A Monte Carlo estimation of effective dose in chest tomosynthesis

The recent introduction of digital tomosynthesis imaging into routine clinical use has enabled the acquisition of volumetric patient data within a standard radiographic examination. Tomosynthesis requires the acquisition of multiple projection views, requiring additional dose compared to a standard projection examination. Knowledge of the effective dose is needed to make an appropriate decision between standard projection, tomosynthesis, and CT for thoracic x-ray examinations. In this article, the effective dose to the patient of chest tomosynthesis is calculated and compared to a standard radiographic examination and to values published for thoracic CT.

Radiographic technique data for posterior-anterior (PA) and left lateral (LAT) radiographic chest examinations of medium-sized adults was obtained from clinical sites. From these data, the average incident air kerma for the standard views was determined. A commercially available tomosynthesis system was used to define the acquisition technique and geometry for each projection view. Using Monte Carlo techniques, the effective dose of the PA, LAT, and each tomosynthesis projection view was calculated. The effective dose for all projections of the tomosynthesis sweep was summed and compared to the calculated PA and LAT values and to the published values for thoracic CT.

The average incident air kerma for the PA and left lateral clinical radiographic examinations were found to be 0.10 and 0.40 mGy, respectively. The effective dose for the PA view of a patient of the size of an average adult male was determined to be 0.017 mSv (ICRP 60) [0.018 mSv (ICRP 103)]. For the left lateral view of the same sized patient, the effective dose was determined to be 0.039 mSv (ICRP 60) [0.050 mSv (ICRP 103)]. The cumulative mA s for a tomosynthesis examination is recommended to be ten times the mA s of the PA image. With this technique, the effective dose for an average tomosynthesis examination was calculated to be 0.124 mSv (ICRP60) [0.134 mSv (ICRP103)]. This is less than 75% of that predicted by scaling of the PA mA s ratio. This lower dose was due to changes in the focal-spot-to-skin distance, effective changes in collimation with projection angle, rounding down of the mA s step, and variations in organ exposure to the primary x-ray beam for each view. Large errors in dose estimation can occur if these factors are not accurately modeled.

The effective dose of a chest examination with this chest tomosynthesis system is about twice that of a two-view chest examination and less than 2% of the published average values for thoracic CT. It is shown that complete consideration of the tomosynthesis acquisition technique and geometry is required for accurate determination of the effective dose to the patient. Tomosynthesis provides three-dimensional imaging at a dose level comparable to a two-view chest x-ray examination and may provide a low dose alternative to thoracic CT for obtaining depth information in chest imaging.