ISSN 1547-4771, Physics of Particles and Nuclei Letters, 2023, Vol. 20, No. 4, pp. 690–698.

© Pleiades Publishing, Ltd., 2023.

RADIOBIOLOGY, ECOLOGY,
AND NUCLEAR MEDICINE

Fetal Organ Dose Assessment during Chest CT Examination

Using Monte Carlo/Gate Simulation
Y. Benameura, b, *, M. Tahiria, M. Mkimela, R. El Baydaouia, B. El Hariria, M.R. Mesradia,
A. Hilalia, and S. Elmadania
a
Hassan First University of Settat, laboratoire sciences et technologies de la santé, institut supérieur des sciences de la santé,
Settat, Morocco
b
Department of Radiophysics University Hospital, Ibn Rochd, Casablanca, Morocco
*e-mail: y.benameur@uhp.ac.ma
Received August 18, 2022; revised December 13, 2022; accepted December 21, 2022

Abstract—A CT scan of a pregnant patient is often a source of distress for the patient and staff. In addition,
patients are usually worried about the risk of unfavorable effects on the fetus from radiation. Therefore,
assessing radiation dose and related risks to the fetus and pregnant patient is an important aspect of radiation
protection. The aim of this study is to estimate the fetal organ and effective dose during a chest CT protocol
for a pregnant patient. For this purpose, we model the SOMATOM EMOTION 16 CT (Siemens Medical
Solutions, Erlangen, Germany) and the pregnant patient using GATE code. The CT scanner is modelled
based on the data provided by the supplier, operating at 80, 110 and 130 kV and 0.5–1.5 for the pitch, regarding
the patient, she is modelled with a voxelized pregnant phantom (KATJA, 29 yr old) at the 24th week. Fetal
effective doses are estimated to be 0.8, 1.7 and 2.4 mSv for 80, 110 and 130 kV, respectively. When the energy
is decreased from 130 to 80 kV, the dose to the fetal organs in the heart and lenses is reduced by 64.3 and
64.6%. Moreover, the fetus organ dose is reduced by 21.5, 19.2, 30.0 and 17.6% for crane, eyes, heart and
brain for a pitch ranging from 0.5 to 1.5. Since the cumulative dose to the fetus does not exceed 100 mGy, the
doses to the fetus are considered acceptable.

Keywords: fetus, pregnant, organ dose, simulation Monte Carlo, GATE, voxelized phantom, KATJA
DOI: 10.1134/S1547477123040088

INTRODUCTION these studies, pregnancy stages varied from early ges-

Chest Computed Tomography (CT) is widely used
for screening benign and malignant tumors, tubercu-
losis and chronic lung diseases. It was recently
approved for screening patients with COVID19. CT
scanning of a pregnant patient and fetus should be per-
formed only if it is determined that the diagnostic ben-
efits outweigh the potential radiation risks to the fetus.
Compared to adults and children, fetuses have a higher
risk of developing cancer due to radiation exposure,
mainly because of their high radiosensitivity and lon-
ger life expectancy [1, 2]. Therefore, the assessment of
radiation dose and related risk to the fetus and preg-
nant is an important aspect of radiation protection. In
the literature, the radiation fetal dose is estimated to be
less than 100 mGy for some commonly performed CT
examinations [3, 4].
Some earlier studies have focused on the use of
Monte Carlo (MC) simulations to determine the
doses received by the fetus during radiological exam-
inations [5, 6]. The MC codes used in these studies are
as follows: SIERRA [5], WinODS [7], MCNPX [8, 6],
MCNP [9], ImpactMC [10] and EGSnrc [11]. Within
tation (7 weeks) to late gestation (37 weeks), with a
general focus on some stages of pregnancy. The major-
ity of these works are related to CT examinations of the
chest, abdomen and pelvis. Furthermore, a mathe-
matical phantom for estimating the fetal dose from a
multi-detector CT scan of the trunk at any stage of
gestation is developed [9]. Some of the most recent
works are focuses on comparing different methods of
assessing radiation dose with the concept [11] and on
comparing the results of dosimetric calculations and
MC simulation [12]. Moreover, it is found that images
of pregnant women lack information on fetal dosime-
try, which may lead to an underestimation or overesti-
mation of radiation exposure and cancer risk [13, 14].
In previous studies, the fetal dose was either measured
or simulated by MC.
In other report, they created 24 models of maternal
and fetal anatomy from scanned pregnant patients and
simulated a single set of acquisition parameters speci-
fied (120 kVp; slice thickness: 1.25–10 mm and pitch:
1.0) to assess radiation dose to the fetus [15].

