RADIATION

DOSIMETRY IN CT
CHIKAWA AMANDA T H210123C
KACHIDZA BRIGHTON
MEDA CHIDOCHASHE R H210181Y
MURUNGWENI PRIDE
 OBJECTIVES
1. INTRODUCTION
2. MEASUREMENT TERMINOLOGY
3. RADIATION DOSE MEASUREMENTS IN CT
4. FACTORS AFFECTING RADIATION DOSE
5. WAYS TO REDUCE RADIATION DOSE
INTRODUCTION
• RADIATION IS THE EMISSION OF ENERGY FROM A SOURCE AS
ELECTROMAGNETIC WAVES OR MOVING SUBATOMIC PARTICLES
THAT TRAVELS THROUGH SPACE/ A MEDIUM.
• DOSIMETRY IS DEFINED AS THE WAY IN WHICH QUANTIFICATION
(MEASUREMENT & DETERMINATION) OF BIOLOGICAL EFFECTS
OF RADIATION ON HUMANS IS DONE BY MEANS OF A DOSIMETER.
• MEDICAL IMAGING USES IONIZING RADIATION AND IS
RECOGNIZED AS PROVIDING VALUABLE DIAGNOSTIC
INFORMATION THAT OFFERS SUBSTANTIAL BENEFITS TO MOST
PATIENTS, HOWEVER IT CARRIES A SMALL RISK OF
CARCINOGENESIS.
 CONT…..
• IMAGING PRACTITIONERS MUST UNDERSTAND HOW MUCH
RADIATION IS BEING USED IN ANY RADIOLOGICAL
EXAMINATION, HOW MUCH RADIATION IS ABSORBED BY
PATIENTS, AS WELL AS THE CORRESPONDING RADIOLOGICAL
RISKS.
• THEREFORE, RADIATION DOSIMETRY IS THE MEASUREMENT,
CALCULATION AND ASSESSMENT OF IONIZING RADIATION
DOSE ABSORBED BY THE HUMAN BODY.
 MEASUREMENT TERMINOLOGY
• WHEN THE X-RAYS FROM A CT SCANNER STRIKE A
PATIENT AND INTERACT WITH TISSUE, THERE IS ENERGY
THAT IS ABSORBED BY THE BODY TISSUES WHILST SOME
OF IT PASSES THROUGH TO THE DETECTOR.
• THE UNIT OF ABSORBED DOSE IS CALLED THE RADIATION
ABSORBED DOSE, OR RAD. THIS UNIT DESCRIBES THE
AMOUNT OF ENERGY ABSORBED BY BODY TISSUE DUE
TO IONIZING RADIATION PER UNIT MASS (J/KG). SI UNIT
OF ABSORBED DOSE IS THE GRAY (GY).
• IN RECOGNITION OF THE HEALTH EFFECTS OF X-RAYS,
ANOTHER CONVERSION FACTOR, CALLED THE QUALITY
FACTOR (QF), IS APPLIED TO THE ABSORBED DOSE. QF
ACCOUNTS FOR THE DIFFERENT BIOLOGICAL EFFECTS
PRODUCED FROM DIFFERENT TYPES OF IONIZING
RADIATION.
• WHEN THE QUALITY FACTOR HAS BEEN APPLIED TO THE
RADIATION ABSORBED DOSE THE NEW QUANTITY IS
CALLED THE EQUIVALENT DOSE. SI UNIT IS THE SIEVERT
(SV).
 CONT…
• DOSE IS MORE UNIFORM IN CT THAN IN GENERAL
RADIOGRAPHY FOR TWO REASONS:
1. IN CT, THE BEAM IS HEAVILY FILTERED AS IT EXITS THE
X-RAY TUBE, THUS FEWER LOW-ENERGY (OR “SOFT”)
PHOTONS REMAIN AND A LOWER PERCENTAGE OF THE
BEAM WILL BE ABSORBED OR SCATTERED AS IT PASSES
THROUGH PATIENT TISSUE.
2. THE CT EXPOSURE COMES FROM ALL DIRECTIONS,
CREATING A MORE UNIFORM EXPOSURE
• THE UNIFORMITY OF THE DOSE DECREASES AS THE SCAN
FIELD OF VIEW AND PATIENT THICKNESS INCREASE( IE
BODY SCANS ARE LESS UNIFORM THAN HEAD SCANS).
• THE CENTRAL DOSE FOR A BODY SCAN IS APPROXIMATELY
ONE-THIRD TO ONE-HALF THAT OF THE PERIPHERAL DOSE
 RADIATION DOSE
MEASUREMENTS IN CT
• TO ACCURATELY ASSESS THE Z AXIS DOSE DISTRIBUTION,
THE RADIATION THAT SCATTERS INTO ADJACENT SLICES
MUST BE ADDED TO THE DOSE TO A SINGLE SLICE.
• DUE TO INHERENT SCATTER IN CT, SOME OF THE RADIATION
SPREADS TO TISSUE OUTSIDE THE DESIGNATED SLICE,
WHERE AREAS OF SCATTER INTO ADJACENT TISSUE ARE
CALLED TAILS.
• THE TOTAL DOSE TO PATIENT WILL BE HIGHER WHEN
MULTIPLE SCANS ARE PERFORMED.
• HOW MUCH THE SCATTER WILL CONTRIBUTE TO THE
DOSE DEPENDS ON FACTORS SUCH AS BODY HABITUS
AND THE KVP USED.
• IN GENERAL, THE TAILS CONTRIBUTE APPROXIMATELY
25% TO 40% ADDITIONAL DOSE TO THE ENTIRE
EXAMINATION.
 CONT…
• MOST CT APPLICATIONS INVOLVE MULTIPLE ADJACENT
SLICES HENCE DOSE IS USUALLY CALCULATED FROM
MULTIPLE SCANS.
• MEASUREMENTS ARE MADE AT THE CENTER OF THE SLICE
AND SEVERAL POINTS AROUND THE PERIPHERY WITH
PLASTIC PHANTOMS.
• THIS PROCEDURE ACCOUNTS FOR THE EFFECT OF
SCATTER FROM THE TAILS OF EACH SLICE INTO THE
NEIGHBORING SLICES.
• TOTAL DOSE = THE CENTRAL SLICE RADIATION DOSE +
THE SCATTER OVERLAP (OR TAILS).
• THIS IS CALLED THE MULTIPLE SCAN AVERAGE DOSE
(MSAD). THE MSAD WILL INCREASE IF SLICES OVERLAP
AND DECREASE IF THERE ARE GAPS BETWEEN SLICES.
 CONT…

