Optimization of CT pulmonary angiography for pulmonary embolism using task-based image quality assessment and diagnostic reference levels: A multicentric study.

PURPOSE: To establish size-specific diagnostic reference levels (DRLs) for pulmonary embolism (PE) based on patient CT examinations performed on 74 CT devices. To assess task-based image quality (IQ) for each device and to investigate the variability of dose and IQ across different CTs. To propose a dose/IQ optimization. METHODS: 1051 CT pulmonary angiography dose data were collected. DRLs were calculated as the 75th percentile of CT dose index (CTDI) for two patient categories based on the thoracic perimeters. IQ was assessed with two thoracic phantom sizes using local acquisition parameters and three other dose levels. The area under the ROC curve (AUC) of a 2 mm low perfused vessel was assessed with a non-prewhitening with eye-filter model observer. The optimal IQ-dose point was mathematically assessed from the relationship between IQ and dose. RESULTS: The DRLs of CTDIvol were 6.4 mGy and 10 mGy for the two patient categories. 75th percentiles of phantom CTDIvol were 6.3 mGy and 10 mGy for the two phantom sizes with inter-quartile AUC values of 0.047 and 0.066, respectively. After the optimization, 75th percentiles of phantom CTDIvol decreased to 5.9 mGy and 7.55 mGy and the interquartile AUC values were reduced to 0.025 and 0.057 for the two phantom sizes. CONCLUSION: DRLs for PE were proposed as a function of patient thoracic perimeters. This study highlights the variability in terms of dose and IQ. An optimization process can be started individually and lead to a harmonization of practice throughout multiple CT sites.

Proposed DRLs for mammography in Switzerland.

The aim of this study is to propose diagnostic reference levels (DRLs) values for mammography in Switzerland. For the data collection, a survey was conducted among a sufficient number of centres, including five University hospitals, several cantonal hospitals, and large private clinics, covering all linguistic regions of Switzerland to be representative of the clinical practice. The data gathered contained the mean glandular dose (MGD), the compressed breast thickness (CBT), the mammography model and the examination parameters for each acquisition. The data collected was sorted into the following categories: 2D or digital breast tomosynthesis (DBT) examination, craniocaudal (CC) or mediolateral oblique (MLO) projection, and eight categories of CBT ranging from 20 mm to 100 mm in 10 mm intervals. A total of 24 762 acquisitions were gathered in 31 centres on 36 mammography units from six manufacturers. The analysis showed that the data reflects the practice in Switzerland. The results revealed that the MGD is larger for DBT than for 2D acquisitions for the same CBT. From 20-30 mm to 90-100 mm of CBT, the 75th percentile of the MGD values obtained increased from 0.81 mGy to 2.55 mGy for 2D CC acquisitions, from 0.83 mGy to 2.96 mGy for 2D MLO acquisitions, from 1.22 mGy to 3.66 mGy for DBT CC acquisitions and from 1.33 mGy to 4.04 mGy for DBT MLO acquisitions. The results of the survey allow us to propose Swiss DRLs for mammography according to the examination type (2D/DBT), projection (CC/MLO) and CBT. The proposed values are very satisfactory in comparison with other studies.

Clinical commissioning of the first point-of-care spectral photon-counting CT for the upper extremities.

