A CT X-ray Dose Crash Course

Clinical Population
Diagnostic Dose
Confidence Risk

GE Medical Systems
Tom Toth

1
Introduction
n What is X-ray dose
n How is dose measured in CT
n Regulations regarding dose
n Reducing Patient Dose

2
 What is Dose ?
Absorbed energy from exposure to ionizing radiation

X-ray Photons

L
K

Genetically
Genetically damages
damages or
or kills
kills living
living cells
cells
3
 Dose Measurement Units
• Exposure
• air kerma (mGy) (Roentgen is old unit, 87.6 mGy = 1 R)
– kerma - kinetic energy released in material
• 1 mGy is approximately 3 ×10-6 Coulombs /kg

• Dose - Energy absorbed by patient or material

• milli-Gray (mGy) (rads is old unit, 10 mGy =1 rad )

• Dose Equivalent (Dose of X-rays having the same biological effect,)

• Sievert (Sv) (old unit is the rem)
(1mSv = 1 mGy at diagnostic X-ray energies)

4
 Acute
Acutebiological
biologicaleffects
effectsof
ofIonizing
IonizingRadiation
Radiation

Exposure
ExposureLevels
LevelsatatWhich
WhichHealth
HealthEffects
EffectsAppear
AppearininHealthy
HealthyAdults
Adults

Effects Acute whole body dose (mGy)

Blood count changes 500

Vomiting (threshold) 1000
Mortality (threshold) 1500

Acute
AcuteWhole-body
Whole-bodyRadiation
RadiationSyndromes
Syndromes

Syndrome Acute dose (Gy) Characteristics/Sequellae

Subclinical syndrome < 2 Subclinical

Hematopoietic syndrome 2-4 Granulocytopenia, thrombocytopenia, hemorrhage,
infection, electrolyte imbalance
Gastrointestinal syndrome 6-10 Lethargy, diarrhea, dehydration, degeneration
of bowel epithelium, death in 10-14 days
Central Nervous syndrome > 10 Agitation, apathy, disorientation, disturbed
equilibrium, vomiting, opisthotonus,
convulsions, prostration, coma, death in 1-2
days
__________________________________________________________________________________________
From: NCRP Report 98 "Guidance on Radiation Received in Space Activities", NCRP, Bethesda(MD) (1989).

Biological
Biologicaleffects
effectsat
athigh
highdoses
dosesare
arewell
wellknown
known 5
The
TheLinear
LinearNo
NoThreshold
ThresholdRadiogenic
RadiogenicCancer
CancerRisk
RiskModel
Model

Acute
Acute
measurable
measurable
Effects
Effects

Stochastic
Stochastic
Effects
Effects
Radiogenic
Cancer and
Genetic
Risks

Typical
TypicalCT
CTExam
Exam 1-20 500 1000 1500
Effective Dose 2000
Effective Dose
Dose (mGy)

Population
PopulationRisks
Risksat
atDiagnostic
DiagnosticDose
DoseLevels
Levelsare
areStatistically
StatisticallyEstimated
Estimated
Based studies of Japanese A-Bomb survivors and nucular accidents
Based studies of Japanese A-Bomb survivors and nucular accidents
6
 Sources of Radiation Exposure
Received by US population
From NCRP Report No. 93

1%
3%
Radon
4%
11% Other Natural Sources
Medical X rays
Nuclear Medicine
55%
26% Consumer Products
Other

Medical X-rays Account for 11 % of the US Population Radiation Exposure

CT
CTaccounts
accountsfor
for33--4%
4%ofofmedical
medicalexaminations
examinations
and
and10
10--40%
40%of
ofthe
thetotal
totaldose
dosecontribution
contribution
Source FDA TEPRSSC meeting May, 2000

7
 How does CT dose compare to
other sources?

10 years in Denver vs sea level 22 mGy

Average US background radiation 5 mGy
10 years in a stone or brick house 1 mGy
1 year smoking a pack of cigarettes/day 20 mGy
1 chest X-ray 0.2 mGy
1 whole body CT scan 50 mGy
Source: GE Medical Systems Radiation Safety Training Manual May, 1996

