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Biomed. Phys. Eng. Express 8 (2022) 065007 https://doi.org/10.

1088/2057-1976/ac8e71

PAPER

Evaluation of computed tomography dose profiler probe for


RECEIVED
12 June 2022
computed tomography dose index and geometric efficiency
REVISED
22 August 2022
measurements
ACCEPTED FOR PUBLICATION
1 September 2022
PUBLISHED
Philomina Akhilesh∗ , M S Pathan and S D Sharma
13 September 2022 Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400085, India

Author to whom any correspondence should be addressed.
E-mail: pmina@barc.gov.in

Keywords: CT dose profiler, solid state sensor, CTDI100 metric, geometric efficiency, radiochromic film
Supplementary material for this article is available online

Abstract
The purpose of this study was to evaluate the performance of solid-state sensor based computed
tomography dose profiler (CTDP) probe for measurement of standard computed tomography dose
metric CTDI100 and free in air geometric efficiency for various beam widths available in a 128-slice CT
scanner and also to estimate the efficiency of CTDI100 metric. The response accuracy of CTDP probe
was verified using a standard 100 mm long ionization chamber. The geometric efficiency
measurements performed by the CTDP probe were validated using XR-QA2 radiochromic film
measurements. The efficiency of CTDI100 metric was assessed by calculating the ratio of CTDI100
measured in the center hole position to CTDI∞ measured in the same position of both head and body
phantoms. The weighted CTDI values derived from CTDI100 measured by the CTDP probe showed an
average difference of 8% from ionization chamber measured values. The efficiency of CTDI100 metric
estimated using CTDP probe and 150 mm long phantoms was in the range of 82% to 86% and 76% to
80% for head and body phantom measurements respectively. The differences in the geometric
efficiency values for various beam settings and tube voltages measured by the CTDP probe and films
were within 7%. Taken together, the results of this study proved that unlike the 100 mm long
ionization chamber, the CTDP probe can be efficiently used to determine CTDI for any length over
which dose integration is desired and also measure geometric efficiency of MDCT scanners for various
beam widths in helical mode of operation.

1. Introduction CT since the 1980s [4]. Under certain conditions, the


CTDI values are used to assess the dose received by
Computed Tomography (CT) scan examinations are patients [5].
considered to be relatively high dose diagnostic CTDI is defined as the integral of dose profile
procedures. The amount of dose delivered in typical along the z-axis acquired in a single axial scan normal-
CT scan examinations ranges from 1 to 14 mSv which ized to beam width. The integration limits for CTDI
is about two orders higher in magnitude compared to are ±50 mm which corresponds to the length (100
the dose in conventional radiography examinations mm) of the ionisation chamber used for the measure-
[1]. Due to the rapid increase in the frequency of CT ment and the quantity measured is the standard CT
scans and patient dose concerns, there is a need to dose descriptor CTDI100. CT scanner technology has
improve the accuracy of radiation dose assessment in advanced at a very rapid pace leading to the present
CT examinations. The computed tomography dose day multi-detector CT (MDCT) scanners with nom-
index (CTDI), originally proposed by Kambic et al [2] inal beam widths of 40 mm or more (up to 160 mm)
and established by Shope et al [3], has served as a [6]. However, CT dose metrics and methodology of
standard measure of radiation dose to phantom from CT scanner output measurement have had few