BACKGROUND: Acceptance testing and quality assurance (QA) of computed tomography (CT) scans are of great importance to ensure the appropriate performance of the systems. However, current standards and guidelines do not include a dedicated QA program for spectral photon-counting CT (SPCCT), nor adapted tolerance levels. PURPOSE: To evaluate the technical performance, in terms of image quality and radiation dose, of the first point-of-care SPCCT for the upper extremities (MARS Extremity 5X120, MARS Bioimaging Ltd., Christchurch, New Zealand) and to establish a comprehensive QA program. METHODS: The specific dimensions of the scanner with a 125 mm diameter gantry and a small voxel size of 0.1 × 0.1 × 0.1 mm3 require the use of suitable phantoms and evaluation techniques. Indicators such as CT number accuracy, image noise, uniformity, and slice thickness were assessed to characterize the image quality. The in-plane and longitudinal spatial resolutions were evaluated by means of the modulation transfer function (MTF). Noise power spectra (NPS) were calculated to further evaluate the image noise. Material identification capabilities were assessed using clinically relevant high-Z materials (iodine, gold, gadolinium, and calcium). A 100-mm diameter CTDI-like phantom was used to measure the dose indices. A complete radiation survey was carried out to measure the radiation exposure at different points around the scanner. RESULTS: The proposed QA program is based on international and local recommendations as well as practical experience. It includes standardised CT tests and SPCCT-specific methods. Additional methodologies to further assess the system performance are also presented. Tolerance levels are discussed and revised when appropriate. Both in-plane and longitudinal high spatial resolutions were evidenced by the MTF measurements with 1.8 lp· mm-1 and 5.0 lp· mm-1 at 10%, respectively. The calculated effective slice thickness ranged between 0.15 and 0.16 mm for the five energy bins and for a reconstructed voxel size of 0.1 × 0.1 × 0.1 mm3 . Reference values of the linear attenuation coefficient of water have been calculated and used to assess the CT number uniformity of water. Evaluation of the CT number accuracy and stability of various clinically relevant materials showed excellent spectral correlation and linearity between HU values and concentrations (r2 > 0.99). The NPS showed less noise correlation between slices than within transverse slice, as well as a systematic increase at low spatial frequencies. The volume CT dose index (CTDI v o l $_{vol}$ ) for a custom-made 100 mm diameter phantom was 9.32 mGy. Radiation measurements around the scanner showed that it is completely shielded except for the access port, and that no additional protective measures are necessary for the patient. CONCLUSIONS: A routine QA framework for SPCCT systems has been proposed. Image quality and radiation dose were assessed using newly designed phantoms, relevant metrics, and automated algorithms. Baseline values were established and tolerance levels discussed for the MARS SPCCT scanner based on collected data and international recommendations.

Virtual Noncontrast Abdominal Imaging with Photon-counting Detector CT.

Background Accurate CT attenuation and diagnostic quality of virtual noncontrast (VNC) images acquired with photon-counting detector (PCD) CT are needed to replace true noncontrast (TNC) scans. Purpose To assess the attenuation errors and image quality of VNC images from abdominal PCD CT compared with TNC images. Materials and Methods In this retrospective study, consecutive adult patients who underwent a triphasic examination with PCD CT from July 2021 to October 2021 were included. VNC images were reconstructed from arterial and portal venous phase CT. The absolute attenuation error of VNC compared with TNC images was measured in multiple structures by two readers. Then, two readers blinded to image reconstruction assessed the overall image quality, image noise, noise texture, and delineation of small structures using five-point discrete visual scales (5 = excellent, 1 = nondiagnostic). Overall image quality greater than or equal to 3 was deemed diagnostic. In a phantom, noise texture, spatial resolution, and detectability index were assessed. A detectability index greater than or equal to 5 indicated high diagnostic accuracy. Interreader agreement was evaluated using the Krippendorff α coefficient. The paired t test and Friedman test were applied to compare objective and subjective results. Results Overall, 100 patients (mean age, 72 years ± 10 [SD]; 81 men) were included. In patients, VNC image attenuation values were consistent between readers (α = .60), with errors less than 5 HU in 76% and less than 10 HU in 95% of measurements. There was no evidence of a difference in error of VNC images from arterial or portal venous phase CT (3.3 HU vs 3.5 HU, P = .16). Subjective image quality was rated lower in VNC images for all categories (all, P < .001). Diagnostic quality of VNC images was reached in 99% and 100% of patients for readers 1 and 2, respectively. In the phantom, VNC images exhibited 33% higher noise, blotchier noise texture, similar spatial resolution, and inferior but overall good image quality (detectability index >20) compared with TNC images. Conclusion Abdominal virtual noncontrast images from the arterial and portal venous phase of photon-counting detector CT yielded accurate CT attenuation and good image quality compared with true noncontrast images. © RSNA, 2022 Online supplemental material is available for this article See also the editorial by Sosna in this issue.

X-ray imaging detector for radiological applications adapted to the context and requirements of low- and middle-income countries.

This paper describes the development of a novel medical x-ray imaging system adapted to the needs and constraints of low- and middle-income countries. The developed system is based on an indirect conversion chain: a scintillator plate produces visible light when excited by the x rays, and then, a calibrated multi-camera architecture converts the visible light from the scintillator into a set of digital images. The partial images are then unwarped, enhanced, and stitched through parallel field programmable gate array processing units and specialized software. All the detector components were carefully selected focusing on optimizing the system's image quality, robustness, cost-effectiveness, and capability to work in harsh tropical environments. With this aim, different customized and commercial components were characterized. The resulting detector can generate high quality medical diagnostic images with detective quantum efficiency levels up to 60% (@2.34 µGy), even under harsh environments, i.e., 60 °C and 98% humidity.