690
 FETAL ORGAN DOSE ASSESSMENT DURING CHEST CT EXAMINATION
y
20 cm
z 20 cm x20 cm
Fig. 1. GATE visualization of CT scan.
Studies that estimate fetal radiation dose using MC
simulations from chest CT scans are very limited and
existing studies use the MC code for a single value of
kV or pitch. This work illustrates the use of GATE in
estimating absorbed fetal organs doses and effective
dose for various kV and pitch in order to predict the
risks related to the fetus during chest CT examination.
To this purpose, first of all using GATE code, we
model the geometry of the CT scanner, a PMMA and
an ionization chamber. To ensure the validity of this
model, experimental measurements were carried out
using the same materials under the same conditions
and compared with those obtained by Monte Carlo
simulation. Finally, we replace the PMMA phantom
by a voxelated phantom of a pregnant patient to esti-
mate the effective dose and compare our results with
those obtained using different MC simulation software:
Impact CT, CT expo and Web-based tool software.
MATERIALS AND METHODS
Multidetector CT Scanner Model
Figure 1 shows the modelled geometry of a third
generation SOMATOM EMOTION CT scanner (Sie-
mens Medical Solutions, Erlangen, Germany) using
GATE MC simulation. The CT scanner was equipped
with 16 detector arrays. It allows the user to operate in
both axial and helical modes with different pitch of 0.5
to 1.5. The distances from the focal spot to isocenter
and to detector were 536 and 941 mm, respectively.
The fan beam is collimated in the x–y plane to a fan
angle of 52° and two collimators each one has the
dimensions 50, 50, 5 cm respectively x, y and z, made
by aluminum. The X-ray tube available voltages are
80, 110 and 130 kV and the current from 80 to 360 mA.
In order to improve GATE MC simulation,
SRS-78 was used to model the X-ray spectrum that
PHYSICS OF PARTICLES AND NUCLEI LETTERS Vol. 20
691
emitted from a point at the location of the x-ray tube
anode. The distance from the source to the point
where the spectrum is recorded, the thickness and
material definition of flat filters (absorbers) for certain
energy, were defined. In this study, tree spectrums
were generated for 80, 110 and 130 kV, for each one the
energy was incremented to 5 kV in order to reduce
exposure time Fig. 2. The beam is shaped in GATE
using General Particle Source (GPS). It was defined
as a point source with an isotropic angular distribution
equal to:
88.72° ≤ ϕ ≤ 91.28° and 62.10 ≤ θ ≤ 117.9°.
When ϕ and θ are the spherical angle coordinates.
In the present study, only Body bow-tie filter was
used. Initially, we deducted shape and equivalent
attenuation of bow-tie filter. Then, simplified geome-
try was built by rectangles which we made from Alumi-
num to simulate that filter. For the purpose of the
present dose calculation.
KATJA Pregnant Phantom Modeling
Virtual human models based on medical image
data of real patients are currently at the forefront of
progress for the calculation of doses in radiation pro-
tection. Because organ doses are not measurable, their
realistic three-dimensional modelling of human anat-
omy is critical for the estimation of organ doses.
In the literature, there are several models of preg-
nant women, the first of which is the ORNL series of
mathematical models by Stabin et al. [20] and Chen
[21] presenting the human anatomy by mathematical
means, such as Naomi de Dimbylow [22] and Silvy
[23] are constructed for the calculation of non-ioniz-
ing radiation.
Human phantom are mathematically described as
three-dimensional matrices of organ identification
No. 4 2023
692 BENAMEUR et al.

1.6E+008
GATE
1.4E+008 SRS-78

Flux in air, photon/mAs mm2

1.2E+008

1.0E+008

8.0E+007

6.0E+007

4.0E+007

2.0E+007

–2.0E+007
0 20 40 60 80 100 120
Tube voltage, kVp

Fig. 2. Normalized x-ray spectrum for a tungsten target at 110 keV was generated using the SRS-78 program and GATE.