© 2022 IOP Publishing Ltd


Biomed. Phys. Eng. Express 8 (2022) 065007 P Akhilesh et al

changes to meet the requirements of new and dimensions. As per our knowledge, no published
advanced capabilities of current day CT scanner. A study has fully evaluated various applications of the
major drawback of 100 mm long ionisation chamber current version of the solid-state detector-based
measurements based CTDI100 metric is its inability to probe. This is the first comprehensive study that has
measure scatter dose tails that extend beyond the stan- focused on the evaluation of the use of the CTDP
dard 100 mm integration limits [5]. Another drawback probe in the determination of CTDI, geometric effi-
is its inability to provide information about dose dis- ciency measurements, and its capability to integrate
tribution along z-axis and the amount of radiation that the entire dose profile for CTDI∞ measurements.
goes beyond active detector arrays [7].
Alternative methods of CTDI measurements
include a linear array of point dose measurements
2. Materials and methods
using thermoluminescence dosimeter (TLD), optically
2.1. CT scanner
stimulated luminescence (OSL) strips, small volume
A Philips Ingenuity 128 multi-slice helical CT (Philips
ionisation chambers, and solid-state diode detectors
[8]. Among these, the diode detector possesses several Medical Systems, The Netherlands) was used in the
advantages due to its high sensitivity, high spatial reso- current study. This scanner has four options of
lution, and the capability to perform real-time mea- operating voltages viz., 80, 100, 120, and 140 kV and
surements. Therefore, the solid-state diode detector the operating current range is 10–665 mA. The
appears to be a promising alternative to the ionization scanner has 64 rows of solid state GOS detectors with a
chamber based CT dosimetry [9]. The present study total z-axis coverage of 40 mm (64×0.625 mm).
aimed to evaluate the solid state sensor based com-
puted tomography dose profiler (CTDP) probe which 2.2. CTDI measurements
claims to overcome the drawbacks of ionization cham- Standard CTDI head and body phantoms (Perspex
ber based CT dose measurements through real-time cylinders of 160 mm and 320 mm diameter respec-
dose profile measurements [10]. In addition to CTDI tively and 150 mm length) were used for CTDI
measurements, the CTDP probe can be used to mea- measurements. DCT 10 ionization chamber (RTI
sure the geometric efficiency (GE) of CT scanners. As Electronics, Sweden) which is a standard 100 mm long
per international electrotechnical commission ionisation chamber was used for CTDI100 measure-
requirements [11], the GE should be checked and the ments. CT dose profiler version 2.0 was used with
values should be displayed on the CT scanner console Piranha electrometer (RTI Electronics, Sweden) for
when GE along the z-axis is 70% or less. In MDCT CTDI measurements in helical mode as recommended
scanners, the x-ray beam width is increased beyond by the manufacturer. The CTDP probe is a point dose
the active detector arrays to avoid penumbral effects detector that has a solid-state sensor of 0.25 mm
and attain uniform sensitivity profiles for all detector thickness placed 30 mm from the end of the probe. On
arrays involved in image data acquisition. This leads to irradiation, the detector registers the dose value at that
primary exposure of patient body section wider than point and sends the information to the recording
the active detector array width [7]. This effect is refer- system at a sampling rate of 2000 dose values per
red to as over beaming and can be quantified through second [10]. To collect the dose at the different
GE measurements [12]. GE measurements are sig- positions for creating the dose profile, the probe must
nificant, especially in the case of narrow beam collima- be moved through the CT beam which is achieved by
tions to avoid excessive overlapped dose delivery in placing it free in air or in a phantom and then using the
MDCT scanners [13]. couch movement to scan the probe. Hence it is not
The objectives of the work reported in this paper possible to use axial scans for measuring CTDI with
were to evaluate the performance of CTDP for (i) mea- the CTDP probe.
surement of CTDI100 values and comparison with 100 Since majority of adult scan procedures are per-
mm ionization chamber measured values; (ii) estima- formed using 120 kV and pediatric protocols use 80
tion of efficiency of CTDI100 metric; and (iii) determi- kV, CTDI measurements were performed for these
nation of free in air geometric efficiency for various two tube voltage settings. The standard procedure as
beam widths and comparison with the results outlined in AAPM Report No. 96 [15] was followed for
obtained using radiochromic film. Although there are CTDI measurements using a DCT 10 ionization
a few previously reported studies on solid-state detec- chamber for both head and body protocols. For CTDI
tor-based profiler probe [7, 8, 12, 14], they have pro- measurements using the CTDP probe, instructions
vided only fragmented information about its given in the user manual were followed. To measure
applications. Moreover, most of these works have used CTDI100, CTDP was connected to the Piranha electro-
the probe only as a tool for inter-comparison studies meter which in turn was connected to a computer loa-
of other measurement tools/methodologies. In addi- ded with the Ocean software (Version 3.12A RTI
tion, the majority of the reported studies had been car- Electronics, Sweden) for evaluation and calculation of
ried out using an earlier version of the CTDP probe different parameters from the measured dose profile.
(CT-SD16), which had a different design and For CTDI measurements, CTDP was positioned in the