Quantum Iterative Reconstruction for Low-Dose Ultra-High-Resolution Photon-Counting Detector CT of the Lung.

The aim of this study was to characterize image quality and to determine the optimal strength levels of a novel iterative reconstruction algorithm (quantum iterative reconstruction, QIR) for low-dose, ultra-high-resolution (UHR) photon-counting detector CT (PCD-CT) of the lung. Images were acquired on a clinical dual-source PCD-CT in the UHR mode and reconstructed with a sharp lung reconstruction kernel at different strength levels of QIR (QIR-1 to QIR-4) and without QIR (QIR-off). Noise power spectrum (NPS) and target transfer function (TTF) were analyzed in a cylindrical phantom. 52 consecutive patients referred for low-dose UHR chest PCD-CT were included (CTDIvol: 1 ± 0.6 mGy). Quantitative image quality analysis was performed computationally which included the calculation of the global noise index (GNI) and the global signal-to-noise ratio index (GSNRI). The mean attenuation of the lung parenchyma was measured. Two readers graded images qualitatively in terms of overall image quality, image sharpness, and subjective image noise using 5-point Likert scales. In the phantom, an increase in the QIR level slightly decreased spatial resolution and considerably decreased noise amplitude without affecting the frequency content. In patients, GNI decreased from QIR-off (202 ± 34 HU) to QIR-4 (106 ± 18 HU) (p < 0.001) by 48%. GSNRI increased from QIR-off (4.4 ± 0.8) to QIR-4 (8.2 ± 1.6) (p < 0.001) by 87%. Attenuation of lung parenchyma was highly comparable among reconstructions (QIR-off: -849 ± 53 HU to QIR-4: -853 ± 52 HU, p < 0.001). Subjective noise was best in QIR-4 (p < 0.001), while QIR-3 was best for sharpness and overall image quality (p < 0.001). Thus, our phantom and patient study indicates that QIR-3 provides the optimal iterative reconstruction level for low-dose, UHR PCD-CT of the lungs.

Performance of Spectral Photon-Counting Coronary CT Angiography and Comparison with Energy-Integrating-Detector CT: Objective Assessment with Model Observer.

AIMS: To evaluate spectral photon-counting CT's (SPCCT) objective image quality characteristics in vitro, compared with standard-of-care energy-integrating-detector (EID) CT. METHODS: We scanned a thorax phantom with a coronary artery module at 10 mGy on a prototype SPCCT and a clinical dual-layer EID-CT under various conditions of simulated patient size (small, medium, and large). We used filtered back-projection with a soft-tissue kernel. We assessed noise and contrast-dependent spatial resolution with noise power spectra (NPS) and target transfer functions (TTF), respectively. Detectability indices (d') of simulated non-calcified and lipid-rich atherosclerotic plaques were computed using the non-pre-whitening with eye filter model observer. RESULTS: SPCCT provided lower noise magnitude (9-38% lower NPS amplitude) and higher noise frequency peaks (sharper noise texture). Furthermore, SPCCT provided consistently higher spatial resolution (30-33% better TTF10). In the detectability analysis, SPCCT outperformed EID-CT in all investigated conditions, providing superior d'. SPCCT reached almost perfect detectability (AUC ≈ 95%) for simulated 0.5-mm-thick non-calcified plaques (for large-sized patients), whereas EID-CT had lower d' (AUC ≈ 75%). For lipid-rich atherosclerotic plaques, SPCCT achieved 85% AUC vs. 77.5% with EID-CT. CONCLUSIONS: SPCCT outperformed EID-CT in detecting simulated coronary atherosclerosis and might enhance diagnostic accuracy by providing lower noise magnitude, markedly improved spatial resolution, and superior lipid core detectability.

Task-based characterization of a deep learning image reconstruction and comparison with filtered back-projection and a partial model-based iterative reconstruction in abdominal CT: A phantom study.