Radiation
Radiationper
peryear
yearfrom
from cigarette
cigarettesmoking
smokingisisabout
aboutequivalent
equivalentto
toaaCT
CTscan
scan
8
 Stochastic Biological Risk vs Dose
• Organ dose - Dose to specific organs
• Effective Dose - The organ dose expressed as the whole body dose that
lung _ risk
effective _ dose = lung _ dose ×
produces the same biological risk: example: whole _ body _ risk

160
140
Risk
Risk x10 -4

120
Cancer Mortality

100
Per 1000 mGy

80
Cancer Mortality

60
40
20
0
Esophagus

Remainder
Leukemia
Stomach

Bladder
Breast
Colon

Ovary
Liver

Lung

Thyroid
Bone

Skin

Kidney
O r g an

Source: Estimating Radiolgenic Cancer Risks May 1999 EPA 402-R-99-003

Cancer -4
CancerMortality
MortalityRisk
Riskxx10
10-4per
per1000
1000mGy
mGybybyOrgan
Organ
5.75
5.75%
%per
per1000
1000mGy
mGywhole
wholebody
body
9
 Biological Risk vs age

% risk per unit dose

Age (yrs)

BEIR V (Biological Effects of Ionizing Radiation) committee

ICRP report 60 (International Commission on Radiological Protection)

10
 Patient Dose Risks from CT

• A conventional CT results in a stochastic risk to the

population. A .03% cancer risk increase for a typical
whole body CT exam (10 mGy effective dose). The risk to
the average individual is not statistically significant but
the risk increases significantly with decreasing age.

• A misused CT Fluoroscopy procedure resulting in a 1 or 2

Sv skin dose can produce erythema. A 25 mGy/Sec dose
(120 kv, 300 mA body ) over the same location for 40
seconds approaches this dose threshold!

11
How do we determine organ dose?
• Model of incident X-ray beam
Incident • Model of patient
X-ray photon • Monte Carlo model of X-ray interactions and energy deposition

Organ
Organdose
doseand
andeffective
effectivedose
dosedata
data

• Difficult to obtain
(University Physics Departments and Regulatory Agencies)

• Generally not significant to an individual patient at

diagnostic radiation levels

• May be stochastically significant to researchers

interested in evaluating outcomes of screening
procedures

For
Forroutine
routineclinical
clinicaluse
useaaCT
CTDose
DoseIndex
Indexisisemployed
employedas
asan
anindicator
indicatorof
ofdose
dose
and not the actual organ or effective patient dose
and not the actual organ or effective patient dose

12
 CTDI - CT Dose Index
• First CT dose index (late 70’s) Reference Phantoms
16 cm dia Head
• Defined by FDA publication 32 cm dia Body Pencil chamber
> 14 cm thick PMMA 100 mm long
21CFR 1020.33 1cm dia
Slice Plane

• Dose absorbed a specified edge or

center point in pmma reference Rotation
Axis 11.2

phantom at the center of 14

contiguous slices

Holes for chamber

• Contains dose from primary beam at center and 1 cm dosimeter
plus scattered beam in a plastic inside surface

phantom

FDA
FDArequires
requiresCT
CTmanufacturers
manufacturersto
todisclose
disclosethe
theCTDI
CTDI
for
forstandard
standardhead
headand
andbody
bodyprotocols
protocolsand
andadjustment
adjustmentfactors
factors
13
 CTDI measurement
n The CTDI dose is computed
X-ray scatters
according to a formula out of plane within
an object generating
a dose profile in Z
n TLDs are required to measure the
central and peripheral dose profile in
the reference phantom

n Once the dose profiles are available ,

a14/a10 scale factors can be applied
to pencil chamber readings as a
estimate of the 14 slice integral
14 slices

n However most evaluators do not go 4x1.25 mm CTDI Body Phantom Dose Profile
through this much trouble 50
1 7T