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Biomed. Phys. Eng. Express 8 (2022) 065007 P Akhilesh et al

central hole of the CTDI phantom and a helical scan the maximum value and similarly it searches for the
was performed. The pitch values of 0.3 and 1 were 50% point in the forward direction (D2). The full
used for head and body protocols, respectively. Unlike width at half maximum (FWHM) is calculated as the
CTDI measurements using a standard 100 mm long distance between D1 and D2. GE is then calculated as
ionization chamber which requires five axial scans to
GE = (Dose between D1 and D2*100) / Total dose
estimate dose in one central and four peripheral posi-
(3)
tions in CTDI phantom for calculating weighted CTDI
(CTDIw), only one helical scan is required to estimate Free in air dose profiles were measured for both head
CTDI values using CTDP. Ocean software uses and body protocols for all available beam collimations
k-factor which is a ratio of CTDIw to CTDI100,center as a in helical scanning mode viz.,40 mm, 25 mm, and 10
multiplication factor to convert measured mm for head and 40 mm, 25 mm, 10 mm, 5 mm, and
CTDI100,center to CTDIw. User may also specify 2.5 mm for body scan protocol. The tube load was
k-factor calculated from ion chamber measurements adjusted so that only small focal spot was in use for all
for the scanner type used, in which case calculations scans performed for the determination of GE.
will be performed based on the user defined value.
Based on the kilovoltage, filtration, and mode of mea- 2.5. Verification of free in air geometric efficiency
surement specified by the user in the template before using XR-QA2 films
measurement, the software automatically corrects all GafchromicTMXR-QA2 film (Ashland Inc., Caving-
dose and dose rate values measured by CTDP for the ton, KY) specially designed for general radiology
energy dependence of the solid-state detector. quality assurance tests was used for recording the dose
CTDIw values measured by CTDP in helical scan- profile. The XR-QA2 film dimensions used in this
ning mode were normalised to 100 mAs (nCTDIw) as study were 10’× 12’. Each film was cut into three strips
given below [14] and compared with CTDIw (mGy/ each of dimensions 80 mm×300 mm. The film
100 mAs) measured by DCT 10 ionization chamber: calibration procedure and readout methodology are
nCTDIw= available in detail elsewhere [17]. Since radiochromic
100 films exhibit considerable energy dependence, film
CTDIw ⁎ calibration was performed for both 80 kV and 120 kV
Applied mA ⁎ Tube rotation time
beam qualities used in the current study. To measure
´ [mGy / 100mAs] (1)
free in air GE, film strip was positioned at the scanner
isocenter with the support of a long plastic scale affixed
2.3. Efficiency of CTDI100 dose metric to the end of the patient table to avoid table
The integrations limits of the dose profile were placed interference (Supplementary figure 2). The exposed
beyond the end of scatter dose tails of the measured films were scanned after 24 h using an Epson Expres-
dose profile through the interactive Ocean software sion 10000XL flatbed scanner.
and the resulting CTDI was noted as CTDI∞. The The scanned 16-bit images with 72 dpi resolution
efficiency ( ) of the CTDI100 metric was assessed by were imported into Octave. Several (∼10) profiles of
calculating the ratio of CTDI100 measured in the center 200 mm length along the z-axis in the central region of
hole position to CTDI∞ measured in the same the film were considered for the calculation of net
position of both head and body phantoms [5] reflectance. Depending upon the energy of the beam
the calibration factors were applied to derive the dose
CTDI100
= (2) for various profiles along the z-axis.
CTDI¥
Each dose profile was normalized to the maximum
value and pixel indices of half values on both sides of
2.4. Determination of free in air geometric efficiency the maximum dose value were recorded as PX1 and
using CTDP PX2. Using the resolution of the image (R) the FWHM
Geometric efficiency is defined as the integral of the was calculated as
dose profile along the z-direction, integrated over the
FWHM = ∣ PX1 - PX2∣*25.4 R (4)
range subtended by the detector elements used during
acquisition, expressed as a percentage of the total Similarly, for every profile, the FWHM values were
integral of the dose profile in the z-direction [16]. calculated for each film. The median value of FWHM
The CTDP probe was positioned free in air at the was used in the computation of GE. The GE was com-
isocenter for the measurement of GE (Supplementary puted as
figure 1 (available online at stacks.iop.org/BPEX/8/ PX 2
065007/mmedia)). The GE calculations are done from
the dose profile waveform measured by the detector
ò
GE = PX1
D (z ) dz
(5)
100
probe. The software finds the maximum dose rate that
occurred during the scan from the waveform. From
ò-100 D (z ) dz

this point, the software searches backward to find the As the pixel values are discrete the above equation (4)
point where the dose profile goes below 50% (D1) of can be written as