PURPOSE: We aimed to thoroughly characterize image quality of a novel deep learning image reconstruction (DLIR), and investigate its potential for dose reduction in abdominal CT in comparison with filtered back-projection (FBP) and a partial model-based iterative reconstruction (ASiR-V). METHODS: We scanned a phantom at three dose levels: regular (7 mGy), low (3 mGy) and ultra-low (1 mGy). Images were reconstructed using DLIR (low, medium and high levels) and ASiR-V (0% = FBP, 50% and 100%). Noise and contrast-dependent spatial resolution were characterized by computing noise power spectra and target transfer functions, respectively. Detectability indexes of simulated acute appendicitis or colonic diverticulitis (low contrast), and calcium-containing urinary stones (high contrast) (|ΔHU| = 50 and 500, respectively) were calculated using the nonprewhitening with eye filter model observer. RESULTS: At all dose levels, increasing DLIR and ASiR-V levels both markedly decreased noise magnitude compared with FBP, with DLIR low and medium maintaining noise texture overall. For both low- and high-contrast spatial resolution, DLIR not only maintained, but even slightly enhanced spatial resolution in comparison with FBP across all dose levels. Conversely, increasing ASiR-V impaired low-contrast spatial resolution compared with FBP. Overall, DLIR outperformed ASiR-V in all simulated clinical scenarios. For both low- and high-contrast diagnostic tasks, increasing DLIR substantially enhanced detectability at any dose and contrast levels for any simulated lesion size. CONCLUSIONS: Unlike ASiR-V, DLIR substantially reduces noise while maintaining noise texture and slightly enhancing spatial resolution overall. DLIR outperforms ASiR-V by enabling higher detectability of both low- and high-contrast simulated abdominal lesions across all investigated dose levels.

Task-Based Model Observer Assessment of A Partial Model-Based Iterative Reconstruction Algorithm in Thoracic Oncologic Multidetector CT.

To investigate the impact of a partial model-based iterative reconstruction (ASiR-V) on image quality in thoracic oncologic multidetector computed tomography (MDCT), using human and mathematical model observers. Twenty cancer patients examined with regular-dose thoracic-abdominal-pelvic MDCT were retrospectively included. Thoracic images reconstructed using a sharp kernel and filtered back-projection (reference) or ASiR-V (0-100%, 20% increments; follow-up) were analysed by three thoracic radiologists. Advanced quantitative physical metrics, including detectability indexes of simulated 4-mm-diameter solid non-calcified nodules and ground-glass opacities, were computed at regular and reduced doses using a custom-designed phantom. All three radiologists preferred higher ASiR-V levels (best = 80%). Increasing ASiR-V substantially decreased noise magnitude, with slight changes in noise texture. For high-contrast objects, changing the ASiR-V level had no major effect on spatial resolution; whereas for lower-contrast objects, increasing ASiR-V substantially decreased spatial resolution, more markedly at reduced dose. For both high- and lower-contrast pulmonary lesions, detectability remained excellent, regardless of ASiR-V and dose levels, and increased significantly with increasing ASiR-V levels (all p < 0.001). While high ASiR-V levels (80%) are recommended to detect solid non-calcified nodules and ground-glass opacities in regular-dose thoracic oncologic MDCT, care must be taken because, for lower-contrast pulmonary lesions, high ASiR-V levels slightly change noise texture and substantially decrease spatial resolution, more markedly at reduced dose.

Optimal slice thickness for object detection with longitudinal partial volume effects in computed tomography.

Longitudinal partial volume effects (z-axial PVE), which occur when an object partly occupies a slice, degrade image resolution and contrast in computed tomography (CT). Z-axial PVE is unavoidable for subslice objects and reduces their contrast according to their fraction contained within the slice. This effect can be countered using a smaller slice thickness, but at the cost of an increased image noise or radiation dose. The aim of this study is to offer a tool for optimizing the reconstruction parameters (slice thickness and slice spacing) in CT protocols in the case of partial volume effects. This optimization is based on the tradeoff between axial resolution and noise. For that purpose, we developed a simplified analytical model investigating the average statistical effect of z-axial PVE on contrast and contrast-to-noise ratio (CNR). A Catphan 500 phantom was scanned with various pitches and CTDI and reconstructed with different slice thicknesses to assess the visibility of subslice targets that simulate low contrast anatomical features present in CT exams. The detectability score of human observers was used to rank the perceptual image quality against the CNR. Contrast and CNR reduction due to z-axial PVE measured on experimental data were first compared to numerical calculations and then to the analytical model. Compared to numerical calculations, the simplified algebraic model slightly overestimated the contrast but the differences remained below 5%. It could determine the optimal reconstruction parameters that maximize the objects visibility for a given dose in the case of z-axial PVE. An optimal slice thickness equal to three-fourth of the object width was correctly proposed by the model for nonoverlapping slices. The tradeoff between detectability and dose is maximized for a slice spacing of half the slice thickness associated with a slice width equal to the characteristic object width.