nT −ò50
CTDI 100 = 1
D( z)dz CTDI =
nT ò D( z)dz
−7T

CTDI
CTDIUnderstates
Understatesthe
thedose
dosefor
fornarrow
narrowslices
slices
14
 CTDI100 and CTDIW
• CTDI100 and CTDIW are newer IEC standards
• CTDI100 is the dose measured in the CTDI reference
phantom integrated over a fixed 100 mm length
• CTDI100 is computed as the dose absorbed in air not pmma
• Dose in Air is about 11% higher than dose in PMMA
• CTDIw is 2/3 peripheral CTDI100 + 1/3 central CTDI100
• CTDIw provides a convenient index for comparing
scanner dose and patient exposures

CTDI100
CTDI100and
andCTDIw
CTDIware
arebetter
betterindicators
indicatorsof
ofCT
CTdose
dose
15
MSAD - Multiple Scan Average Dose
CTDI adjusted for helical pitch or slice increment

Axial Step and Shoot

Total _ Slice _ thickness

MSAD = CTDI × Table _ increment ≠ 0
Table _ Increment

Helical

CTDI Table _ travel

MSAD = NormalizedPitch =
Normalized _ Pitch å detector _ row _ widths

MSAD
MSADisiscurrently
currentlycomputed
computedand
anddisplayed
displayedas
asan
anadjusted
adjustedCTDIw
CTDIw
16
 DLP - Dose Length Product

DLP = MSAD × ( Exposure _ length )

•DLP is in mGyCm Units

•Dose times the Exposure Length

100 mGyCm = 10 mGy CTDI × 10 cm 300 mGyCm = 10 mGy CTDI × 30 cm

DLP
DLPis
isaaconvenient
convenientindex
indexfor
fortotal
totalpatient
patientdose
dose
17
 Why
Whyshould
shouldwe
wecare
care about
about beam
beam quality?
quality?
Incident 120 kv X-ray spectrum Exit X-ray 120 kv spectrum, 40 cm of Water

Spectrum for Spectrum for

No. X-ray metal frame tube metal frame tube
photons with Be window No. X-ray with Be window
photons

Spectrum with
0.15 mm of Cu

Spectrum with
0.15 mm of Cu

keV keV
Unfiltered has 40% higher exposure Unfiltered has 14 % higher exposure

We
Wedon’t
don’twant
wantsoft
softX-ray
X-raythat
thathas
hasvirtually
virtuallyno
noprobability
probabilityof
ofbeing
beingdetected
detected
18
 Half Value Layer
X-ray X-ray
• A measure of beam
quality
Aluminum • How much aluminum
filters
(or other material) is
HVL
needed to reduce the
dose by one half

11.2
11.2 5.6

19
 Quantity equivalent filtration
Unfiltered Unfiltered
• Measure the dose with X-ray X-ray

filtration and obtain

the same dose by Filtration Quantity
under test Equivalent
adding aluminum Filtration
filters
• The quantity
equivalent filtration is
the thickness of 11.2 11.2

aluminum required to
get the same dose
20
 Quality equivalent filtration
X-ray X-ray Filtration
• Measure HVL with under test

filtration under test Aluminum

filters
HVL
• Determine thickness
of the aluminum (or 11.2
11.2 5.6

other) layers that Quality

X-ray X-ray
provide same HVL Equivalent
filtration

• Must be done in Aluminum

filters
specified conditions HVL
(same as
(kV, inherent 16
11.2 8 above)

filtration)
21
 Some Major CT Regulations
• FDA 21CFR 1020.33
CTDI, HVL, IQ performance statements
• IEC 601
Overall minimum safety standards (mechanical, S/W, EMC, dose...)
(just meeting the minimum is not a good design!)
• IEC 601-1-3
General X-ray dose
• IEC 61223-2-6
Quality assurance testing for CT
• IEC 601-2-44
All safety for CT, Report CTDIw and dose efficiency on monitor
• IEC 601-1-5 draft - not a released standard
Will set Minimal IQ requirements below stated dose limits
IEC 61223-3-6 draft - not a released standard
Will set standards for CT equipment acceptance testing
• Euratom 97/43 (European Union)
Directive for EU to produce regulations by May 2000 regarding
Use of dose reference guidelines
Maintaining individual, procedure, and equipment dose records

