheng
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
| | - Christopher Hayre
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, Devon, UK.
| | - Kelly Spuur
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
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Hu X, Yu Y. Explore the Value of Dual Source Computer Tomography Automatic Tube Current Regulation in Reducing the Radiation Dose of CTA in Lower Extremity Vessels. Front Surg 2022; 9:896370. [PMID: 35592130 PMCID: PMC9112657 DOI: 10.3389/fsurg.2022.896370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the value of dual source computer tomography automatic tube current regulation in reducing the radiation dose of CTA in lower limb vessels. Methods From February 2020 to December 2021, 64 patients with lower limb artery CTA were selected in our hospital because of the symptoms of foot ischemia. According to the random number table, patients were divided into control group (treated with fixed tube current technology) and observation group (treated with automatic tube current regulation technology), with 32 cases in each group. All patients underwent a dual source computer tomography scan. Control group: tube voltage 120 kV, tube current 250 mA; Observation group: tube voltage was 80 kV, and reference tube current was 80–380 mA. Other scanning conditions of patients in the two groups were the same. CTDIvol, DLP and calculated SNR and CNR were recorded to obtain the ED. Results The values of CTDIvol, DLP and ED in the observation group were lower than those in the control group (P < 0.05). There was no significant difference in CT value, SD value, SNR value and CNR value of the femoral artery segment, popliteal artery segment and posterior tibial artery segment between the two groups (P > 0.05). The image quality scores of patients in the control group were slightly higher than those in the observation group, but there was no statistical difference between the two groups (P > 0.05). Conclusion The application of dual source computer tomography automatic tube current adjustment technology in CTA examination of lower limb vessels can automatically adjust the compensation output and realize the output of different tube currents in different thicknesses, densities and angles. On the premise of not affecting the image quality, the radiation dose in the scanning process to the maximum extent, and reasonably protect the examined patients.
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Affiliation(s)
- Xin Hu
- Department of Guangdong Armed Police Corps Hospital, Medical Engineering, Guangzhou, Guangdong, China
| | - Yi Yu
- School of Foreign Languages of Guangdong University of Technology, Guangzhou, Guangdong, China
- Correspondence: Yi Yu
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Al‐Hayek Y, Zheng X, Davidson R, Hayre C, Al‐Mousa D, Finlay C, Spuur K. 0° vs. 180° CT localiser: The effect of vertical off-centring, phantom positioning and tube voltage on dose optimisation in multidetector computed tomography. J Med Radiat Sci 2022; 69:5-12. [PMID: 34402591 PMCID: PMC8892417 DOI: 10.1002/jmrs.535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Patient positioning is an essential consideration for the optimisation of radiation dose during CT examinations. The study objectives seek to explore the effects of vertical off-centring, localiser direction (0° and 180°), and phantom positioning (supine and prone) on radiation dose, using three different tube voltages in multidetector computed tomography (MDCT) imaging. METHODS The trunk of a PBU-60 anthropomorphic phantom was imaged using a Discovery CT750 HD - 128 slice (GE Healthcare). Images employing 0° and 180° localisers were acquired in supine and prone orientation for each combination of vertical off-centring (±100, ±60 and ±30 mm) and different tube voltages (80, 120 and 140 kVp), using the system's automatic tube current modulation (ATCM) function. The displayed volume CT dose index (CTDIvol ) and dose length product (DLP) were recorded. RESULTS With incremental table off-centring of ±100 mm, the dose at 120 kVp in the supine position ranged from 63% to 196% (0° localiser) and from 66% to 191% (180° localiser) as compared to iso-centre. While in the prone position, the dose ranged from 62% to 195% (0° localiser); and 62% to 193% (180° localiser), with a notable dose increase at higher tube voltages. Dose variation and vertical off-centring showed a significant relationship for both 0° and 180° localisers (r = 0.94 and 0.96, respectively, P < 0.001). The CTDIvol variation between supine and prone phantom positions at ±100 mm off-centring was 0.22 mGy (2.9%), and 0.19 mGy (2.3%) when the 0° and 180 ° localisers were utilised, respectively. CONCLUSIONS Phantom off-centring and localiser direction evidenced large dose variation. It is recommended that the 0° localiser is employed during CT examinations, in order to minimise the potential additional radiation dose which may result from off-centring and the use of lower tube voltages where clinically appropriate.
