Investigating the CT localizer radiograph: acquisition parameters, patient centring and their combined influence on...

To systematically investigate the effect of CT localizer radiograph acquisition on the tube current modulation and thus radiation dose of the subsequent diagnostic scan.

Localizer radiographs of an abdominal section CT phantom were taken, and the resulting volume CT dose index (CTDIvol) for the diagnostic scan was recorded. Variables included tube potential, the phantom's alignment within the CT scanner gantry in both the vertical and horizontal directions and the X-ray source angle at which the localizer was acquired.

Diagnostic scan CTDIvol decreased with increasing tube potential. Vertical (table height) movement was found to affect radiation dose more than horizontal movement, with ±50 mm table movement resulting in a standard deviation in the diagnostic scan CTDIvol of 4.4 mGy, compared with 2.5 mGy with ±50 mm horizontal movement. Correspondingly, localizer angles of 90° or 270° (3 o'clock and 9 o'clock X-ray source positions) were less sensitive overall to alignment errors, with a standard deviation of 2.5 mGy, compared with a 0° or 180° angle, which had a standard deviation of 3.8 mGy.

To achieve a consistently optimized radiation dose, the localizer protocol should be paired with the diagnostic acquisition protocol. A final acquisition angle of 90° should be used when possible to minimize dose variation resulting from alignment errors.

Localizer parameters that affect radiation output were identified for this scanner system. The importance of tube potential and acquisition angle was highlighted.