22
Dose Reduction Opportunities
The Radiologist
The CT Manufacturer

Use only the Improve Inherent CT

required dose system dose efficiency
for a diagnostic
quality image

Incident patient
X-ray

X-ray
information

Go
Go for
for ALARA
ALARA !!
As
As Low
Low As
As Reasonably
Reasonably Achievable
Achievable 23
 The
TheRadiologist
RadiologistALARA
ALARADilemma
Dilemma

Diagnostic quality from Technologist/

training and experience Radiologist must
make an educated
guess
Procedure
•Chest Estimated
•abdomen mAs
•pelvis
•head
Reasons for using too much dose

Size / weight are

Patient
•size • Large patient attenuation variability
A Substitute for • Fixed protocols (not weight indexed)
•weight
patient • Risk of non diagnostic scan
x-ray attenuation •age
information

The immediate risk to the patient

from a non diagnostic scan generally
overrides the stochastic risk to the
population.

Limited
Limitedmeans
meansto
toestimate
estimateand
andadjust
adjustfor
forpatient
patientattenuation
attenuationvariability
variability
24
 How
Howvariable
variableis
isthe
thepatient
patientpopulation?
population?

attenuation vs exam
Data from 45 patient Examinations

2500
max atten
2000
min atten
1500 avg atten

1000

500

s/ is
s / is
s/ is
is
l u abs
l u abs
l u abs
bs
s

ng

s
s
ad
ad

s/ d
l u ck
er

ab
ab
ab elv

ab elv

lv
a b elv
a b ea
/a
lu
ne

he
he

pe
ld

/
/
/

h
ng
ng
ng
ng

p
p
ou
sh

In
Insome
somecases
casesaafactor
factorof
of10
10for
forthe
thesame
sameanatomy
anatomy

25
Image
ImageNoise
Noiseis
isstrongly
stronglyinfluenced
influencedby
bypatient
patientattenuation
attenuation

42cm
30cmΦ
Image Noise

25cmΦ
35cm
20cmΦ
15cmΦ
10cmΦ 25cm

Phantom (Patient) attenuation

Attenuation correlates with patient weight and size

Protocols could be indexed by weight
Or information available to the scanner can be used to accurately predict require mA

26
 Auto
AutomA
mA --Required
Requireddose
dosedepends
dependson on
required
requireddiagnostic
diagnosticimage
imagequality
qualityand
andpatient
patientattenuation
attenuation

Research Technologist selects

Determines required protocol for patient
diagnostic quality for
clinical protocols
Clinical Protocol
Target Image Noise
IQ 2.5
normal 2.8 Consistent IQ
Low Dose 3.0 independent of patient

System calculates
required mA
for consistent IQ

Patient information from scan

Radiologist/Technologist
Radiologist/Technologistselects
selectsaatarget
targetnoise
noisevalue
valueinstead
insteadofofmA
mA
Repeatable
Repeatablediagnostic
diagnosticimage
imagequality
quality independent
independentofofpatient
patientvariability
variability
27
 Auto
AutomA
mAor
or Automatic
AutomaticExposure
ExposureControl
Control

1 5 10 15

250
200

mA
150
Information for mA adjustment
100
can be obtained from scout scans
50
or
in real time from prior projections 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
location

Adjusts
Adjuststhe
themA
mAtotoachieve
achieveaaconsistent
consistentdiagnostic
diagnosticquality
quality
Dose
Dosereductions
reductionsof
ofup
upto
to35
35%
%have
havebeen
beenreported
reportedfor
forGE
GELX/i
LX/i
28
Scan Tech. Optimization 2: Patient by Patient
Auto Exposure Control
Adult Head(34 years old) Infant Head(3 weeks old)