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Biomed. Phys. Eng. Express 8 (2022) 065007 P Akhilesh et al

Figure 1. Plot of normalised CTDIw values estimated using CTDP in helical mode (pitch=0.3 for head and pitch = 1 for body
protocol) and 100 mm long ionization chamber in axial mode for head and body protocols for various beam widths.

å PX D (z )
PX1
profile observed for various beam collimation settings
GE = 2
(6) over which dose profile integration was performed for
å -100 D (z )
100
calculating CTDI∞ are also given in table 1. For the
most commonly used tube voltage of 120 kV, the
reduction in CTDI100 efficiency with an increase in
2.6. Repeatability of measurements using CTDP
beam width from 10 mm to 40 mm was approximately
The repeatability of solid-state detector based CTDP
4% for head and body phantom measurements.
probe for CTDI and GE measurements was assessed in
Figures 3 and 4 show the real time dose profiles mea-
terms of standard deviation. Five repeated measure-
sured by CTDP for estimation of CTDI at 120 kV for
ments of CTDIw were performed for all beam collima-
tions available in head mode of operation at 120 kV. different beam collimations in head and body phan-
Similarly free in air GE measurements were also tom respectively. In all cases, the dose profiles show
repeated five times using the CTDP probe at 120 kV, that scatter dose tails extend beyond the standard 100
body mode of operation to estimate the standard mm length of integration limits defined for CTDI100.
deviation for every available collimation. Free in air beam profiles measured by CTDP probe
for various beam collimations at 120 kV (head mode)
to determine GE are shown in figure 5 along with the
3. Results corresponding profiles measured using XR-QA2
films. GE values measured by CTDP probe and XR-
Normalised CTDIw values estimated using CTDP QA2 films for head and body modes of operation at 80
probe in helical mode and 100 mm long ionization kV and 120 kV are presented in table 2. The differences
chamber in axial mode for head and body protocols at between the GE values measured by the solid-state
80 kV and 120 kV are presented in figure 1. detector probe and films were within 7%. The GE
Good correspondence was observed, but with a value was below 70% only for the beam collimation of
slightly larger difference in measurements performed 2.5 mm.
with the head phantom. As all CTDI measurements The repeatability of the CTDP probe estimated for
using CTDP are performed in helical mode, a compar- five repeated measurements of CTDIw and GE in the
ison was made between CTDIvol values displayed on current study was found to be within 0.3% and 0.7%,
the CT scanner console and CTDIvol values measured respectively.
by the CTDP probe. Results of comparison for all
selectable beam collimations available in the helical
mode of scanner operation are illustrated in figure 2. 4. Discussion
The average difference between CTDIvol displayed by
the CT scanner console and CTDP measured values The standard method of CTDI measurements is based
was less than 2%. on five axial scans with a 100 mm long ionization
The ratios of CTD1100 efficiency determined for chamber positioned in the central and four peripheral
various beam collimation settings and tube voltages holes in the cylindrical CTDI phantom. The CTDP
are presented in table 1. The lengths of the total dose evaluated in the present study is designed to fit into the

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Biomed. Phys. Eng. Express 8 (2022) 065007 P Akhilesh et al

Figure 2. Plot of CTDIvol values measured by CTDP probe and the corresponding values displayed on CT scanner console (pitch = 0.3
for head and pitch = 1 for body protocol).

