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Influence of Off-Centre Positioning, Scan Direction, and Localiser Projection Angle on Organ-Specific Radiation Doses

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Summary

Protocol variations in low-dose CT lung cancer screening significantly impact organ doses due to automatic tube current modulation (ATCM) differences across vendors. Scanner-specific optimization is crucial for accurate dose assessment.

Keywords:
Monte Carlo simulationsautomatic tube current modulationlocaliser radiographlow-dose computed tomographylung cancer screeningoff-centre positioningradiation dosimetryscan direction

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Area of Science:

  • Medical Physics
  • Radiological Imaging
  • Radiation Dosimetry

Background:

  • Low-dose CT lung cancer screening involves numerous examinations, increasing the likelihood of variations in patient positioning and scan parameters.
  • These variations can affect automatic tube current modulation (ATCM) performance, but organ-specific dose implications across different CT scanner models are not well understood.

Purpose of the Study:

  • To systematically investigate the impact of variations in participant positioning, scan direction, and localiser angle on organ doses in low-dose CT lung cancer screening.
  • To characterize these effects across CT scanners from major vendors (GE, Siemens, Canon, Philips).

Main Methods:

  • Utilized the Alderson RANDO phantom and 32 patient-specific voxel models for Monte Carlo simulations.
  • Established ATCM profiles on four vendors' scanners, introducing vertical/lateral mispositioning, craniocaudal/caudocranial scan directions, and varied localiser angles (single PA or dual PA+lateral).
  • Calculated doses to organs including lungs, heart, thyroid, liver, and breasts for each setup.

Main Results:

  • Demonstrated statistically significant and scanner-dependent dose variations. Posteroanterior (PA) localisers generally yielded higher organ doses.
  • Philips showed >50% dose increase after lateral projection; GE and Siemens had pronounced increases with downward mispositioning and single PA localisers (18-50% and 5-25%), mitigated by dual localisers.
  • Canon and Philips showed stable ATCM with vertical off-centring, but Canon had notable increases with lateral mispositioning (up to 37.5%). Scan direction effects were model- and organ-dependent, with dual localisers mitigating deviations on GE, Canon, and Philips (within 10%). Siemens showed persistent significant differences (20-35% lower lung, heart, breast, liver doses with craniocaudal scans).

Conclusions:

  • Minor protocol deviations in low-dose CT lung cancer screening can lead to significant underestimation of organ-specific doses.
  • Scanner-specific optimization, informed by medical physics expertise, is essential for accurate radiation dose assessment and patient safety.