412.5mAs 97.5mAs
(275mA x 1.5sec) (65mA x 1.5sec)
Image SD=2.32 Image SD=2.29

Same
Samepediatric
pediatricimage
imagenoise
noiseat
at1/4
1/4the
theadult
adultmA
mA 29
 Smart
SmartScan
Scan--Adjusts
AdjustsIncident
IncidentX-ray
X-rayto
toMatch
MatchPatient
PatientShape
Shapevariation
variation

Prescribed mA Noise at a point in the image

SmartScan is approximately related to the square
Incident X-ray root of the sum of the squares of the
decreased vs angle noise from the individual positive
depending on individual rays.
patient asymmetry

å P (α , β )
2

N x, y =

Hence noise in the image is dominated

by the highest noise views when the
Decreased mA
patient attenuation is asymmetric.

▼Patient asymmetry is determined from orthogonal scout scans

▼ Periodic mA modulation is determined from the attenuation asymmetry

Dose
Dosereductions
reductionsbeyond
beyond25%
25%are
arepossible
possiblewithout
withoutaasignificant
significantimage
imagenoise
noiseincrease
increase

30
 Methods
Methodsof
ofAuto
AutomA
mAand
andSmartScan
SmartScan

Intensity variation
not shown to scale
Auto mA
(LX/i, ZX/I, NX/i)

SmartScan (CT/i)
(fixed modulation)

Auto mA &
SmartScan
(w Z modulation)
Future potential

(continuous Z modulation
per previous views)
Future potential

31
 Advantages
Advantagesof
ofaabowtie
bowtiebeam
beamshaping
shapingfilter
filter
Normalized
CTDI body phantom edge dose
vs gantry angle (degrees)
0 deg
Off axis rays
attenuated more
Bowtie filter
by bowtie filter

Flat filter only

90 deg

Degrees from top of phantom

Reduces
Reduces surface
surface dose
dose by
byabout
about 1/2
1/2
32
 Multiple
MultipleBowtie
Bowtiefilters
filters(SmartBeam)
(SmartBeam)

Small Large
Bowtie Bowtie
for small for large
anatomy anatomy
uniform uniform
x-ray x-ray
field field

▼ Maintain a more uniform x-ray field at detector

▼ Minimize surface dose
▼ Reduce x-ray scatter

Multiple
Multiple bowtie
bowtiefilters
filterscan
canbetter
bettermatch
matchdose
doseto
topatient
patientanatomy
anatomy

33
Potential
Potentialfor
forCardiac
Cardiac Dose
DoseReduction
Reduction
mA maximum
during systole

Gate the mA
value as a
function
of the R peak mA minimize
elsewhere

AAvariation
variationof
of SmartScan
SmartScan
34
 Dose
Dosereduction
reductionimage
imagefilter
filter

A Six Sigma Project in partnership with Dr. Frush (Duke)

Presently used in MR and Ultrasound to make high noise images acceptable

70% Dose Virtual 100% Real 100% Dose

Objective:
Objective: Can
Canan
anadaptive
adaptivefilter
filterimprove
improveradiologist
radiologistacceptance
acceptanceof
ofusing
usinglower
lowerdose?
dose?
35
 How
Howcan
canthe
theradiologist
radiologistknow
knowwhat
whatisisneeded
neededfor
foraadiagnostic
diagnosticquality
qualityimage?
image?