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Affiliation(s)
- Yazan Al‐Hayek
- Medical Radiation ScienceSchool of Dentistry and Health SciencesFaculty of Science and HealthCharles Sturt UniversityWagga WaggaNew South WalesAustralia
- Medical ImagingFaculty of Applied Health SciencesThe Hashemite UniversityZarqaJordan
| | - Xiaoming Zheng
- Medical Radiation ScienceSchool of Dentistry and Health SciencesFaculty of Science and HealthCharles Sturt UniversityWagga WaggaNew South WalesAustralia
| | - Rob Davidson
- Medical Radiation ScienceSchool of Health SciencesFaculty of HealthUniversity of CanberraCanberraAustralian Capital TerritoryAustralia
| | - Christopher Hayre
- Medical Radiation ScienceSchool of Dentistry and Health SciencesFaculty of Science and HealthCharles Sturt UniversityWagga WaggaNew South WalesAustralia
- School of Health and Sport SciencesUniversity of SuffolkIpswichSuffolkUK
| | - Dana Al‐Mousa
- Allied Medical SciencesFaculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | | | - Kelly Spuur
- Medical Radiation ScienceSchool of Dentistry and Health SciencesFaculty of Science and HealthCharles Sturt UniversityWagga WaggaNew South WalesAustralia
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Cournane S, Reade M, McCavana J, Lucey J. MODELLING AUTOMATIC EXPOSURE CONTROL RESPONSE TO THE PRESENCE OF THE PATIENT SCANNING BED IN A HYBRID PET/CT SCANNER. RADIATION PROTECTION DOSIMETRY 2021; 196:199-206. [PMID: 34635915 DOI: 10.1093/rpd/ncab151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/24/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Automatic Exposure Control (AEC) systems optimise radiation dose to the patient while providing adequate image quality. This study examined the effect that the increased localiser region of interest of a hybrid PET/CT has on the CTDIvol, focussing on the role of extraneous objects and patient attenuation profiles. A Siemens Biograph™ 16 Horizon PET/CT system and a Siemens Somatom Sensation 64, both employing the Siemens CAREDose 4D AEC system, were used for acquisition of a range of phantoms. The effect of patient miscentring and effect of the patient bed impinging on the localiser was established and modelled. For PA localiser scans, a non-linear relationship between miscentring and CTDIvol was observed, attributable to the presence of the patient bed being misinterpreted as the patient width. The model identified how the presence of the patient bed led to an increase in the CTDIvol significantly larger than expected (~12%, or 1 mSv), particularly prevalent for smaller patients.