Fig. 3. Image of voxelized phantom KATJA.

codes (numbers). Rows, columns and slices are
arranged to represent the size, depth and height of a
human. An organ or tissue is identified by unique
numbers. Using this phantom, it is possible to calcu-
late organ doses from MC [24] photon transport sim-
ulations.
KATJA is a female voxelized phantom one ICRP
[25] has a voxel resolution of 1.775 × 1.775 × 4.84 mm3,
a height of 1.63 m and weight of 60 kg in her 24 weeks
of pregnancy. The woman is a modified version of the
ICRP-AF, the adult female reference model. All organ
masses but adipose tissue, skin, urinary bladder and
uterus remained the ICRP reference masses. The
woman has 153 organs and the fetus 18. The seg-
mented organs of the fetus are brain, skull, brain
liquor, eyes, eye lenses, skin, soft tissue, spinal cord,
lungs, liver, kidneys, heart, gall bladder and stomach.
They were taken from the MRI scan as they could be
seen Fig. 4. To calculate organ doses, KATJA was
inserted and scanned for 80, 110 and 130 kV respec-
tively.
Organ Dose Analysis
A chest CT routine scan was simulated using scan
parameters and scan length of chest CT examination
reported in Table 1. For all scan acquisitions, organ
doses were obtained and analyzed in order to describe
scan parameters (pitch, kV) effect on radiation dose
received by fetus organs and effective doses. Effective