Protocol file portfolio

Web based resource facilitated by GE

product
procedure Bulletin Confidential
FAQ’s
Board Chat room
Patient (weight, age)

Subscribers Radiologist can

contribute select diagnostic
and receive quality and dose
protocols relative to peers

Radiology
Radiologycommunity
communityshares
sharesprotocols
protocolsand
anddose
dosemetrics
metrics 36
 Other ALARA Opportunities we
might consider for the future

Noise addition to scan data

Radiologist can do ALARA experiments without additional patient dose
Adjustable dose caps in protocols
Prevent accidental higher than desired dose selections if no automA
Weight Indexed protocols
For systems that can not support AutomA
Portable Protocol files
Share good results with peers

37
 System Dose Efficiency
Some
SomeSystem
SystemDose
DoseEfficiency
EfficiencyMetrics!
Metrics!

LCD vs dose
ImPACT Q2 factor
System DQE (Dose Quantum Efficiency)
Multislice Z axis dose efficiency

You
Youcan’t
can’tjust
justmeasure
measuredose
doseto
tocompare
comparesystems!
systems!
You
Youmust
mustknow
knowthethedose
doserequired
requiredto
toobtain
obtainaaspecified
specified
image
imagesignal
signalto
tonoise
noiseratio!
ratio!

38
 LCD
LCDmeasurement
measurementmethods
methods
Present methods rely on phantoms with fixed patterns and have large observer variability 1 to 2 HU
Human
Image display Observer
LCD Scan Data Processing (film or monitor)
X-ray Phantom
filter
Filtered
Backprojection
Reconstruction
X-Ray
Generator
&
Bowtie Detector
kv, mAs
Filter and DAS

A Statistical LCD method eliminates the large human observer variability about 0.1 to 0.2 HU
Tile image to represent regions with areas True CT# of True CT# of low
of increasing pixel counts. background contrast object

3.29σµ
Compute standard deviation of the means.
We can’t simple reduce the pixel standard
deviation by 1 Distribution of
mean CT#’s of ROI
Distribution of mean
CT#’s of ROI on low
N on background contrast object

since CT noise is not Poisson distributed.

(See also ASTM E1695) 5% 5%

Use the standard deviation to make a

detection
statistical confidence statement about LCD threshold

AAdose
doseassessment
assessmentwithout
withoutan
anobjective
objectiveLCD
LCDmeasure
measurecan
canbe
bemisleading
misleading
39
 Q 2
Q2factor,
factor,ImPACT
ImPACTgroup
groupof
ofUK
UKMDA
MDA

Head Q2 Body Q2

LightSpeed 6.8 2.2

LightSpeed+ 6.3 2.2
Marconi Mx8000 5.7 2.1
Siemens VZ 5.6 1.7
Toshiba Acquilion 5.5 1.7

Information from ImPACT Four Slice CT Scanner Comparison Report, Version 3, March 2001

IMPACT Q2 (Quality factor) f ave = ( MTF50% + MTF10% ) / 2 Avg spatial resolution

f 3 σ= Image pixel standard deviation

Q2 = ave
σ 2 z1CTDI w z1 = FWHM of slice sensitivity profile
CTDI w = Dose Index
Q2
Q2is
isaameasure
measureof
ofdose
doseefficiency
efficiency-- Higher
HigherQ2
Q2is
isbetter!
better!
40
 Why do multi-slice scanners require
more dose than single slice scanners?

Single Slice Detector

Unused
UnusedX-ray
X-rayfalls
fallsoff
offthe
thedetector
detectorends
endsand
andbetween
betweencell
cellsegments
segments 41
 DQE
DQEDose
Dosequantum
quantumEfficiency
Efficiency
Percent of photons detected relative to photons available to be measured

CT Detector Assembly
Flex
Plate and
Photodiode Lumex Wire Grid Carbon
Window

X-Ray X-Ray
Conversion Conversion Transmission of
from Light Transmission
from X-Rays to Carbon window
to Charge of Collimator
Light

Photon
Photontransmission
transmissionin
inaamultislice
multislicedetector
detectormust
mustbe
behigh
high
42
 Multislice
MultisliceZZaxis
axisDose
DoseEfficiency
Efficiency
Z-axis Focal spot
thermal movement

X-ray for
image slices

Total X-ray
beam width
total _ image _ slice _ width
Z efficiency = × 100%
total _ Xray _ beam _ width