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Affiliation(s)
- Seán Cournane
- St Vincent's University hospital (SVUH), Elm Park, Dublin 4, Ireland
- Centre for Physics in Health and Medicine (CPHM), School of Physics, Science Centre North, University College Dublin, Belfield, Dublin 4, Ireland
| | - Matthew Reade
- National University of Ireland, Galway (NUIG), University Road, Galway, Ireland
| | - Jackie McCavana
- St Vincent's University hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - Julie Lucey
- St Vincent's University hospital (SVUH), Elm Park, Dublin 4, Ireland
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Zheng X, Gutsche L, Al-Hayek Y, Stanton J, Elshami W, Jensen K. Impacts of Phantom Off-Center Positioning on CT Numbers and Dose Index CTDIv: An Evaluation of Two CT Scanners from GE. J Imaging 2021; 7:jimaging7110235. [PMID: 34821866 PMCID: PMC8625132 DOI: 10.3390/jimaging7110235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/17/2022] Open
Abstract
The purpose of this work is to evaluate the impacts of body off-center positioning on CT numbers and dose index CTDIv of two scanners from GE. HD750 and APEX scanners were used to acquire a PBU60 phantom of Kagaku and a 062M phantom of CIRS respectively. CT images were acquired at various off-center positions under automatic tube current modulation using various peak voltages. CTDIv were recorded for each of the acquisitions. An abdomen section of the PBU60 phantom was used for CT number analysis and tissue inserts of the 062M phantom were filled with water balloons to mimic the human abdomen. CT numbers of central regions of interests were averaged using the Fiji software. As phantoms were lifted above the iso-center, both CTDIv and CT numbers were increased for the HD750 scanner whilst they were approximately constant for the APEX scanner. The measured sizes of anterior-posterior projection images were also increased for both scanners whilst the sizes of lateral projection images were increased for the HD750 scanner but decreased for the APEX scanner. Off-center correction algorithms were implemented in the APEX scanner. Matching the X-ray projection center with the system's iso-center could improve the accuracy of CT imaging.
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Affiliation(s)
- Xiaoming Zheng
- Medical Radiation Science, School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia; (L.G.); (Y.A.-H.)
- Correspondence: ; Tel.: +61-2-6933-2068
| | - Lachlan Gutsche
- Medical Radiation Science, School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia; (L.G.); (Y.A.-H.)
| | - Yazan Al-Hayek
- Medical Radiation Science, School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia; (L.G.); (Y.A.-H.)
| | - Johanna Stanton
- I-Med Radiology Network, 36 Hardy Ave, Wagga Wagga, NSW 2650, Australia;
| | - Wiam Elshami
- Department of Diagnostic Imaging, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - Kelsey Jensen
- Veterinary Clinical Center, School of Agricultural Environmental and Veterinary Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2678, Australia;
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Perisinakis K, Ntoufas N, Velivassaki M, Tzedakis A, Myronakis M, Hatzidakis A, Damilakis J. Effect of scan projection radiography coverage on tube current modulation in pediatric and adult chest CT. Z Med Phys 2020; 30:259-270. [PMID: 32513526 DOI: 10.1016/j.zemedi.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/22/2020] [Accepted: 05/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the effect of scan projection radiography (SPR) coverage on tube current modulation in pediatric and adult thoracic CT examinations. METHODS Sixty pediatric and 60 adult chest CT examinations were retrospectively studied to determine the incidence rate of examinations involving SPRs that did not include the entire image volume (IV) or the entire primarily exposed body volume (PEBV). The routine chest CT acquisition procedure on a modern 64-slice CT system was imitated on five anthropomorphic phantoms of different size. SPRs of varying length were successively acquired. The same IV was prescribed each time and the computed tube current modulation plan was recorded. The SPR boundaries were altered symmetrically by several steps of ±10mm with respect to the IV boundaries. RESULTS The upper IV boundary was found to be excluded from SPR in 52% of pediatric and 40% adult chest CT examinations. The corresponding values for the lower boundary were 15% and 20%, respectively. The computed tube current modulation was found to be considerably affected when the SPR did not encompass the entire IV. SPR deficit of 3cm was found to induce up to 46% increase in the computed tube current value to be applied during the first tube rotations over lung apex. CONCLUSIONS The tube current modulation mechanism functions properly only if the IV set by the operator is entirely included in the localizing SPR image. Operators should cautiously set the SPR boundaries to avoid partial exclusion of prescribed IV from SPRs and thus achieve optimum tube current modulation.
