CTDI and DLP Notes

TOSHIBA CORPORATION, Medical Systems Company
Notes document with CTDI and DLP presentation
Slide 1
Medical Systems / Japan HQ 2002
CTDI and DLP within Computer Tomography
CTDI
and
DLP
What is the value of each?
© MSC HQ Nasu / February 2002 1
With this presentation we want to explain the value of CTDI and DLP,
indicating their relation and more over their differences.
CTN Marketing Group

HB Version 2002-Feb-21 Page 1/22
Slide 2
Reference used for definitions
As a basis for this presentation we used and sometimes quote the through the
CICIR published document Radiation Exposure in Computed Tomography
written by Dr Hans Dieter Nagel.
CTN Marketing Group

Slide 3
CTDI
Computer Tomography Dose Index
Exposed dose at standardised conditions
DLP
Dose Length Product
Exposed patient dose at clinical conditions
CTDI stands for Computer Tomography Dose Index and indicates the
exposed dose at standardized or normalized scanconditions. DLP stands for
Dose Length Product and indicates the total to the patient exposed dose at
real clinical conditions, whereby a for the diagnosis relevant image quality is
obtained.
CTN Marketing Group

Slide 4
How is CTDI measured?
Set standardised conditions:

120 kV
100 mAs
360° acquisition
100 mm scan length
Place phantom
Place measurement device
Rotate and acquire
First of all we need to know how CTDI is measured. CTDI is measured at

standard conditions whereby a radiation sensitive devise, like a pencil
ionization chamber, is exposed. In the by IEC applied protocol a single scan
on a phantom with a length exceeding the length of the ionization chamber is
used. Next to this, the scan is performed twice once on a phantom with a 16
cm diameter simulating the head mode and once on a phantom with a
diameter of 32 cm simulation the body mode.
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Slide 5
How is CTDI measured?
Measurement of dose:
Remove phantom from system
Remove measurement device
from phantom
Read out dose in device
After the scans the dose sensitive device is read out and used as a basis for
the DLP calculations
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Slide 6
What does CTDI represent?
CTDI is a characteristic quantity for a scanner

which simply represents the capacity of a scanner
in terms of output
Page 8
Radiation Exposure in Computed Tomography
Edited by Hans Dieter Nagel
The absolute value of the measured CTDI gives an indication of the quantity
of X-ray photons generated at a normalized scan condition and because of its
normalized character represents an index and not a dose figure for the
particular scanner.
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Slide 7
What does CTDI represent?
• CTDI represents the exposed dose under defined

acquisition conditions (120 kV, 100 mAs, 360°),
it is an indication for tube/filter output
• CTDI does not represent dose efficiency as the

system (detector, algorithms, etc) is excluded
from the measurement
• CTDI gives no indication of dose needed for

good quality imaging in a clinical environment
So CTDI represents the exposed dose at normalized scanconditions.

It does not represent any dose efficiency of the scanner as the image quality
is not aspect in the assessment.
And it gives note indication of the dose required for a clinical scan.
CTN Marketing Group

Slide 8
How How
to calculate DLP for Inner Ear?
is DLP measured?
Collect
DLPconditions
is not of acquisition: it is calculated
measured,
Tube/filter output
Used kV from ExamPlan
Used mAs from ExamPlan
Number of rotations from ExamPlan
Number of slices/rotation from ExamPlan
Slice thickness (cm) from ExamPlan
The Dose Length Product is calculated from the real applied conditions in the
clinical environment and uses the CTDI value as the basis for the tube output.
This CTDI is multiplied with all factor that are calculated from the difference
between the normalized and the clinical applied parameters.
CTN Marketing Group

Slide 9
How is DLP calculated for Inner Ear?
Tube/filter output
Marconi Toshiba Aquilion

MX8000
Tube/filter output is CTDI Multi
values can be found

Headin public sources Head
Slice Slice
thickness mGy thickness mGy
2x0,5 29,86 4x0,5 40,87
4x1 15,76 4x1 28,61
4x2,5 12,94 4x2 22,48
4x5 12,00 4x3 20,43
2x8 12,24 4x4 19,41
2x10 12,00 4x5 18,80
4x8 17,88
2x10 18,80
CTDI values at 120kV and 100 mAs
CT-Expo V1.0, Copyright G. Stamm and H.D. Nagel
For our CTDI value we used the program developed by Dr Nagel and Dr
Stamm Which were checked against our own values as well as against the
values measured on a standard Siemens Volume Zoom. In both cases the
values did not differ more that 10%.
For the comparison of the DLP value we used the Marconi Mx8000 and the
Aquilion Multi, since they differ in CTDI the most, whereby because of the
CTDI value, the Mx8000 is perceived as a low dose machine.
CTN Marketing Group