Table 1. CTDI100 efficiency values for all available beam output measurements should be explored. Since the
collimations in helical scan mode. The measurements were
performed with the CTDP probe positioned in the central hole of CTDP probe moves through the beam during expo-
the CTDI head and body phantoms. sure, measuring CTDI along any length of choice is
Length of
possible with this system. The associated software
Collimation dose pro- CTDI100 Effi- provides real time display of the captured dose profile
Protocol kV (mm) file (mm) ciency (ò) (%) which is a superior feature of the CTDP system. The
present study was undertaken to evaluate the perfor-
Head 120 40 233 82.3 mance of solid-state diode based CTDP probe for
25 208 84.6
CTDI measurements and also to experimentally
10 185 85.7
80 40 237 84.7 determine the efficiency of CTDI100 dose metric when
25 213 85.3 standard phantoms are used.
10 188 86.2 The difference between values of CTDIw derived
Body 120 40 257 76.1 from the CTDP probe and ionization chamber was in
25 223 78.6 the range of 3% to 12% and the average difference was
10 196 80.0
8%. The values of CTDIw measured by CTDP were
5 184 80.5
consistently lower than the same measured by DCT 10
80 40 255 77.3
25 224 80.1 ionization chamber for both tube voltages and various
10 203 81.0 beam collimation settings used in the present study.
5 186 81.4 The Ocean software calculates CTDI100 from the dose
profile waveform which includes a maximum of 1024
samples [10]. The sampling losses during the dose pro-
standard CTDI phantoms and a single helical scan file integration may be a reason for the difference
performed with the probe in the center hole of the between CTDP and ion chamber measured values.
head/body phantom is only required for the head/ The differences were more in case of head phantom
body CTDI measurement respectively. The standard which may be due to table attenuation resulting from
ionization chamber based method of CTDI measure- multiple tube rotations in helical mode in head proto-
ment cannot measure scatter dose tails beyond its col due to the lower pitch value, in comparison to ion
length of 100 mm and also the user cannot see the chamber measurements in axial mode.
measured dose profile. The results of Monte Carlo Good agreement was observed between the
simulation studies performed by Boone JM [5] illus- CTDIvol values displayed on the CT scanner console
trate that the efficiency of the CTDI100 measurement and CTDP measured CTDIvol values. The efficiency of
even for 10 mm beam widths is low and, consequently, CTDI100 metric estimated using CTDP probe and 150
dose computations based on this metric may not yield mm long phantoms was in the range of 82% to 86%
the desired accuracy. As current day MDCT scanners for head phantom and varied from 76% to 80% for
provide much higher beam collimations, alternate body phantom measurements. The ò values in the pre-
detectors and methodology for CT scanner dose sent study for center hole measurements in head

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Biomed. Phys. Eng. Express 8 (2022) 065007 P Akhilesh et al

Figure 3. Dose profiles measured by CTDP probe positioned in central hole of head phantom for estimation of CTDI at 120 kV for
beam collimations of (A) 64*0.625 mm=40 mm, (B) 40*0.625 mm=25 mm, and (C) 16*0.625 mm = 10 mm.

phantom are in close agreement (4% difference) with in simulating scatter generated in human head
the ò values reported by Boone JM [5] based on the whereas the standard 150 mm length of the body
Monte Carlo simulation study carried out using ioniz- phantom is insufficient in generating the scatter to
ation chamber. However, there was a large difference simulate the length of human torso.
(16% higher in the current study) in the efficiency of The CTDI measurements using CTDP are rela-
CTDI100 metric estimated in the center hole of the tively quick and easy to perform. Use of TLDs, OSL
body phantom. The Monte Carlo simulation study by strips, methacrylic acid-based gel (nMAG) dosimeter,
Boone JM [5] has modelled a 500 mm long detector small volume ionization chambers, and photodiode
and infinitely long phantom for estimation of CTDI∞ arrays for CTDI measurements have been reported [8,
which would increase the scatter dose contribution to 18–20]. The use of TLD arrays for performing CTDI
dose profile relatively more in body phantom due to its measurements is labour intensive and time consum-
larger size. This will in turn increase CTDI∞, resulting ing due to complex annealing and read out proce-
in lower ò values. The results prove that the standard dures. OSL based CTDI probe though easy to use, has
150 mm length of the head CTDI phantom is adequate a major limitation that it needs to be sent back to the

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Biomed. Phys. Eng. Express 8 (2022) 065007 P Akhilesh et al

Figure 4. Dose profiles measured by CTDP probe positioned in the central hole of body phantom for estimation of CTDI at 120 kV for
beam collimations of (A) 64*0.625 mm=40 mm, (B) 40*0.625 mm=25 mm, and (C) 16*0.625 mm = 10 mm.