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Affiliation(s)
- Kostas Perisinakis
- University of Crete, Medical School, Department of Medical Physics, 71003 Heraklion, Crete, Greece; University Hospital of Heraklion, Department of Medical Physics, P.O. Box 1352, 71110 Heraklion, Crete, Greece.
| | - Nikos Ntoufas
- University of Crete, Medical School, Department of Medical Physics, 71003 Heraklion, Crete, Greece
| | - Mary Velivassaki
- University Hospital of Heraklion, Department of Medical Physics, P.O. Box 1352, 71110 Heraklion, Crete, Greece
| | - Antonis Tzedakis
- University Hospital of Heraklion, Department of Medical Physics, P.O. Box 1352, 71110 Heraklion, Crete, Greece
| | - Marios Myronakis
- University of Crete, Medical School, Department of Medical Physics, 71003 Heraklion, Crete, Greece; Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School
| | - Adam Hatzidakis
- University of Crete, Medical School, Department of Radiology, Heraklion, Crete, Greece
| | - John Damilakis
- University of Crete, Medical School, Department of Medical Physics, 71003 Heraklion, Crete, Greece; University Hospital of Heraklion, Department of Medical Physics, P.O. Box 1352, 71110 Heraklion, Crete, Greece
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Eberhard M, Blüthgen C, Barth BK, Frauenfelder T, Saltybaeva N, Martini K. Vertical Off-Centering in Reduced Dose Chest-CT: Impact on Effective Dose and Image Noise Values. Acad Radiol 2020; 27:508-517. [PMID: 31358357 DOI: 10.1016/j.acra.2019.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the effect of vertical off-centering in tube current modulation (TCM) on effective-dose and image-noise in reduced-dose (RD) chest-CT. METHODS One-hundred consecutive patients (36 female; mean age 56 years) were scanned on a 192-slice CT scanner with a standard-dose (ND) and a RD chest-CT protocol using tube current modulation. Image-noise was evaluated by placing circular regions of interest in the apical, middle, and lower lung regions. Two independent readers evaluated image quality. Study population was stratified according to patient position in the gantry: positioned in the gantry isocenter (i), higher than the gantry isocenter (ii), and lower than the gantry isocenter, (iii). Pearson correlation was used to determine the correlation between effective radiation dose and vertical off-centering. Student's t test was used to evaluate for differences in image-noise between groups (i-iii). RESULTS Mean vertical off-centering was of 10.6 mm below the gantry-isocenter (range -45.0-27.9 mm). Effective radiation dose varied in a linear trend, with the highest doses noted below gantry isocenter, and the lowest doses noted above gantry isocenter (ND: r = -0.296; p = 0.003 - RD: r = -0.258; p = 0.010). Lowest image-noise was observed where patients were positioned below the gantry isocenter, and highest in patients positioned above (ND: 79.35 HU vs. 94.86 HU - RD: 143.44 HU vs. 160.13 HU). Subjective image quality was not significantly affected by patient-position (p > 0.05). Overall, there was no over-proportional noise-increase from the ND to the RD protocol in patients which were positioned off-center. CONCLUSION Vertical off-centering influences effective radiation dose and image-noise on ND and RD protocols. ADVANCES IN KNOWLEDGE There is no over-proportional noise increase in RD compared to ND protocols when patients are positioned off-center.
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Affiliation(s)
- Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Christian Blüthgen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Borna K Barth
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Natalia Saltybaeva
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
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Wu D, Wang G, Bian B, Liu Z, Li D. Benefits of Low-Dose CT Scan of Head for Patients With Intracranial Hemorrhage. Dose Response 2020; 19:1559325820909778. [PMID: 32214915 PMCID: PMC7065437 DOI: 10.1177/1559325820909778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/23/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: For patients with intracranial hemorrhage (ICH), routine follow-up computed tomography (CT) scans are typically required to monitor the progression of intracranial pathology. Remarkable levels of radiation exposure are accumulated during repeated CT scan. However, the effects and associated risks have still remained elusive. This study presented an effective approach to quantify organ-specific radiation dose of repeated CT scans of head for patients with ICH. We also indicated whether a low-dose CT scan may reduce radiation exposure and keep the image quality highly acceptable for diagnosis. Methods: Herein, 72 patients with a history of ICH were recruited. The patients were divided into 4 groups and underwent CT scan of head with different tube current–time products (250, 200, 150, and 100 mAs). Two experienced radiologists visually rated scores of quality of images according to objective image noise, sharpness, diagnostic acceptability, and artifacts due to physiological noise on the same workstation. Organ-/tissue-specific radiation doses were analyzed using Radimetrics. Results: In conventional CT scan group, signal to noise ratio (SNR) and contrast to noise ratio (CNR) of ICH images were significantly higher than those in normal brain structures. Reducing the tube current–time product may decrease the image quality. However, the predilection sites for ICH could be clearly identified. The SNR and CNR in the predilection sites for ICH were notably higher than other areas. The brain, eye lenses, and salivary glands received the highest radiation dose. Reducing tube current–time product from 250 to 100 mA can significantly reduce the radiation dose. Discussion: We demonstrated that low-dose CT scan of head can still provide reasonable images for diagnosing ICH. The radiation dose can be reduced to ∼45% of the conventional CT scan group.
