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KEY CT PARAMETERS - WHAT ARE

THEY CALLED AND WHAT DO THEY


MEAN?
Michael McNitt-Gray, PhD, DABR, FAAPM
Professor, Department of Radiology
Director, Biomedical Physics Graduate Program
David Geffen School of Medicine at UCLA
mmcnittgray@mednet.ucla.edu

DISCLOSURES
Institutional research agreement,
Siemens AG
Recipient research support Siemens AG
Consultant, Flaherty Sensabaugh
Bonasso PLLC
Consultant, Fulbright and Jaworski, LLC

PURPOSE
Introduce some of the important tech.
parameters in CT scanning that affect
both radiation dose and image quality
Describe the terms used by the major
manufacturers
Discuss similarities and differences
between them.

IMPORTANT REFERENCE

AAPM Website (www.aapm.org)


CT Protocols Link
Lexicon Tab
Excel document

http://www.aapm.org/pubs/CTProtocols/documents/CTTerminology
Lexicon.pdf

AAPM LEXICON
from Working Group on nomenclature and CT
protocols

TECHNICAL PARAMETERS

CT localizer radiograph
kV
mA, mAs, effective mAs (aka mAs/slice)
Pitch
Tube Current Modulation (TCM) Systems
One form of Automatic Exposure Control (AEC)
Systems

TECH. PARAMETERS: CT LOCALIZER


RADIOGRAPH
The scanned projection radiograph, often acquired
by the CT system to allow the user to prescribe the
start and end locations of the scan range
Used for Planning CT Scan Start and End Locations
ALSO All Automatic Exposure Control systems
use this to plan adjustments based on patient
size/attenuation

TECHNICAL PARAMETERS

4000
a.p. (measured)

3500

lateral (calculated)

2500
2000
1500
1000
500
0
600

500

400

300

table position

200

100

attenuation I_0 / I

3000

CT LOCALIZER RADIOGRAPH

Generic
Termzs

GE

Philip Siemen Toshiba


s
s

Hitachi

Neuso Neuroligi
ft
ca

CT
localizer
Radiogra
gh

Sco
ut

Survie Topogra
w
m

Scanogr
am

Survie
w

Scanogr
am

Scout

CT LOCALIZER RADIOGRAPH
Importance of centering

Each manufacturer has a different name for the


projectional image that is used for planning a CT
exam, including Scout, Surview, Topogram, and
Scanogram, but the generic name is actually the:

1. Planning View
2. CT localizer
radiograph
3. CT survey projection
4. Localizer Scan
5. Monitoring Scan

Each manufacturer has a different name for the


projectional image that is used for planning a CT exam,
including Scout, Surview, Topogram, and Scanogram, but
the generic name is actually the:
1.
2.
3.
4.
5.

Planning View
CT localizer radiograph
CT survey projection
Localizer Scan
Monitoring Scan

Answer: 2, CT localizer radiograph


Ref: AAPM CT Lexicon version 1.3 04/20/2012

TECH. PARAMETERS: KV
Tube potential
The electric potential applied across an x-ray
tube to accelerate electrons towards a target
material, expressed in units of kilovolts (kV)
Often reduced in peds/smaller patients
kV selection methods part of AEC
NOTE: In CT, all scans are constant kV; There
is no kV modulation or varying of kV within the
scan

TUBE POTENTIAL

Generic
Termzs

GE

Philip Siemen Toshiba


s
s

Hitachi

Neuso Neuroligi
ft
ca

Tube
potential

kV

kVp

kVp

kV

kV

kV

kV

TECH. PARAMETERS: KV
Contrast in image
Lower kV can give more contrast,
especially with iodinated contrast agents
(exploit k-edge)

Tube output (mR/mAs)


Lower kV yields lower tube output >
noise increase
So, reducing kV often involves increasing
mAs to offset noise increase

TECH. PARAMETERS: KV
Dose

CTDIvol (kV)2.5
So, reducing kV from 120 to 80
(80/120) 2.5 = .36 (64% reduction)
IF mAs is held constant

TECH. PARAMETERS: KV
Dose

CTDIvol (kV)2.5
So, reducing kV from 120 to 80
(80/120) 2.5 = .36 (64% reduction)
IF mAs is held constant

TECH. PARAMETERS: TUBE CURRENT, ETC.


Tube current (in mA)
Tube Current time product (in mAs)
Effective Tube Current Time Product
Effective mAs
mAs/Slice
= mAs/pitch

TUBE CURRENT, ETC.


Generic
Terms

GE Philips Siemen Toshiba


s

Hitac
hi

mA

m
A

mA

mA

mAs

mAs
(axial)

mAs
(axial)

Eff. mAs
=
mAs/pitc
h

mAs/sli
ce
(helical
)

Eff. mAs Eff. mAs


(helical) (helical)

mAs

Neusoft Neuroligi
ca
mA
mAs

mAs

mAs/slic
e

mAs

Manufacturers use different terms for the tube


current, tube current time product or the effective
tube current time product. The definition of the
effective tube current time product is:
1. The number of electrons accelerated across an x-ray tube per
unit time, expressed in units of milliampere (mA)
2. The product of tube current and exposure time per rotation,
expressed in units of milliampere seconds (mAs).
3. In helical scan mode, the product of tube current and rotation
time (expressed in mAs) pitch

4. In axial mode, this is equal to tube current (scan angle 360)


rotation time.
5. In helical mode, this is equal to tube current rotation time.

Manufacturers use different terms for the tube current, tube


current time product or the effective tube current time
product. The definition of the effective tube current time
product is:
1.
2.

3.
4.
5.