PHYSICS OF PARTICLES AND NUCLEI LETTERS Vol. 20 No. 4 2023

 FETAL ORGAN DOSE ASSESSMENT DURING CHEST CT EXAMINATION
(a)
Fig. 4. (a) slice phantom KATJA, (b) slice output simulated.
dose for all scans simulations were calculated using
weighting factor (ICRP 103) [20].
In addition, to calculate organ doses MC simula-
tions were performed in a (High-Performance Com-
puting), which has the following characteristics:
64 cores, 256 GB RAM, 8T storage (High institute of
health, University Hassan 1st). 108 primary photons
were generated in MC simulation. The normalization
factor for the 5 mm beam collimation of the protocols
was 7 × 108, 5.44 × 108 and 9.82 × 108 particles per
100 mAs for 80, 110 and 130 kV respectively. GATE
simulation results were obtained as a 3D dose map
where the energy deposited by voxel (in MeV) is stored
Fig. 4b.
Dose Calculation/GATE Monte Carlo Software
GATE is open-source program created by the
international OpenGate cooperation for radiation and
medical imaging simulations. It is based on the
Geant4 simulation toolkit [26].
The GATE code contains all the cross-sectional
data needed for neutron, photon and electron trans-
port calculations and is suitable immediately for dose
modeling at 3D volumes, since it contains a special
“Dose By Region Actor”.
GATE assures a Range of acquisitions and Time-
dependence at all steps of the simulation. Thus, in
helical scan modeling, overall motion of source and
table were set. For one source rotation, a total of
360 projections per 1s were simulated. Therefore,
Table translation step along Vertical axis Z was tuned
Table 1. Parameters of the chest CT examination
kV mAs Pitch
80 100 0.5–0.6–0.7–0.8–1–1.5
110 100 0.8
130 100 0.8
PHYSICS OF PARTICLES AND NUCLEI LETTERS
693
(b)
to achieve six pitch values (0.5, 0.6, 0.7, 0.8, 1 and 1.5).
GATE package provides a geometry modeling used to
build CT system parts (filter, table and collimator).
Tracking particle model allows also optimizing calcu-
lation. The default energy cut-off and kill actor was
performed to maintain only particles in direction of
phantoms and that deposited energy exceed 1 keV.
Accordingly, time per simulation was reduced approx-
imately to 90 min for the use of 5 × 109 photons.
The dosimetry actor in GATE account for energy
deposited on voxels and regions. 3D dose map was
generated by “dose by region actor” taking into
account primary and secondary tracking photons
through a voxelized model and tallying dose in voxels.
Besides, a geometry detector was used to store the dose
deposited in each labeled phantom region.
Dose Calculators Software
Organ dose and effective dose were assessed from
IMPACT CT [27] and CT-EXPO v2.5. Towing soft-
ware has been used to calculate typical organ doses as
well as effective doses for CT protocols. ImPACT
Group created the IMPACT CT Patient Dosimetry
Calculator (Imaging Performance Assessment of CT
scanners, St Georges Hospital, London, UK). For
27 scanner types used in the UK, a home-made pro-
gram code with a hermaphrodite phantom (MIRD5,
20 organs) was programmed to carry out 23 sets of MC
simulations [28]..Built on the organ dose database
created at the GSF in Germany, CT-EXPO makes use
Bowtie filter KATJA phantom scan length, cm
Body 19
Vol. 20 No. 4 2023
694
Fig. 5. Interface of Web-based tool software.
of the stylized male and female phantoms ADAM and
EVA [29].
On the other hand, Web-based tool software Fig. 5,
were widely-used to derive typical organ and effective
doses for CT protocols. A hybrid phantom was used to
representing pregnant patients at the end of the third,
sixth and ninth months of pregnancy developed by
Xu et al. [30] (Rensselaer Polytechnic Institute, RPI,
New York, NY). In contrast to stylized models, hybrid
computational phantoms represent realistic geome-
tries of pregnant patients [31, 32]. These phantoms
were voxelized of the phantoms were removed, since
patients’ arms are usually located outside of the field
of view (FoV). In addition, users must enter the CT
Dose Index Volume (CTDIvol) and select the upper
12 h
3h
Centre
9h
6h
Fig. 6. CTDI100 measurement in PMMA body phantom.
The phantom has been placed on the CT table with its long
axis aligned with the gantry’s axis of rotation. It has a
diameter of 32 cm.
PHYSICS OF PARTICLES AND NUCLEI LETTERS
BENAMEUR et al.
and lower scan positions. Users can also add gesta-
tional age, tube voltage and maternal circumference in
millimeters to improve the accuracy of calculations,
Web-based tool software was validated [33] by Insti-
tute of Diagnostic and Interventional Radiology, Uni-
versity Hospital Zurich, University of Zurich.
CTDI Dose Measurements
A Siemens Somatom Emotion 16-slice scanner is
used with a 32 cm diameter PMMA phantom (ρ =
1.19 g/cm3) to simulate the human body measuring
15 cm in length. The phantom was setup on the CT
table so that its long axis corresponded to the rotation
axis of the CT gantry (Fig. 6). The PMMA phantom
was scanned in chest region with the following scan
parameters: 80, 110, 130 kV, 100 mAs and 10 mm beam
collimation. CTDI100 measurements were performed
using a calibrated pencil ion chamber (model 10X6-3CT
RADCAL CORPORATION USA), with an active
volume of 3 cm3 and a length of 10 cm, connected to
an electrometer (RADCAL CORPORATION USA),
using Accu-Gold+ interface software to display out-
put parameters such as absorbed dose.
Thus, CDTIw and dose length product (DLP) were
calculated using equations (1) and (2), respectively. In
these equations, DLP is proportional to the total
absorbed energy related to the length scan acquisition,
pitch is defined as the ratio of table displacement per
rotation and L is the length of the scan [16] and
CTDIw is the average absorbed radiation dose over the
longitudinal (x) and Lateral (y) directions of space axis
[17, 18]. In addition, the effective dose was calculated
by weighting the DLP by the kDLP factor (ICRP103),
which is set according to the anatomical region and the
patient’s age [19].
Vol. 20 No. 4 2023
 FETAL ORGAN DOSE ASSESSMENT DURING CHEST CT EXAMINATION 695

Table 2. Measured CTDIw and simulated CTDIW for the CTDI body phantom using the Siemens Emotion 16 slices
(100 mA, 1 s scan and 10 mm beam collimation)
Tube voltage, kVp 80 110 130
Measured CTDIw, mGy 3.39 ± 0.46 8.27 ± 0.73 12.48 ± 0.93
Simulated CTDIw, mGy 3.15 ± 0.38 8.16 ± 0.98 11.78 ± 0.83
Relative difference 7.2% 1.3% 5.6%