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Affiliation(s)
- Dan Wu
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Gang Wang
- Department of Orthopedics, The Third Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Bingyang Bian
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Zhuohang Liu
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Dan Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Inoue Y, Itoh H. Effects of scout radiographic imaging conditions on tube current modulation in chest computed tomography. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:253-269. [PMID: 31914423 DOI: 10.1088/1361-6498/ab694b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
For the optimisation of radiation dose in computed tomography (CT), dose reduction is attempted while preserving diagnostic performance. To reduce the overall radiation dose related to CT, the dose from scout radiography may be reduced by decreasing the tube voltage and tube current. We evaluated the effects of scout imaging conditions on CT radiation dose. An anthropomorphic chest phantom was imaged on two CT scanners (scanners A and B) from different vendors, manipulating the scout imaging conditions in terms of imaging direction, tube voltage and tube current, and assessed the tube current modulation in subsequent CT and pixel values in scout radiographs. The direction of the scout radiography influenced the shape of the tube current modulation curve and total radiation dose in subsequent CT. When compared with the use of the lateral projection, use of the posteroanterior or anteroposterior projection alone increased the radiation dose substantially on scanner A, but did not change, or mildly decreased, the dose on scanner B. When imaged using the lateral scout on scanner A, reduction in tube voltage and tube current for scout radiography decreased the CT dose in the cranial part of the scan range and, to a lesser degree, the total radiation dose. On the low-voltage, low-current lateral radiograph, the image contrast was impaired and pixel values were underestimated around the lung apex. Without the use of the lateral radiograph, neither the tube voltage nor tube current for scout radiography influenced the CT dose. On scanner B, reduced tube voltage for scout radiography increased the CT dose. In conclusion, reduced tube voltage and tube current may affect scout radiographs, resulting in alteration of the tube current modulation pattern and total radiation dose in subsequent CT. These effects vary depending on the CT scanners and scout direction.