The number of electrons accelerated across an x-ray tube


per unit time, expressed in units of milliampere (mA)
The product of tube current and exposure time per
rotation, expressed in units of milliampere seconds
(mAs).
In helical scan mode, the product of tube current and
rotation time (expressed in mAs) pitch
In axial mode, this is equal to tube current (scan angle
360) rotation time.
In helical mode, this is equal to tube current rotation
time.

Answer: (3) mAs pitch; this is also known as mAs/Slice in some


systems.
Ref: AAPM CT Lexicon version 1.3 04/20/2012

TECH. PARAMETERS: PITCH


Pitch = Table feed per rotation/nominal
collimation
Pitch = I/NT
Influences:
Total scan time (e.g. breathold)
Dose (?)
Effective width of reconstructed image thickness
minor effect in most MDCT)

TECH. PARAMETERS: PITCH


ONLY influences dose if everything else is
constant
GE, Toshiba use mA and Pitch independently
If Pitch , CTDIvol and patient dose

Philips, Siemens use effective mAs or mAs/slice


Eff mAs = mAs/pitch
System AUTOMATICALLY adjusts mAs with changes in
pitch to provide a constant eff mAs
If Pitch then mAs and no net change in CTDIvol

TECH. PARAMETERS: COLLIMATION

Detector Configuration
Nominal Collimation - NxT
N = Number of Detector Channels
T = Width of each Detector Channel
Example: 64 x 0.625mm
N= 64, T=0.625mm, NT = 40mm

DETECTOR CONFIGURATION (DET


CONF)
Gener GE
ic
Terms
Detect
or
Config

Philips

Det Collimati
Con on N x T
f
(mm)

Siem
ens

Toshi
ba

Hitac
hi

Neusoft

Neuroligic
a

Det
Conf
or
Acq

Det
Conf

Det
Conf

Collimati
on
NxT
(mm)

Det
Conf

TECH. PARAMETERS: COLLIMATION


Changing Collimation has some influence
on dose
Wider Collimation settings are usually
more efficient

TECH. PARAMETERS: COLLIMATION


Collimation

CTDIw
(mGy/100 mAs)

64x.625mm 8.5
32x.625mm 9.0
16x.625mm 10.5
8x.625mm 12.5
4x.625mm 12.4
2x.625mm 15.1

TECH. PARAMETERS: TUBE CURRENT


MODULATION

CARE Dose 4D
Topogram Evaluation: a.p. and lat.

4000

a.p. (measured)

3000
2500
2000
1500
1000
500
0

600

500

400

300

table position

200

100

attenuation I_0 / I

3500

lateral (calculated)

Long Axis Modulation


Shoulder
Region

Breast
Tissue

Lung
Region

Abdomen

180 degrees
(LAT)

90 degrees
(AP)

CTDIVOL IN CONTEXT OF AEC


When Tube current modulation is used:
CTDIvol reported is based on the average
mA used throughout the scan

Scan where Tube Current Modulation was used


Blue Curve Represents actual instantaneous mA
Red Curve Represents avg mA for each image
Yellow Curve Represents avg mA over entire scan
Overall avg is used for CTDIvol reported in Dose
Report

TUBE CURRENT MODULATION

LOTS of Different Names


Siemens: CareDose4D
GE: Smart Scan, Auto mA, Smart mA
Philips: DOM, Z-DOM
Toshiba: SureExposure, SureExposure3D

TUBE CURRENT MODULATION

Siemens: CareDose4D

User sets a Quality Reference mAs

System uses online modulation (180 degree lag)

The mAs (or effective mAs, if helical scan) that would be used
on a standard sized patient

Quality Reference mAs is NOT the max or min

ACTUAL mAs (eff. mAs) can be larger than this (should be for
large patients)

ACTUAL mAs (eff. mAs) can be less than this (should be for
smaller patients)

TUBE CURRENT MODULATION


GE SmartmA
User sets: Max mA, min mA and Noise Index (NI)
NI is approximately the standard deviation in a 20 cm water
phantom scanned under these conditions
The higher the NI, the lower the mA
The lower the NI, the higher the mA
Scanner output is influenced by recon. image thickness
(Kanal AJR 2007)
Attempts to keep noise constant across patient size/anatomy

While all tube current modulation systems base their


calculations from the CT localizer radiograph, the image
quality reference parameters vary from system to
system. Which of the following will result in an increase
in dose for a patient of a given size where the scan is
being performed with AEC
1.
2.
3.
4.

Decreasing the Noise Index (NI) on a GE Scanner


Decreasing the Quality Reference mAs on a Siemens
Scanner
Increasing the Standard Deviation on a Toshiba Scanner
Increasing the Standard Deviation (% ) a Hitachi
Scanner

from the CT localizer radiograph, the image quality reference


parameters vary from system to system. Which of the following
will result in an increase in dose for a patient of a given size
where the scan is being performed with AEC
1.
2.

Decreasing the Noise Index (NI) on a GE Scanner


Decreasing the Quality Reference mAs on a
Siemens Scanner
3. Increasing the Standard Deviation on a Toshiba
Scanner
4. Increasing the Noise Index (NI) on a GE Scanner
5. Increasing the Standard Deviation (% ) a Hitachi
Answer: 1, Decreasing
the Noise Index on a GE Scanner
Scanner
Ref: AAPM CT Lexicon version 1.3 04/20/2012
Kanal et al. AJR 2007 Jul;189(1):219-25 and Kanal et al. AJR 2011
Aug;197(2):437-41

SUMMARY
Introduce some of the important tech. parameters
that affect both radiation dose and image quality
CT localizer radiograph, kV, mA/mAs/effective mAs, pitch and
TCM

Describe the terms used by the major manufacturers


Discuss similarities and differences between them.
Important Resources AAPM CT Protocols Lexicon