Effects of protocol and obesity on dose conversion factors in adult body CT

In computed tomography (CT), organ dose, effective dose, and risk index can be estimated from volume-weighted CT dose index (CTDI(vol)) or dose-length product (DLP) using conversion coefficients. Studies have investigated how these coefficients vary across scanner models, scan parameters, and patient size. However, their variability across CT protocols has not been systematically studied. Furthermore, earlier studies of the effect of patient size have not included obese individuals, which currently represent more than one-third of U.S. adults. The purpose of this study was to assess the effects of protocol and obesity on dose and risk conversion coefficients in adult body CT.

Whole-body computational phantoms were created from clinical CT images of six adult patients (three males, three females), representing normal-weight patients and patients of three obesity classes. Body CT protocols at our institution were selected and categorized into ten examination categories based on anatomical region examined. A validated Monte Carlo program was used to estimate organ dose. Organ dose estimates were normalized by CTDI(vol) and size-specific dose estimate (SSDE) to obtain organ dose conversion coefficients (denoted as h and h(ss) factors, respectively). Assuming each phantom to be 20, 40, and 60 years old, effective dose and risk index were calculated and normalized by DLP to obtain effective dose and risk index conversion coefficients (denoted as k and q factors, respectively). Coefficient of variation was used to quantify the variability of each conversion coefficient across examination categories. The effect of obesity was assessed by comparing each obese phantom with the normal-weight phantom of the same gender.

For a given organ, the variability of h factor across examination categories that encompassed the entire organ volume was generally within 15%. However, k factor varied more across examination categories (15%-27%). For all three ages, the variability of q factor was small for male (<10%), but large for female phantoms (21%-43%). Relative to the normal-weight phantoms, the reduction in h factor (an average across fully encompassed organs) was 17%-42%, 17%-40%, and 51%-63% for obese-class-I, obese-class-II, and obese-class-III phantoms, respectively. h(ss) factor was not independent of patient diameter and generally decreased with increasing obesity. Relative to the normal-weight phantoms, the reduction in k factor was 12%-40%, 14%-46%, and 44%-59% for obese-class-I, obese-class-II, and obese-class-III phantoms, respectively. The respective reduction in q factor was 11%-36%, 17%-42%, and 48%-59% at 20 years of age and similar at other ages.

In adult body CT, dose to an organ fully encompassed by the primary radiation beam can be estimated from CTDI(vol) using a protocol-independent conversion coefficient. However, fully encompassed organs only account for 50% ± 19% of k factor and 46% ± 24% of q factor. Dose received by partially encompassed organs is also substantial. To estimate effective dose and risk index from DLP, it is necessary to use conversion coefficients specific to the anatomical region examined. Obesity has a significant effect on dose and risk conversion coefficients, which cannot be predicted using body diameter alone. SSDE-normalized organ dose is not independent of diameter. SSDE itself generally overestimates organ dose for obese patients.