Slide 10
Parameters from ExamPlan
Company: Marconi Toshiba

kV 140 120
mAs 295 50
Number of rotations 16 5,715
Number of slices/rotation 2 4
Slice thickness (cm) 0,05 0,05
Indiana University Charite

Indianapolis Berlin
USA Germany
This table shows the difference in acquisition parameters between the inner
ear protocol for the Mx8000 and the Aquilion Multi. The protocols are retrieved
from those used at the Indiana university and Charite university and can be
found on the Internet
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Slide 11
Calculate correction factor for kV difference

kV 140 120
Formula:
(Used kV / Reference kV)²
Page 19
Calculation (140/120)² (120/120)²
Correction factor Kc 1,36 1,00
Here we calculate the conversion factor for the clinically applied High Voltage.
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Slide 12
Calculate correction factor mAs difference

mAs 295 50
Formula:
Used mAs/Reference mAs
Page 19
Calculation 295/100 50/100
Correction factor Ac 2,95 0,50
Also the conversion factor for the mAs product is to be calculated
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Slide 13
Calculate number of slices

Number of rotations 16 5,715
Number of slices/rotation 2 4
Formula:
Rotations x (slices/rotation)
Page 40
Calculation 16 x 2 5,715 x 4
Correction factor Ac 32 22.86
The pitch and the number of rotations per cm are established through the
Pitch factor and the number of slices per rotation
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Slide 14
Calculate DLP
DLP = CTDI . Kc . Ac . n . h
Page 19
Kc Correction factor kV
Ac Correction factor mAs
n Number slices
h Slice thickness (cm)
Multiplication of all these factors with the CTDI gives us the DLP value
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Slide 15
Calculate DLP

CTDI 29,86 40,87
Kc 1,36 1,00
Ac 2,95 0,50
n 32 22,86
h (cm) 0,05 0,05
Here again the CTDI and the individual conversion factors for both systems
CTN Marketing Group

Slide 16
Marconi
191,67 mGy (29,86 x 1,36 x 2,95 x 32 x 0,05)
Toshiba
23,35 mGy (40,87 x 1,00 x 0,50 x 22,86 x 0,05)

CTDI 29,86 40,87
Kc 1,36 1,00
Ac 2,95 0,50
n 32 22,86
h (cm) 0,05 0,05
As a result of the multiplication the Mx8000 needs 191 mGy to establish an

appropriate image, whereas the Aquilion Multi can do the same with a dose of
only 23 mGy. This means that spite a lower CTDI a much higher dose is
administrated to the patient.
CTN Marketing Group

Slide 17
Comparisons
DLPw based on clinical acquisition protocols

CTDI values/mAs DLP relative values
Marconi MX8000 Toshiba Marconi MX8000 Toshiba
Aquilion Multi Aquilion Multi
Inner ear 0,2986 0,4087 er 821% 100%
Neck 0,1294 0,2861 ec 261% 100%
Cervical spine 0,1576 0,2861 cal 337% 100%
Shoulder 0,0893 0,1598 ou 299% 100%
Lung 0,0680 0,1141 un 201% 100%
Abdomen standard 0,0680 0,1141 n 184% 100%
Lumbar spine 0,0893 0,1598 ar 210% 100%
Aneurysm Aorta Abdominalis 0,0733 0,1598 rta 100% 106%
Wrist 0,2986 0,4087 Wri 216% 100%
< Lowest value + 10%
> Lowest value + 25%
When we compare all available scan protocol used in the Mx8000 with those
used in the Aquilion Multi almost everywhere a higher DLP is administrated to
the patient than with the Aquilion despite the lower CTDI in the Mx8000.
CTN Marketing Group

