Radiation Dose

& Image Quality

in CT Scan.
Rinad M.Alyami
 INTRODUCTION
Computed Tomography ( CT ) scan is one of the imaging techniques
used in the medical diagnostic field and is considered a powerful
modality, but unfortunately, it contributes most of the medical
radiation doses experienced by patients. It is well known that the risk
of cancer increases with increasing radiation dose, so the high dose
from CT is very concerning.
Therefore, the medical physicists' role comes in performing the
required evaluation tests for the image quality characteristics and the
measurements of the CT dose, to make sure that the protocols are
applied. Where the strength of CT is its ability in visualizing the
structures of the images in diagnostically acceptable quality at the
lowest dose possible according to ALARA principle.

Image Radiation
Quality Dose

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 Image
Quality.
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 THE CT
IMAGE
QUALITY
PHANTOM
( ACR )
The CT image quality is described in terms of some characteristics
that can be checked and measured by using a solid phantom called
the ACR American College of Radiology phantom, which is
constructed originally from a water-equivalent material that consists of
four independent parts. Each part has a width of 4 cm and length of
20cm, and there is an outer white alignment marking that reflects
alignment lights on each module for allowing centering of the
phantom.

MODULE 1:
• Alignment
• CT Numbers
• Slice Thickness
MODULE 2 : MODULE 4 :
• Low Contrast • High Contrast
Resolution (Spatial)
Resolution

MODULE 3 :
• Uniformity ,
Noise ,and
Distance
Accuarcy

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 MODULE 1
Used For

- Alignment:
Checking the alignment of the laser with the phantom, and the
accuarcy of the scout image in identifying the precision of the
scan position.
- CT Numbers:
Checking the accuarcy of CT number (Hounsfield number), by
measuring the mean value to different densities , to determine
the CT precision at distinguishing different densities of the
patient’s specific volume as expected.
- Slice Thickness :
Checking the slice thickness, to determine that the
reconstructed slice thickness value agreed the tested slice
thickness value.

MODULE 2
Used For
25 mm - Low Contrast:
6 mm 2 mm Checking the contrast of the target to the
3 mm background visually and numerically ,by measuring
contrast to noise ratio CNR , and comparing the
4 mm measurements to the protocols, to make sure that
5 mm
it's adequate for diagnosis.

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 MODULE 3
Used For

- CT Number Uniformity ,Noise , and Distance

Accuarcy : 100 mm

Checking the precision of spatial uniformity , the mean CT

number and noise value of CT image of homogeneous
material, to avoid the noise and artifacts by measuring the
difference between the mean value of each peripheral and
center region of interest (ROI) and calculating the
corresponding standard deviations, and the two BBs included
in assessing the accuracy of in-plane distance measurements.

MODULE 4
Used For
- High Contrast Resolution :
12
4 10

Checking the spatial resolution performance of the

5 9
scan by identifying the highest spatial frequency in
8
6
the image, to make sure that it's adequate for
7
diagnosis.

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Dosimetry.

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 THE CT DOSIMETRY
PHANTOM
( CTDI PHANTOMS )
Estimating accurate dose is important for evaluating patient cancer-
risk and optimization of protocols. The standard descriptor for
estimating the output dose of a CT scanner is the volume CT dose
index (CTDI.vol) which measured in (mGy), and it can be found by
using a CT cylindrical acrylic dosimetry phantoms represents the adult
head of 16 cm diameter and body of 32 cm diameter of length
approximately 14–15 cm, where the adult head represent the
pediatric body.It have four holes in the peripheral at the 3-,6-,9-, and
12- o’clock positions, and one in the center.
by inserting pencil ionization chamber in the holes the dose
measurements can be obtain.

Head Phantom Body Phantom

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 - CT Dose Index ( CTDI ) -

To verify the safe dose delivered from the CT scan to the patients, the dose can be
checked and estimated by measuring the CT dose index (CTDI) of a single slice. The
CTDI is considered a useful estimation of the radiation dose of a direct x-ray beam
within a slice of a region that is scanned, and the scattered radiation coming out of
the sides of the slice. It provides a good approximation of the dose proficiency
according to the scan protocol, but it is not completely precise and useful for
estimating the dose of individual patients, because it requires the length of the scan
and the number of times that a particular region might be scanned.
By using the CT dose phantoms, the CTDI parameters can be found to check the
dosimetry performance of the CT scan in an axial acquisition by stopping the
automatic current exposure and any dose reduction features.

L : Active length pencil ion chamber ( typically = 100 mm )

f : Conversion factor from exposure to dose in air, use 0.87 rad/R (or conversion factor from air kerma to dose in air, use 1.0 mGy/
mGy)
C : Calibration factor for electrometer (typically 1.0, 2.0 for some)
E : Measured value of exposure in R

N : Number of acquired slices of thickness per single axial rotation.

T : Width of a single acquired slice .
N.T : Total z-direction beam width irradiating the N simultaneously slices.( Nominal radiation beam width)
I : Table increment per rotation ( Table speed )

1- Finding the CT dose index CTDI.

[ CTDI 100 , CTDI weighted , CTDI volume ]
a.CTDI 100:
The CTDI 100 represents dose distribution over a pencil ionization chamber of 100
mm
Unit : rad or mGy
CTDI100rad = f x C x E x L
N.T (mm)
CENTER |
CTDI100mGy = Dose center ( mGy )
-Taking multi-measurements at the center hole, and taking their average -

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 PERIPHERAL |
CTDI100mGy = Dose peripheral ( mGy )
-Taking the measurements at the four peripheral holes, and taking their average -

b.CTDI Weighted :
The CTDIw measure the dose distribution within the phantom in different positions.
[ lower dose at the center , and in other areas the dose vary with body dimension ,
composition and MA modulation ]
Unit : mGy
CTDI w = 1/3 CTDI center + 2/3 CTDI periphery
c.CTDI Volume :
The CTDIv measure the total radiation deposited per unit mass and it can estimate the
effect of the pitch since the couch movement can affect the dose.
Unit : mGy

CTDI.vol = CTDIw (( N x T ) / I ) ( Axial CT )

CTDI.vol = CTDIw / Pitch factor ( Helical CT )

Pitch = Table travel per one 360 gantry rotation (mm)/ Total nominal beam width
I
Pitch =
NT

Dose is always inversely proportional to pitch :

- Low pitch < 1.0 = more concentrated dose.
- High pitch > 1.0 = less concentrated dose.

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 - Dose Length Product (DLP)-
The dose length product is a useful clinical dose indicator in finding the total radiation
exposure for the whole series of individual patient images, and it can be used to obtain
the effective dose.

1. Finding the dose length product DLP

a.DLP:
Unit : mGy x cm
DLP = CTDL.vol X L
L: Scan length

2. Finding the effective dose :

a.Effective dose
Used in estimation the radiation risks.
Unit : mSv
Effective Dose = DLP X k .
k: conversion coefficient in mSv/ mGy* cm

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