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Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Japan
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Hoye J, Sharma S, Zhang Y, Fu W, Ria F, Kapadia A, Segars WP, Wilson J, Samei E. Organ doses from CT localizer radiographs: Development, validation, and application of a Monte Carlo estimation technique. Med Phys 2019; 46:5262-5272. [PMID: 31442324 DOI: 10.1002/mp.13781] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/01/2019] [Accepted: 08/15/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The purpose of this study was to simulate and validate organ doses from different computed tomography (CT) localizer radiograph geometries using Monte Carlo methods for a population of patients. METHODS A Monte Carlo method was developed to estimate organ doses from CT localizer radiographs using PENELOPE. The method was validated by comparing dosimetry estimates with measurements using an anthropomorphic phantom imbedded with thermoluminescent dosimeters (TLDs) scanned on a commercial CT system (Siemens SOMATOM Flash). The Monte Carlo simulation platform was then applied to conduct a population study with 57 adult computational phantoms (XCAT). In the population study, clinically relevant chest localizer protocols were simulated with the x-ray tube in anterior-posterior (AP), right lateral, and PA positions. Mean organ doses and associated standard deviations (in mGy) were then estimated for all simulations. The obtained organ doses were studied as a function of patient chest diameter. Organ doses for breast and lung were compared across different views and represented as a percentage of organ doses from rotational CT scans. RESULTS The validation study showed an agreement between the Monte Carlo and physical TLD measurements with a maximum percent difference of 15.5% and a mean difference of 3.5% across all organs. The XCAT population study showed that breast dose from AP localizers was the highest with a mean value of 0.24 mGy across patients, while the lung dose was relatively consistent across different localizer geometries. The organ dose estimates were found to vary across the patient population, partially explained by the changes in the patient chest diameter. The average effective dose was 0.18 mGy for AP, 0.09 mGy for lateral, and 0.08 mGy for PA localizer. CONCLUSION A platform to estimate organ doses in CT localizer scans using Monte Carlo methods was implemented and validated based on comparison with physical dose measurements. The simulation platform was applied to a virtual patient population, where the localizer organ doses were found to range within 0.4%-8.6% of corresponding organ doses for a typical CT scan, 0.2%-3.3% of organ doses for a CT pulmonary angiography scan, and 1.1%-20.8% of organ doses for a low-dose lung cancer screening scan.
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Affiliation(s)
- Jocelyn Hoye
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Duke University, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
| | - Shobhit Sharma
- Department of Physics, Carl E. Ravin Advanced Imaging Laboratories, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
| | - Yakun Zhang
- Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
| | - Wanyi Fu
- Department of Electrical and Computer Engineering, Carl E. Ravin Advanced Imaging Laboratories, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
| | - Francesco Ria
- Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
| | - Anuj Kapadia
- Departments of Radiology and Physics, Medical Physics Graduate Program, Carl E. Ravin Advanced Imaging Laboratories, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
| | - W Paul Segars
- Departments of Radiology, Biomedical Engineering, Medical Physics Graduate Program, Carl E. Ravin Advanced Imaging Laboratories, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
| | - Joshua Wilson
- Medical Physics Graduate Program, Clinical Imaging Physics Group, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
| | - Ehsan Samei
- Medical Physics Graduate Program, Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA.,Departments of Radiology, Physics, Biomedical Engineering, and Electrical and Computer Engineering, Carl E. Ravin Advanced Imaging Laboratories, 2424 Erwin Rd, Suite 302, Durham, NC, 27705, USA
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Lin Y, Ouyang Y, Chen K, Lu Z, Liu Y, Cao X. Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience. Front Oncol 2019; 9:760. [PMID: 31475110 PMCID: PMC6707003 DOI: 10.3389/fonc.2019.00760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate treatment outcomes and toxicity in patients with cervical cancer (CC) treated with volumetric modulated arc therapy (VMAT), followed by three-dimensional high-dose-rate intracavity combined with interstitial brachytherapy (IC/IS BT) compared with intensity-modulated radiation therapy (IMRT) treatment. Materials and Methods: A total of 398 patients with stage IA–IVB CC treated with definitive radiotherapy with or without chemotherapy were retrospectively analyzed (331 VMAT and 67 IMRT). A total prescription dose of 45–50 Gy was delivered to pelvic field with VMAT/IMRT in 25/28 fractions, with five fractions per week. Every patient further received IC/IS BT for four to six 6.0-Gy fractions. Local control (LC), disease-free survival (DFS), overall survival (OS), and distant metastasis-free survival (DMFS) rates were calculated. Acute hematotoxicity and late toxicity were recorded. Results: The median follow-up period was 25.47 (range, 0.93–58.93) months for the VMAT and 35.07 (4.8–90.37) months for IMRT. The 3-year OS, DFS, LC, and DMFS rate were 80.5, 65.4, 88.7, and 78.1% in VMAT group, and 76.2, 76.4, 83.1, and 86.1% in the IMRT group, respectively. No significant differences were found between VMAT and IMRT groups for OS, DFS, LC, and DMFS rate. However, patients in the VMAT group had lower incidence of chronic enterocolitis complication (26.6 vs. 38.8%, p = 0.004). In addition, a total of 3 (0.9%) patients developed grade 3 chronic cystitis, and 7 (2.1%) patients developed grade 3 or greater chronic enterocolitis in VMAT group. Conclusion: VMAT combined with IC/IS BT can result in satisfactory curative outcomes and low incidences of late radiation enterocolitis and cystitis in CC treatment.
