Calculation of scan length and size-specific dose at longitudinal positions of body CT scans using dose equilibrium...

Dose evaluation at longitudinal positions of body computed tomography (CT) scans is useful for CT quality assurance programs and patient organ dose evaluation. Accurate estimates depend on both patient size and scan length.

To propose practical evaluation of the average dose to the transverse slab of an axial image slice for adult body CT examinations, considering not only patient size but also scan length, and to compare the results with those of Monte Carlo (Geant4) simulation [D_sim (z)] and size-specific dose estimates at longitudinal positions of scans [SSDE(z)] from international standards (IEC publication no. 62985).

In a scan series, the total dose at each z-axis location was calculated using the input information identical to the SSDE(z) evaluation. Each axial image slice (slice thickness, 2.5 or 5 mm) was first considered independently. Its z-axis coverage and CTDI_vol (from the DICOM headers) were used to directly calculate a z-axis dose profile for the average dose over the cross-section of a water phantom, using the approach to equilibrium function. The phantom diameter was taken to be equal to the patient water equivalent diameter at that slice. The above was repeated at all slices and the dose at each z-axis location was accumulated from all profiles, referred to as D_calc (z). For validation, we considered a cohort of 65 patients, who underwent chest and abdominopelvic examinations. The resultant D_calc (z) was compared with D_sim (z) and SSDE(z), both available in a previous paper.

D_calc (z) evaluation could be used to accurately assess the scan range average dose, with an accuracy of 7.1%-8.7% for 65 patients in two examinations. On individual image slices, the maximum difference in magnitude between D_calc (z) and D_sim (z) [and between SSDE(z) and D_sim (z) in parentheses] was 37.5% (85%) [two edges (2 × 5 cm) of chest scan range], 17.8% (35.2%) (the remaining central region of chest scan), 26.8% (74.1%) [two edges (2 × 5 cm) of abdominopelvic scan range], and 14.2% (22.5%) (the remaining central region of abdominopelvic scan).

Identical input data are used for D_calc (z) and SSDE(z) evaluations. The latter is limited to the z-axis locations within scan range. At each image slice, SSDE(z) is equivalent to the midpoint dose of a fixed-mA scan of 15-30 cm (scan length). In contrast, D_calc (z) considers dose accumulation from varying scan length (from sub-centimeter to about 1 m) and tube current, and dose profile is also computed outside scan range. Besides greatly improving dose evaluation for individual image slices, D_calc (z) allows for evaluating dose accumulation from multiple series, which typically span different scan ranges. Our proposal may assist CT manufacturers and dose index monitoring software in assessing dose at longitudinal positions of body CT scans.