Difference in performance between 3D and 4D CBCT for lung imaging: a dose and image quality analysis.

The study was to describe and to compare the performance of 3D and 4D CBCT imaging modalities by measuring and analyzing the delivered dose and the image quality. The 3D (Chest) and 4D (Symmetry) CBCT Elekta XVI lung IGRT protocols were analyzed. Dose profiles were measured with TLDs inside a dedicated phantom. The dosimetric indicator cone-beam dose index (CBDI) was evaluated. The image quality analysis was performed by assessing the contrast transfer function (CTF), the noise power spectrum (NPS) and the noise-equivalent quanta (NEQ). Artifacts were also evaluated by simulating irregular breathing variations. The two imaging modalities showed different dose distributions within the phantom. At the center, the 3D CBCT delivered twice the dose of the 4D CBCT. The CTF was strongly reduced by motion compared to static conditions, resulting in a CTF reduction of 85% for the 3D CBCT and 65% for the 4D CBCT. The amplitude of the NPS was two times higher for the 4D CBCT than for the 3D CBCT. In the presence of motion, the NEQ of the 4D CBCT was 50% higher than the 3D CBCT. In the presence of breathing irregularities, the 4D CBCT protocol was mainly affected by view-aliasing artifacts, which were typically cone-beam artifacts, while the 3D CBCT protocol was mainly affected by duplication artifacts. The results showed that the 4D CBCT ensures a reasonable dose and better image quality when mov-ing targets are involved compared to 3D CBCT. Therefore, 4D CBCT is a reliable imaging modality for lung free-breathing radiation therapy.

Precision and Accuracy of Measurements on CT Scout View.

OBJECTIVES: The purposes of this study were to (1) investigate the limits of measurements on scout view in three computed tomography axes, x, y and z and (2) develop a model to provide better understanding of measurement accuracy. METHODS: For the first objective, anteroposterior and lateral scout views of a Catphan phantom 200 mm in diameter and length were acquired with a GE scanner at 21 different table heights. Phantom measurements on scout view were performed by two experienced readers. The comparison of their measures provided estimation of precision. The accuracy was assessed by determining the bias, calculated as the difference between the values measured on scout view and the real phantom size. Second, a model was developed investigating the relationship between the dimensions of the object, its image, and the table height. This relationship was tested on our data. RESULTS: Scout view measurements were precise, with less than 0.53% difference between readers. In addition, small biases of about 1 mm were detected in the z-axis, whatever the table height. In the other axes, serious biases from -13 to +73 mm were measured. Furthermore, at isocentre, overestimations up to 7 mm were shown. The results also indicated that biases in scout view measurements are because of the geometrical projection related to the object-detector distance. CONCLUSIONS: Measurements in the table movement axis are precise and accurate, conferring to scout views an added value for preoperative planning in orthopedic surgery.

Update on the non-prewhitening model observer in computed tomography for the assessment of the adaptive statistical and model-based iterative reconstruction algorithms.

The state of the art to describe image quality in medical imaging is to assess the performance of an observer conducting a task of clinical interest. This can be done by using a model observer leading to a figure of merit such as the signal-to-noise ratio (SNR). Using the non-prewhitening (NPW) model observer, we objectively characterised the evolution of its figure of merit in various acquisition conditions. The NPW model observer usually requires the use of the modulation transfer function (MTF) as well as noise power spectra. However, although the computation of the MTF poses no problem when dealing with the traditional filtered back-projection (FBP) algorithm, this is not the case when using iterative reconstruction (IR) algorithms, such as adaptive statistical iterative reconstruction (ASIR) or model-based iterative reconstruction (MBIR). Given that the target transfer function (TTF) had already shown it could accurately express the system resolution even with non-linear algorithms, we decided to tune the NPW model observer, replacing the standard MTF by the TTF. It was estimated using a custom-made phantom containing cylindrical inserts surrounded by water. The contrast differences between the inserts and water were plotted for each acquisition condition. Then, mathematical transformations were performed leading to the TTF. As expected, the first results showed a dependency of the image contrast and noise levels on the TTF for both ASIR and MBIR. Moreover, FBP also proved to be dependent of the contrast and noise when using the lung kernel. Those results were then introduced in the NPW model observer. We observed an enhancement of SNR every time we switched from FBP to ASIR to MBIR. IR algorithms greatly improve image quality, especially in low-dose conditions. Based on our results, the use of MBIR could lead to further dose reduction in several clinical applications.