Finally, to validate the modelled scanner, a simula-
tion was carried out with the same experimental
equipment under the same conditions indicated
above.
CTDIw = 1 CTDI100 + 2 CTDI100
center periphery
, (1)
3 3
CTDIw
DLP = L. (2)
pitch
RESULT AND DISCUSSION
The comparison between measured and simulated
CTDIw is presented in Table 2. Comparison was per-
formed using Eq. (3) for all tube voltages (80, 110 and
130 kV). In this study, differences ranged between 1.32
and 7.21%. Note that, Lee et al. [34] study indicates
also a discrepancy around 8.6% between simulated
and measured CTDIw. The differences might be due to
simulation conditions, environment and source.
However, such differences are considered acceptable
to validate the model.
dose is reduced by 21.5, 19.2, 30.3 and 17.6% for cra-
nium, eyes, heart and brain, respectively, when pitch
increases from 0.5 to 1.5. Fetal effective dose is
reduced by 29.4% when pitch decrease from 1.5 to 0.5.
In the helical scanning, the pitch and the dose are
inversely proportional due to the table’s displacement
which results “Overlaps” and a higher irradiation
time.
Organ Absorbed Dose Using IMPACT CT, CT-EXPO
and Web-Based Tool Software
The effective doses received by the fetus for tho-
racic examination are calculated using CT-EXPO and
CTDOSIMETRY software (Table 3) and compared to
the values calculated in the KATJA voxilized phan-
tom. Effective doses calculated from Web-based tool
software are also added to the dose comparison.
Table 4 shows a comparison between the effective
doses obtained using GATE and WEB-TOOLS, the
relative difference observed is 16.7, 7.69 and 5.56% for
80, 110 and 130 kV. These results show that the differ-

(
MC )
difference = MC − SC × 100. (3)
ence increases inversely with tube voltage. This differ-
ence is acceptable due to the fact that the phantom
used in WEB-TOOLS is a voxilized phantom, which
Effect of Tube Voltage
The objective of the current section is to examine 80 kV 110 kV 130 kV
2.5
the influence of kV variation on the absorbed dose to
the fetal organs and the effective dose. Figure 7 rep-
Absorbed dose, mGy

resents fetal organs doses for different tube voltage val- 2.0
ues. Since all organs are entirely outside the thoracic
acquisition, fetal organ doses are low. Doses of organs
such as spine, heart and eyes are within the range of 1.5
0.25–0.90 mGy, 0.23–0.68 mGy and 0.25–
0.50 mGy, respectively, for 80–130 kV. 1.0
Fetal doses in heart and spinal cord were reduced
by 64.3 and 50.6% when the energy increases from 80
to 130 kV. Additionally, fetal effective dose is reduced 0.5
by 51.2% when the energy decreases from 130 to 80 kV.
0
Spinal cord
Spine

Liver
Brain

Eyes

Lungs

Heart

Effective Dose
Cranium

Effect of Pitch
In this section, we will study the influence of the
pitch’s variation on the absorbed dose of the fetal
organs as well as on the effective dose for a fixed volt-
age, 80 kV. Figure 8 shows absorbed dose (mGy) val-
ues for various pitches. The organ dose is inversely
proportional to the pitch. It can be seen that organ Fig. 7. Fetal organ doses as function of tube voltage.

PHYSICS OF PARTICLES AND NUCLEI LETTERS Vol. 20 No. 4 2023

696 BENAMEUR et al.

1.4
0.5 0.6 0.7 0.8 1 1.5

1.2

1.0
Absorbed dose, mGy

0.8

0.6

0.4

0.2

0
Spinal cord
Spine

Brain

Eyes

Liver
Lungs

Heart

Effective Dose
Cranium
Fig. 8. Fetal organ doses as function of pitch.