• ANOTHER TYPE OF RADIATION DOSE MEASUREMENT IN CT

IS THE COMPUTED TOMOGRAPHY DOSE INDEX (CTDI).
• THE AMOUNT OF RADIATION USED IN CT EXAMINATIONS IS
QUANTIFIED USING THE CTDI.
• THIS ALLOWS AN ESTIMATE OF THE MSAD TO BE
ACCOMPLISHED WITH A SINGLE SCAN.
• THE CTDI IS WHAT MANUFACTURERS REPORT TO THE U.S.
FDA AND PROSPECTIVE CUSTOMERS REGARDING THE DOSES
TYPICALLY DELIVERED FOR THEIR MACHINES.
• CTDIS ARE NORMALLY OBTAINED FOR A SINGLE ROTATION
OF THE X-RAY TUBE, AND ARE EXPRESSED AS AIR KERMA
(AK; MGY).
• MEASUREMENTS OBTAINED AT THE CT ISOCENTER, IN THE
ABSENCE OF ANY PHANTOM, ARE KNOWN AS CTDIAIR.
 CONT…
• THE CTDI CAN ONLY BE CALCULATED IF SLICES ARE
CONTIGUOUS, THAT IS, THERE ARE NO OVERLAPPING OR
GAPPED SLICES.
• IF THERE IS SLICE OVERLAP OR GAPS, THE CTDI IS
MULTIPLIED BY THE RATIO OF SLICE THICKNESS TO
SLICE INCREMENT.
• THIS WOULD TECHNICALLY BE THE MSAD, BECAUSE THE
CTDI CONDITIONS WOULD NO LONGER EXIST.
• .
• EQUIPMENT MANUFACTURERS REPORT CTDI DOSES
FOR TYPICAL HEAD AND BODY IMAGING TECHNIQUES.
• THESE ARE EQUIVALENT TO THE DOSE A PATIENT
RECEIVES IF MULTIPLE ADJACENT SLICES ARE
ACQUIRED
 CONT…
• MEDICAL PHYSICISTS USUALLY USE A SPECIAL DOSIMETER
CALLED A PENCIL IONIZATION CHAMBER TO MEASURE THE CTDI.
• THIS 100-MM-LONG THIN CYLINDRICAL DEVICE IS LONG ENOUGH
TO SPAN THE WIDTH OF 14 CONTIGUOUS 7-MM CT SLICES.
• THE SPECIAL DOSIMETER INTEGRATES RADIATION INTENSITY
PROFILES IN THE DIRECTION PERPENDICULAR TO THE IMAGING
PLANE.
• THIS PROVIDES A BETTER ESTIMATE OF MSAD FOR THIN SLICES
THAN THAT OF THE SINGLE-SLICE METHOD. WHEN THIS METHOD
IS USED IT IS REFERRED TO AS THE CTDI100 .
 CONT…
• THE DOSE FOR BODY SCANS ARE NOT UNIFORM ACROSS THE SCAN FOV.
• THE DOSE AT THE PERIPHERY OF THE SLICE IS HIGHER THAN THE CENTRAL DOSE.
• THE CTDIW ADJUSTS FOR THIS BY PROVIDING A WEIGHTED AVERAGE OF
MEASUREMENTS AT CENTER AND THE PERIPHERAL SLICE LOCATIONS (I.E., THE X
AND Y DIMENSIONS OF THE SLICE).
• THE CTDIVOL RADIATION DOSE PARAMETER TAKES THE PROCESS A STEP
FURTHER BY TAKING ACCOUNT THE EXPOSURE VARIATION IN THE Z DIRECTION.
• FOR HELICAL SEQUENCES THE CTDIVOL = CTDIW/PITCH.
• THE CTDIVOL IS NOW THE PREFERRED EXPRESSION OF RADIATION DOSE IN CT
DOSIMETRY.
 CONT….