manufacturer for processing and hence immediate Detectors that can record dose profiles can be used for
readouts are not available to the user [20]. The gel measurement of GE. TLD arrays and radiographic
based dosimeter has advantages of being near tissue films are commonly used for the determination of
equivalent and can provide 3D dose distribution but dose profile and geometric efficiency in CT scanners.
has poor sensitivity. The CTDP requires minimum Both the methods are time consuming and laborious
user intervention as the system software automatically due to the handling, calibration, and read out proce-
calculates and displays the CTDI values and dose pro- dures. Determination of x-ray beam width and GE
files, but it cannot measure CTDI100 in axial mode. using self developing radiochromic films has also been
The geometric efficiency is an important para- reported [21]. The spatial resolution and the nature of
meter to be measured in MDCT scanners for quantify- 2D dosimetry make radiochromic films a suitable
ing the radiation beam utilisation efficiency for choice for dose profile measurements [19]. Hence
various beam collimations used for patient scans. IEC radiochromic films were used in the present study to
recommends the CT manufactures to alert the user of validate the dose profile and GE measurements per-
the parameter when its value goes below 70%. formed by the CTDP probe. The Ocean software

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Biomed. Phys. Eng. Express 8 (2022) 065007 P Akhilesh et al

Figure 5. Free in air dose profiles measured by CTDP probe at 120 kV for beam collimations of (A) 40 mm, (B) 25 mm, and (C) 10 mm
(dotted black lines indicate nominal beam collimation); and by XR-QA2 films at 120 kV for beam collimations of (D) 40 mm, (E) 25
mm, and (F) 10 mm for calculation of geometric efficiency.

which is required for use of CTDP has built in tem- 70% only for the beam collimation of 2.5 mm for the
plates for the determination of GE. The user has to 128 slice CT scanner used in the present study. Beam
perform a single helical scan free in air and the soft- collimations narrower than 2.5 mm were not available
ware displays the measured dose profile and calculates in the helical mode in this scanner. GE of ultra narrow
GE for the selected beam collimation. Compared to beam collimations available in the sequential mode
other existing methods solid state detector based was not measured since CTDP is recommended for
CTDP is the fastest means of measuring dose profiles use only in helical mode. No significant effect of tube
and GE. voltage and modes of scanning (head/body) on free in
On comparing the results of the CTDP probe and air GE was observed in this study. Similar findings
XR-QA2 radiochromic film measured GE values, have been reported by a previous study [12]. The dose
good agreement was observed, the maximum differ- profiles measured by both methods show asymmetry
ence being 6.7%. GE decreases with decrease in beam in the high dose region which may be attributed to the
width and is clearly due to the increase in the penum- heel effect and was observed in all beam settings used
bral region in comparison to the total beam width as in the present study. The small undulations observed
the beam width decreases. The GE values were below in the CTDP measured dose profile may be due to a

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Biomed. Phys. Eng. Express 8 (2022) 065007 P Akhilesh et al

Table 2. Free in air geometric efficiency measured by CTDP probe Kadam of RP&AD, BARC during the course of this
and Gafchromic XR-QA2 films (Mode: Helical).
study.
Geometric Effi-
Nominal beam colli- ciency (%)
Protocol kV mation (mm) Data availability statement
XR-
CTDP QA2 film All data that support the findings of this study are
Head 120 40 87.2 90.0
included within the article (and any supplemen-
25 85.4 88.2 tary files).
10 75.2 79.9
80 40 90.5 90.1
25 85.8 86.3
Declaration of interest
10 77.9 76.2
Body 120 40 92.0 92.1 None.
25 90.3 90.7
10 78.5 73.5
5 75.7 71.5
Funding
2.5 55.4 56.0
80 40 91.8 88.0 This research did not receive any specific grant from
25 89.6 86.7 funding agencies in the public, commercial, or not-
10 78.0 83.0 for-profit sectors.
5 71.6 71.1
2.5 60.1 64.0
ORCID iDs

marginal misalignment in the positioning of the probe Philomina Akhilesh https://orcid.org/0000-0002-


0511-8062
at the isocenter. There are some limitations in the pre-
sent study. Standard CTDI phantoms were used for
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