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Affiliation(s)
- Yanzhu Lin
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yi Ouyang
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kai Chen
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiyuan Lu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yonghong Liu
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xinping Cao
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Cournane S, Brunell E, Rowan M. Establishing how patient size and degree of miscentring affect CTDI vol, using patient data from a dose tracking system. Br J Radiol 2019; 92:20180992. [PMID: 31112413 DOI: 10.1259/bjr.20180992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The work aimed to investigate and model the relationship between CT dose index (CTDIvol), patient size and miscentring metrics using data extracted from a dose tracking software tool. Further, using the established model we aimed to extract and estimate further AEC metrics and, finally, demonstrate how the CTDIvol may vary across a range of imaging exams and with variations in patient size, positional metrics and with scan parameters. METHODS CT scan parameters, patient dose metrics, patient positioning information and patient and water equivalent diameter information was extracted from abdomen, thorax-abdomen-pelvis and thorax imaging exams acquired on a 128-slice Siemens Somatom Definition AS + CT system using dose tracking software over a 1 year period. A miscentring factor, accounting for the magnification of the patient due to miscentring was derived. Significant predictors ( p-value < 0.001) of the CTDIvol were considered as inputs into the model following regression analysis. RESULTS The model was capable of describing the CTDIvol and its variation with patient miscentring and patient size. AEC parameters, such as the reference CTDIvol, reference diameter and the AEC strength were estimated. Further, the model allowed for comparisons of how changes in scan settings, such as kVp, pitch and slice thickness affected CTDIvol. CONCLUSIONS We demonstrate the use of clinical data, extracted from dose tracking software, to investigate and monitor AEC behaviour and CT output. ADVANCES IN KNOWLEDGE The presented model allows for the remote investigation of AEC behaviour using patient data.
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Affiliation(s)
- Sean Cournane
- 1 Department of Medical Physics and Bioengineering, St James's hospital , Dublin , Ireland
| | - Eimear Brunell
- 2 Department Medical Physics and Clinical engineering, Tallaght University Hospital , Dublin , Ireland
| | - Michael Rowan
- 3 Department of Radiology, Mater Misericordiae Hospital , Dublin , Ireland
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Akin-Akintayo OO, Alexander LF, Neill R, Krupinksi EA, Tang X, Mittal PK, Small WC, Moreno CC. Prevalence and Severity of Off-Centering During Diagnostic CT: Observations From 57,621 CT scans of the Chest, Abdomen, and/or Pelvis. Curr Probl Diagn Radiol 2019; 48:229-234. [DOI: 10.1067/j.cpradiol.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 11/22/2022]
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Alkadhi H, Saltybaeva N. Lost Opportunities: Radiologists Are Not Sufficiently Using Reduced-Dose CT for Kidney Stones. Radiology 2018; 286:590-591. [DOI: 10.1148/radiol.2017172169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr 100, CH-8091 Zurich, Switzerland
| | - Natalia Saltybaeva
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr 100, CH-8091 Zurich, Switzerland
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Saltybaeva N, Alkadhi H. Vertical off-centering affects organ dose in chest CT: Evidence from Monte Carlo simulations in anthropomorphic phantoms. Med Phys 2017; 44:5697-5704. [DOI: 10.1002/mp.12519] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/13/2017] [Accepted: 07/29/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Natalia Saltybaeva
- Institute of Diagnostic and Interventional Radiology; University of Zurich; Ramistrasse 100 8091 Zurich Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology; University of Zurich; Ramistrasse 100 8091 Zurich Switzerland
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