Dose Issues and

CT
 Radiation
Radiation is the emission and
transmission of energy or particles of
matter from atoms that travels through
some material / through a vacuum1.

2 Types of Radiation

1. Particle Radiation (α & β

radiation)

2. Electromagnetic Radiation
(X and Gamma radiation)
Electromagnetic
Radiation

http://www.mpoweruk.com/radio.htm
• Radiation Exposure: It describes the amount of radiation
traveling through the air. Many radiation monitors measure
exposure. The units for exposure are the roentgen (R)2 .

• Absorbed Dose: which describes the amount of radiation

energy deposited in the patient’s body as a result of
exposure. The units for absorbed dose are the radiation
absorbed dose (rad) and gray (Gy)2.

• Effective Dose: are calculated by calculating the

absorbed doses to individual organs weighted for their
radiation sensitivity.
• The radiation risk to the patient can be estimated from the
effective dose.
• The common unit to measure effective dose is the mSv 2.
Biological Effects of Radiation
Stochastic Effects:

• Stochastic effects are those that occur by chance

and consist primarily of cancer and genetic effects3.
• Stochastic effects often show up years after
exposure3.
• As the dose to an individual increases, the probability that
cancer or a genetic effect will occur also increases3.
• There is no threshold dose below which it is relatively
certain that an adverse effect cannot occur for Stochastic
Effects 1.
Non Stochastic (Deterministic ) Effects:

• These are characterized by a threshold dose above which

they do occur (clear relationship between the exposure and
the effect)1.
• In addition; the magnitude of the effect is directly
proportional to the size of the dose4.
• Non stochastic effects typically result when very large
dosages of radiation are received in a short amount of time4.
• Examples of non stochastic effects include erythema (skin
reddening), skin and tissue burns, cataract formation,
sterility, radiation sickness and death4.
 CT’s Contribution
Total X-Ray Procedures X-Ray Procedure Radiation
Dose
CT:, 17,%
CT:
Rest: 49%
51%
Rest:,
83,%
Radiograph Effective Dose
(mSv) CT Procedure Effective Dose
(mSv)
DEXA Scan Estimated
0.001 dosages of X-Ray
Head 2
Bite Wing Dental 0.004
Skull (AP&Lat) Procedures
0.1
Neck
Chest
3
7
Chest (AP&Lat) 0.1
Abdomen 8
Abdomen (AP) 0.7
Pelvis 6
T-Spine (AP&Lat) 1
T-Spine 6
L-Spine (AP&Lat) 1.5
Chest for PE 15
Coronary Angio 16

Background radiation per annum ≈ 3mSv

1 CT Head ≈ 20 Skull X-ray Examinations
1 CT Abdomen/Pelvis (2 Phase Study) ≈ 32 Abdominal X-
rays 1 CT Abdomen/Pelvis (Urogram) ≈ 60 Abdominal X-rays
1 CT Chest ≈ 70 Chest X-ray Examinations
 Factors to consider
1 Patient Age.
2 Patient Gender.
3 Patient size and weight.
4 Justification : Exam must be medically
• indicated.
5 Optimization: Do the least number of scans at
the lowest exposure .
6 Are non ionizing alternative better suited
(MR and Ultrasound)5.
 CT Dose Descriptors
1. CT Dose Index (CTDIvol)
●This is the primary dose concept in MDCT measured
in milli Gray (mGy).
● It is directly displayed on the MDCT Scanner.
●CTDIvol (weighted average of dose across a single
slice) divided by a pitch factor.
●It can be used to directly compare
radiation dose from different scan
parameter settings.
But it doses not provide an
accurate
dose to the patient and should not
be used to
determine individual risk5.
 CT Dose Descriptors
2. Dose Length Product (DLP)
●DLP is an indicator of the total dose for an entire CT
examination.
● DLP is determined by multiplying the CTDIvol value
by
the scan length, (mGy-cm).
●DLP will change between patients due to differences
in their height and the resulting scan length.
●It also includes overscan (extra
Scanning from MDCT Scans).
●DLP alone is still not sufficient
to
accurately asses the radiation
risk to a patient
 CT Dose Descriptors
3. Effective Dose (ED)
●ED reflects the radiation risk to the individual patient,
measured in milli Sievert (mSv).
●ED takes into account not only the amount of
radiation, but also the sensitivity of the tissue/organ
being radiated.
● ED = k x DLP.
k is the weighting factor accounting for tissue
sensitivity.
●Still mathematical models to compute organ doses
are based on a standard adult (70kg) .
Thus ED estimation can underestimate the risk to
children/ thin patients and overestimate the risk to
obese patients5.
Factors Affecting Radiation
Dose
1. Tube Current (mA)

●Tube Current in CT implies the

amount of x-rays produced in the x-
ray tube.

●mA and mAs has a linear

relationship with respect to CT
radiation dose.

●When all other technical factors are kept the same, and mAs
are lowered , the radiation dosed is also lowered6.
 Factors Affecting Radiation Dose
2. Peak Tube Voltage (kVp)
●This is the peak potential
difference between the anode
and cathode in the x-ray tube.

●It cause acceleration of the

electrons toward the anode to
produce x-rays.

● The most common range of

kVps used in CT are 80 -
140.

●The output of an x-ray tube is approximately proportional

to kVp2 . Therefore if kVp is doubled the radiation dose
 Factors Affecting Radiation Dose
3. Pitch
●Pitch is defined as the ratio of table feed per gantry
rotation to total x-ray beam with.