Slide 18
Comparisons
DLPw based on acquisition protocols

GE Lightspeed Toshiba GE Lightspeed Toshiba
Aquilion Multi Aquilion Multi
Angio Head 1,25mm 0,2928 0,2861 ead 126% 100%
Sinus 0,2928 0,4087 inu 568% 100%
Carotid 0,2928 0,2861 aro 320% 100%
Neck 0,2928 0,2861 ec 250% 100%
Shoulder 0,0960 0,1598 oul 264% 100%
Lung 0,0960 0,1598 un 132% 100%
Lung Fast 0,0960 0,1141 gF 284% 100%
Abdomen Routine 0,0960 0,1598 en 134% 100%
> Lowest value + 25%
In this table we show the discrepancy between CTDI and DLP applied for the
Lightspeed QXi and the Aquilion Multi. Here also, the scanprotocols are
retrieved from the internet, in this case from the official GE web site.
CTN Marketing Group

Slide 19
Comparisons
DLPw based on clinical acquisition protocols

Siemens Toshiba Siemens Toshiba
Volume Zoom Aquilion Multi Volume Zoom Aquilion Multi
Angio Head 0,5mm 0,4977 0,4087 ea 100% 106%
Angio Head 0,2627 0,2861 oH 100% 303%
Head Spiral 0,2838 0,1941 S 264% 100%
Inner ear 0,4977 0,4087 er 290% 100%
Sinus 0,2627 0,4087 nu 349% 100%
Carotid 0,2627 0,2861 ro 122% 100%
Neck 0,2157 0,2861 ec 332% 100%
Neck Thin Slice 0,2627 0,2861 hi 100% 109%
Cervical spine 0,2627 0,2861 cal 167% 100%
Shoulder 0,1090 0,1598 oul 125% 100%
HRCT 0,1090 0,1598 RC 136% 100%
Lung 0,0895 0,1141 un 117% 100%
Comparing the Siemens Volume Zoom with with the Aquilion Multi we see that
a CTDI values are much closer to each other, but still the administrated DLP
is higher. Also in this case the scan protocols were retrieved from the internet
and quoted in the official Siemens web site as well as CTisus of Elliot
Fishman of the John Hopkins University.
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Slide 20
Conclusion
CTDI conveys absolutely nothing

about patient dose
Page 8
Therefore we see that CTDI does not say anything about dose administered
to a patient and
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Slide 21
Conclusion
DLP plays an important role as an

indicator of radiation exposure of the
patient
Page 13
We would like to conclude quoting Dr Nagel again that DLP plays an

important role as an indicator of radiation exposure of the patient and
therefore the applied scan conditions have a much higher impact on dose
reduction than a pure CT scanner selection based on CTDI value. It is clear
that the entire chain of components is decisive in the dose issue.
CTN Marketing Group

Slide 22
Be Aware of Dose
it is
B.A.D.
Therefore we would like to state Be Aware of Dose as it is in a lot of cases

incorrectly interpreted, which is BAD.
CTN Marketing Group


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TOSHIBA CORPORATION, Medical Systems Company

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

What is the value of each?

© MSC HQ Nasu / February 2002 1

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

Reference used for definitions

© MSC HQ Nasu / February 2002 2

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

Exposed dose at standardised conditions

Exposed patient dose at clinical conditions

© MSC HQ Nasu / February 2002 3

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

How is CTDI measured?

Set standardised conditions:

© MSC HQ Nasu / February 2002 4

First of all we need to know how CTDI is measured. CTDI is measured at

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

How is CTDI measured?

© MSC HQ Nasu / February 2002 5

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

What does CTDI represent?

CTDI is a characteristic quantity for a scanner

© MSC HQ Nasu / February 2002 6

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

What does CTDI represent?

• CTDI represents the exposed dose under defined

• CTDI does not represent dose efficiency as the

• CTDI gives no indication of dose needed for

© MSC HQ Nasu / February 2002 7

So CTDI represents the exposed dose at normalized scanconditions.

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

© MSC HQ Nasu / February 2002 8

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

How is DLP calculated for Inner Ear?

Marconi Toshiba Aquilion

values can be found

© MSC HQ Nasu / February 2002 9

CTN Marketing Group

Notes document with CTDI and DLP presentation

CTDI and DLP within Computer Tomography

How is DLP calculated for Inner Ear?

Parameters from ExamPlan

Company: Marconi Toshiba

Indiana University Charite

© MSC HQ Nasu / February 2002 10

CTN Marketing Group