X-ray phase contrast imaging of metallized and non-metallized biological samples.

Imaging of biological samples has been performed with a variety of techniques for example electromagnetic waves, electrons, neutrons, ultrasound and X-rays. Also conventional X-ray imaging represents the basis of medical diagnostic imaging, it remains of limited use in this application because it is based solely on the differential absorption of X-rays by tissues. Coherent and bright photon beams, such as those produced by third-generation synchrotron X-ray sources, provide further information on subtle X-ray phase changes at matter interfaces. This complements conventional X-ray absorption by edge enhancement phenomena. Thus, phase contrast imaging has the potential to improve the detection of structures on images by detecting those structures that are invisible with X-ray absorption imaging. Images of a weakly absorbing nylon fibre were recorded in in-line holography geometry using a high resolution low-noise CCD camera at the ESRF in Grenoble. The method was also applied to improve image contrast for images of biological tissues. This paper presents phase contrast microradiographs of vascular tree casts and images of a housefly. These reveal very fine structures, that remain invisible with conventional absorption contrast only.

Repeated injections of 131I-rituximab show patient-specific stable biodistribution and tissue kinetics.

PURPOSE: It is generally assumed that the biodistribution and pharmacokinetics of radiolabelled antibodies remain similar between dosimetric and therapeutic injections in radioimmunotherapy. However, circulation half-lives of unlabelled rituximab have been reported to increase progressively after the weekly injections of standard therapy doses. The aim of this study was to evaluate the evolution of the pharmacokinetics of repeated 131I-rituximab injections during treatment with unlabelled rituximab in patients with non-Hodgkin's lymphoma (NHL). METHODS: Patients received standard weekly therapy with rituximab (375 mg/m2) for 4 weeks and a fifth injection at 7 or 8 weeks. Each patient had three additional injections of 185 MBq 131I-rituximab in either treatment weeks 1, 3 and 7 (two patients) or weeks 2, 4 and 8 (two patients). The 12 radiolabelled antibody injections were followed by three whole-body (WB) scintigraphic studies during 1 week and blood sampling on the same occasions. Additional WB scans were performed after 2 and 4 weeks post 131I-rituximab injection prior to the second and third injections, respectively. RESULTS: A single exponential radioactivity decrease for WB, liver, spleen, kidneys and heart was observed. Biodistribution and half-lives were patient specific, and without significant change after the second or third injection compared with the first one. Blood T(1/2)beta, calculated from the sequential blood samples and fitted to a bi-exponential curve, was similar to the T(1/2) of heart and liver but shorter than that of WB and kidneys. Effective radiation dose calculated from attenuation-corrected WB scans and blood using Mirdose3.1 was 0.53+0.05 mSv/MBq (range 0.48-0.59 mSv/MBq). Radiation dose was highest for spleen and kidneys, followed by heart and liver. CONCLUSION: These results show that the biodistribution and tissue kinetics of 131I-rituximab, while specific to each patient, remained constant during unlabelled antibody therapy. RIT radiation doses can therefore be reliably extrapolated from a preceding dosimetry study.

Management of patient dose and image noise in routine pediatric CT abdominal examinations.

The aim was to propose a strategy for finding reasonable compromises between image noise and dose as a function of patient weight. Weighted CT dose index (CTDI(w)) was measured on a multidetector-row CT unit using CTDI test objects of 16, 24 and 32 cm in diameter at 80, 100, 120 and 140 kV. These test objects were then scanned in helical mode using a wide range of tube currents and voltages with a reconstructed slice thickness of 5 mm. For each set of acquisition parameter image noise was measured and the Rose model observer was used to test two strategies for proposing a reasonable compromise between dose and low-contrast detection performance: (1) the use of a unique noise level for all test object diameters, and (2) the use of a unique dose efficacy level defined as the noise reduction per unit dose. Published data were used to define four weight classes and an acquisition protocol was proposed for each class. The protocols have been applied in clinical routine for more than one year. CTDI(vol) values of 6.7, 9.4, 15.9 and 24.5 mGy were proposed for the following weight classes: 2.5-5, 5-15, 15-30 and 30-50 kg with image noise levels in the range of 10-15 HU. The proposed method allows patient dose and image noise to be controlled in such a way that dose reduction does not impair the detection of low-contrast lesions. The proposed values correspond to high- quality images and can be reduced if only high-contrast organs are assessed.