● Radiation doses is inversely

Proportional to the pitch.

● Therefore the greater the pitch

the lower the radiation dose to the patient and vise-
versa.

●Protocols demanding high spatial resolution (e.g. Cardiac

ct scans) an pitch < 1 is used, translating in high radiation
doses to the patient5.
 Factors Affecting Radiation Dose
4. Filters
●Consists of absorbent material inserted
between the x-ray tube and the patient .

● Filters absorb low energy x-rays and

“harden” the x-ray beam.

● Low energy x-rays contribute

disproportionally to patient
radiation dose (especially to skin dose).

●Bow tie filters (often used in CT) deliver a uniform

intensity x-ray beam across the scanning object, resulting
in a more uniform distribution of the dose5.
 Factors Affecting Radiation Dose
5. Patient Centering
●Patients normally have an elliptical cross-
Section( thinner in the periphery and
ticker in the centre.
● Bowtie filters are thicker in the
periphery
and thinner in the centre, resulting in more x-rays reaching
the ticker central parts and less the thinner periphery.
● However for these filters to function properly the patient
must be centred at the gantry iso-center.
●If the patient is positioned off centred less x-rays pass
through the patient’s thicker central part ,resulting in more
noise in the centre of the images. While more x-rays reach
the peripheral portion of the body cross-section, increasing
 Factors Affecting Radiation Dose
6. Repeats
●Multiple Scans results in an increase in
radiation dose to the patient .

● During a single visit to a CT suite, the

patient may be scanned multiple times.

● Patients can also undergo multiple ct

scans within a
short period of time.

●How many of these scans are necessary and appropriate

Is the critical question that needs to be answered5.
 Factors Affecting Radiation Dose
7. Dose efficiency (Geometric efficiency)
●In MDCT it is required that an equal number of x-ray
photons reach all active detectors.

●To ensure this a

certain amount of over-
beaming, beyond the
active detectors are
needed (called the
penumbra).

●This proportion of wasted radiation and subsequent dose

penalty is more profound with ct protocols using a thinner
detector configuration than those using a thicker one .
 Factors Affecting Radiation Dose
8. Angular (X/Y) Dynamic Dose Modulation
●It modulates the x-ray tube current during the scan
according to the size of the scanned
object to provide.
●This is to provide optimal
penetration of the x-ray beam at a
specific tube angle for a specific
object.
●It provides the best dose saving for structure that are not
uniform in the x/y planes.
●Provide dose saving of approximately 10% for head
scans and 20-40% for chest scans6.
 Factors Affecting Radiation Dose
9. Longitudinal (Z-axis) Dose Modulation
●It modulates the mAs along the longitudinal (Z) axis.
●Information for this modulation
are obtained from the surview
(scout) scan.
● It reduce dose in organs that
have
lower attenuation(e.g: lungs) due
to the lower dose needed to obtain
diagnostic images.
●It also maintains an uniform image quality within the
scan5.
 Factors Affecting Radiation Dose
10. Cardiac ECG Dose Modulation

● Retrospectively gated cardiac cta’s.

- Higher radiation dose to patient.
- More information that may be diagnostically relevant.
- Give functional information (e.g. Ventricular ejection fractions)
● Prospectively gated cardiac cta’s.
- Less radiation dose to patient (up to 83% less than retrospective studies).
- Loss of information that may be diagnostically relevant.
- No functional information (e.g. Ventricular ejection fractions)
 Factors Affecting Radiation Dose
11. Paediatric Protocols
●The goal is to obtain a balance
between image quality and dose.
● These scan must be done with
the minimum mA that will still
provide a diagnostic relevant
set of images.
● Low kVp settings in patients
<45kg can result in 30-70%
dose reduction.
●Doubling the pitch from 1 to 2 will result in a 50%
decrease in the radiation dose.
●Paediatric examinations should also be performed with the
shortest possible scan time (0.5 ms or less) to minimize
 Smart Card Protection for
Patients
●Up until a decade ago, radiation protection
was centred around protecting staff at
medical facilities.
●Patient protection was seen as not so
important, seen that their exposure to
radiation was thought to be only a few
times in a life time.
●This notion has certainly change, and
the radiation dose
patients received have become more
prominent.
●What's needed is a way to track/record the radiation doses
REFERENCES

1. Health Physics Society. 2013. http://hps.org/publicinformation/ate/faqs/whatisradiation.html

[2 June 2014].

2. United States Nuclear Regulatory Commission. 2013. http://www.nrc.gov/about-

nrc/radiation/health-effects/measuring-radiation.html [02 June 2014].

3. United States Environmental Protection Agency. 2012. http://www.epa.gov/rp

dweb00/understand/health_effects.html [02 June 2014].

4. NDT Resource Center. 2013. https://www.nde-

ed.org/EducationResources/CommunityCollege/RadiationSafety/biological/nonstochastic/
nonst ochastic.htm [02 June 2014]

5. Mahesh, M. 2009. MDCT Physics: The Basics-Technology, Image Quality and Radiation Dose.
Philadelphia: Lippincott Williams & Wilkins.

6. Kalra, M.K., Saini, S. & Rubin, G.D. 2008. MDCT from Protocols to Practice. Milan, Italy:
Springer-Verslag Italia.

7. Siegal, M.J. 2007. Pediatric Body CT. 2nd ed. Philadelphia: Lippincott Williams &
Wilkins.

8. International Atomic Energy Agency. http://www.iaea.org/Publications/Magazines/Bulletin/Bul

l502/50205813137.html [02 June 2014]
The End