Percent
PercentofofX-ray
X-rayused
usedfor
forimage
imageslices
slices
relative
relativeto
tototal
total beam
beamwidth
width
43
 X-ray
X-rayBeam
BeamTracking
Trackingon
onGE
GELightSpeed
LightSpeed®®

focal
spot

Stepper
Steppermotor
motor
repositions
repositionscam
cam An identical
independent
loop operates
on each side
of the beam to
hold penumbra
Firmware
FirmwareComputes
Computes at detector edge
new
new camposition
cam position
from
from Z cell signalratio
Z cell signal ratio 2A / 1A

See Toth etal , ‘A dose reduction x-ray beam positioning system for high speed multislice scanners’
Medical Physics, December 2000

Beam
BeamTracking
Trackingsignificantly
significantlyimproves
improves
Z-axis
Z-axisdose
doseefficiency
efficiency
44
Multislice
Multislicecollimation
collimationopportunities
opportunitieswith
withtracking
tracking

Conventional Tracking Potential Truncated Penumbra Tracking

All rows detector collimated All rows detector collimated

Potential Extended Row Tracking Thin Twin

outer rows source collimated inner two rows source
inner rows detector collimated collimated to focal limit

Extended
Extendedrow
rowandandthin
thinslice
slicetracking
tracking
significantly
significantlyimprove
improveZZaxis
axisdose
doseefficiency
efficiency
45
 Geometric
Geometric Efficiency
Efficiency in
in ZZ

Information from ImPACT Four Slice CT Scanner Comparison Report, Version 3, March 2001

Geometric Efficiency in Z

100 Efficiency with Low dose fet modes

90
% efficiency

GE
80
VZ
70
MX8000
60
15% potential error band Aquilion
50
40
0.5-0.6 1-1.25 2-2.5 3.8-4 5
Slice

Low
LowDose
Dosemodes
modeswill
willgive
giveus
us95%
95%Efficiency
Efficiencyin
inZZfor
forall
allslices
slices
Low
LowDose
Dosemodes
modesare
arepart
partthe
theGE
GE88Slice
SliceDetector!
Detector!

46
 What
Whatisisdone
donefor
forlow
lowsignal
signaldegradation
degradationother
otherthan
thanincrease
increasedose
dose

No projection
filtration
Level 1
filtration Noise contaminated
Level 2
filtration
increased

Level dependent filtered

Electronic noise
contamination

• Filtering contaminated projections

decreases azimuthal resolution
• Level dependent filtering
can minimize resolution loss

AAR
AAR- -Advance
AdvanceArtifact
ArtifactReduction
Reduction
AAlevel
level dependent filter that kicks inwhen
dependent filter that kicks in whenprojections
projections
are contaminated by electronic noise
are contaminated by electronic noise
47
 Some Myths about LightSpeed and Dose
LightSpeed dose is 20-38 times as much as the EBCT
C-150XP/LXP is 42 mGy Head CTDI , 16 mGy Body CTDI @130 kV, 31 mAs
LightSpeed is 39 mGy Head CTDI, 10 mGy Body CTDI @ 120 kV, 260 mAs

LightSpeed dose is so high that children don't get scanned on the unit
Does anyone really buy this myth?
LightSpeed dose is 50% higher than the single slice dose from CT/i
All multislice scanners are higher but this is wrong, look at the data sheets:
QX/i 0.33% noise in a 20 cm water phantom @ 29 mGy (20%)
CT/i 0.33% noise in a 20 cm water phantom @ 25 mGy
Siemens has better dose than GE in all situations
Look at ImPACT report of March 2001, ‘Four Slice CT Scanner Comparison’
GE Wins!

Dose is higher on GE because the source is closer to the patient (geometry change)
A short geometry allows the mA to be reduced and thereby achieve the
same IQ as long geometry geometry without a dose increase
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 Congratulations

• You are now a graduate of the 60 minute CT dose crash course

• You know more about CT dose than 90 % of your customers

• You can confidently answer most questions

• You can further the ALARA concept in radiology

GE is the Multislice CT low dose leader!

We intend to stay there!
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