The effect of angular and longitudinal tube current modulations on the estimation of organ and effective doses in x-ray computed tomography.

PURPOSE: Tube current modulation (TCM) is one of the recent developments in multislice CT that has proven to reduce the patient radiation dose without affecting the image quality. Presently established methods and published coefficients for estimating organ doses from the dose measured free in air on the axis of rotation or in the CT dose index (CTDI) dosimetry phantoms do not take into account this relatively new development in CT scanner design and technology. Based on these organ dose coefficients effective dose estimates can be made. The estimates are not strictly valid for CT scanning protocols utilizing TCM. In this study, the authors investigated the need to take TCM into account when estimating organ and effective dose values. METHODS: A whole-body adult anthropomorphic phantom (Alderson Rando) was scanned with a multislice CT scanner (Somatom Definition, Siemens, Forchheim, Germany) utilizing TCM (CareDose4D). Tube voltage was 120 kV, beam collimation 19.2 mm, and pitch 1. A voxelized patient model was used to define the tissues and organs in the phantom. Tube current values as a function of tube angle were obtained from the raw data for each individual tube rotation of the scan. These values were used together with the Monte Carlo dosimetry tool IMPACTMC (VAMP GmbH, Erlangen, Germany) to calculate organ dose values both with and without account of TCM. Angular and longitudinal modulations were investigated separately. Finally, corresponding effective dose conversion coefficients were determined for both cases according to the updated 2007 recommendations of the ICRP. RESULTS: TCM amplitude was greatest in the shoulder and pelvic regions. Consequently, dose distributions and organ dose values for particular cross sections changed considerably when taking angular modulation into account. The effective dose conversion coefficients were up to 11% lower for a single rotation in the shoulder region and 17% lower in the pelvis when taking angular TCM into account. In the head, neck, thorax, and upper abdominal regions, conversion coefficients changed similarly by only 5% or less. Conversion coefficients for estimating effective doses for scans of complete regions, e.g., chest or abdomen, were approximately 8% lower when taking angular and longitudinal TCMs into account. CONCLUSIONS: The authors conclude that for accurate organ and effective dose estimates in individual cross sections in the shoulder or pelvic regions, the angular tube current modulation should be taken into account. In general, using the average of the modulated tube current causes an overestimation of the effective dose.