takes into account the heterogeneity of tissues as well
as the same period of exposure.
The values of the relative difference between GATE
and CT-Dosimetry phantom on the one hand are
90.0, 62.3 and 62.2%, on the other hand GATE and
CT-Expo are 99.2, 15.4 and 44.4%, respectively for 80,
110 and 130 kV. These large differences are due to the
fact in that, in KATJA phantom we have a real geom-
etry of the fetus, whereas in CT-Expo and CT-Dosim-
etry the effective dose of the fetus is estimated to be
similar of uterus, plus the geometric shape of the
uterus is represented by a sphere.
In the literature, there is no reference standard for
fetal dose that can be used as comparison for this
study. However, there are several existing fetal dose
estimation methods against which the results of this
study can be compared.
The first comparison method for the estimation of
fetal dose was that of Gu et al [6]. For these calcula-
tions, the estimated fetal dose during an chest and kid-
ney examination with phantoms of a pregnant patient
in three different gestational periods to calculate organ
doses for a single voltage 120 kV and pitch 0.9375,
1.375 respectively using MCNPX MC simulation. The
estimated fetal dose was up to 20.5% range compared
with the MC results from this study.
The second and third fetal dose estimation meth-
ods used for comparison were the ImPACT dose cal-
culator and CT-Expo software, which are both based
on MC simulations [35]. These methods were used to
estimate dose to the uterus and represent fetal dose for

Table 3. Show the dosimetric values taken from software by CT-Expo and CT-Dosimetry, simulating Siemens Somata 4
plus scanner, to estimate the effective dose to the uterus during a thoracic scan
CT-Dosimetry CT-Expo
kVp dose uterus CTDIvol, mGy DPL, mGy cm dose uterus CTDIvol, mGy DPL, mGy cm
80 0.012 2.7 88 0.0011 3 115
110 0.049 9 296 0.11 8 306
130 0.068 13 429 0.13 12.3 472

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 FETAL ORGAN DOSE ASSESSMENT DURING CHEST CT EXAMINATION
Table 4. Relative difference (%) between MC/GATE and
Web-based tools software, CT-Expo and CT-dosimetry
Web-based Tools CT-Expo CT-Dosimetry
80 kV 16.7 99.2 90.0
110 kV 7.69 15.4 62.3
130 kV 5.56 44.4 62.2
gestational ages approximately less than or equal to 8
weeks in a standard-size patient. The estimated uterus
dose was ranged from 0.01 to 0.15 mGy.
These differences observed were probably caused
by uncertainties of the X-ray spectrum (filtration),
modelled geometry, phantom volume, fetus age and
organ density.
Radiation effective dose to fetus from multidetec-
tor CT imaging in pregnant patient was estimated
yielding a mean value of 0.8 mGy with a range of 0.8–
2.4 mGy. Although the MC simulations are a single
acquisition in this study. The results can be applied to
assess dose for multiple procedures with varying pitch,
tube current, or gantry rotation duration (in seconds).
To account for differences in pitch, dose should be
proportional to the inverse of pitch. For example, to
estimate the dose for an examination with a pitch of
0.8 (with all other technical parameters constant), the
results from this study can be divided by 0.8.
These research shows that, while individual patient
doses may vary widely, fetal doses from a single chest
CT examination are still substantially below the main-
stream range of minimal risk (50–150 mGy) and
much below the “actionable” level of 100 mGy [8]. It
shouldn’t be interpreted as CT scans in patients who
are pregnant, it must be performed without adequate
medical justification. The dose estimated in this study
represents a single CT acquisition. However, in clini-
cal practice, two or three acquisitions (i.e., pre- and
post-contrast imaging) are needed, thus doubling or
tripling the dose to fetus.
CONCLUSIONS
In this study, the estimation of the fetal organ dose
and the effective dose for a chest examination of a
pregnant patient in the third trimester has been pre-
sented. The outcomes show that the dose is propor-
tional to the kV and inversely proportional to the pitch.
The obtained doses in our study have been compared
to those obtained by different simulation tools: CT-
Expo, CT-Dosimetry and web - based tools. This
comparison highlights that the GATE MC could be an
important tool for calculating fetal organ doses from
CT examinations. Results reveal also that the received
doses by the fetus organs have been under 150 mGy
which is in good agreement with the studies reported
by Angel et al. [8]. In practice, dose reduction in such
protocols should consider the high effect of tube cur-
PHYSICS OF PARTICLES AND NUCLEI LETTERS Vol. 20
697
rent to the dose. A future work is expected to examine
several aspects not covered by this study. Further,
investigations will have to take into account not only
the effects of scan parameters, but also other relevant
factors including maternal perimeter, fetus position
and shielding tools. These aspects are taken into
account in a work that is currently underway and will
be reported soon.
CONFLICT OF INTEREST
The authors declare that they have no conflicts of interest.
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