• IF THE IRRADIATED LENGTH OF THE SCAN IS TO BE ACCOUNTED

FOR, THE PARAMETER USED IS THE DOSE-LENGTH PRODUCT (DLP):
DLP = CTDIVOL × SCAN LENGTH.
• ALTHOUGH THE DLP MORE CLOSELY REFLECTS THE RADIATION
DOSE FOR A SPECIFIC CT EXAMINATION, ITS VALUE IS AFFECTED
BY VARIANCES IN PATIENT ANATOMY.
• THEREFORE, THE CTDIVOL IS A MORE USEFUL TOOL FOR
COMPARING RADIATION DOSES AMONG DIFFERENT PROTOCOLS.
FACTORS AFFECTING
RADIATION DOSE
 1. RADIATION BEAM GEOMETRY
• THEORETICALLY, A ROTATION ARC OF ONLY 180° IS ALL THAT IS
REQUIRED TO SATISFY MOST CONSTRUCTION ALGORITHMS.
• MOST SCANNERS USE A 360° TUBE ARC TO COMPENSATE FOR
RADIATION BEAM DIVERGENCE AND PATIENT MOTION.
• THE EXTRA SCANNING INFORMATION IMPROVES IMAGE
QUALITY BUT INCREASES RADIATION DOSE. ADDITIONALLY,
OVERSCANNING, WHICH IS THE PROCESS OF USING MORE THAN
A 360° TUBE ARC, IS SOMETIMES USED.
• OVERSCANS WILL INCREASE THE RADIATION DOSE.
 2. FILTRATION
• FILTRATION AFFECTS THE RADIATION DOSE BY
REMOVING LOW-ENERGY X-RAYS.
• ADDING METAL FILTERS TO THE BEAM PERMITS
SELECTIVE REMOVAL OF X-RAYS WITH LOW
ENERGY AND REDUCES THE RADIATION DOSE
WHILE MAINTAINING CONTRAST AT AN
ACCEPTABLE LEVEL
 3. DETECTOR EFFICIENCY
• DETECTOR ABSORPTION EFFICIENCY AFFECTS RADIATION
DOSE TO THE PATIENT.
• LESS-EFFICIENT DETECTORS WILL REQUIRE A HIGHER
RADIATION EXPOSURE TO PRODUCE AN ADEQUATE IMAGE.
• SOLID STATE DETECTORS ARE FROM 90% TO 100%
EFFICIENT, WHEREAS THE XENON GAS DETECTORS USED
IN OLDER MODEL SCANNERS ARE SIGNIFICANTLY LESS
EFFICIENT AT ABSORBING X-RAYS.
 4. SLICE WIDTH AND SPACING

• IN CONSIDERING A SINGLE CROSS-SECTIONAL SLICE, AS

SLICE THICKNESS INCREASES, THE VOLUME OF TISSUE
IRRADIATED INCREASES, AND THE DOSE MAY INCREASE
SLIGHTLY TO THE ADJACENT SLICES.
• HOWEVER, FOR MULTIPLE SLICE EXAMINATIONS,
DECREASING SLICE THICKNESS AND USING
CONTIGUOUS SLICES WILL INCREASE THE MSAD
BECAUSE OF THE INCREASED AMOUNT OF SCATTER
RADIATION TO ADJACENT SLICES.
• ALSO, TO MAINTAIN IMAGE QUALITY AT THE SAME
LEVEL, ADDITIONAL RADIATION IS NEEDED FOR
THINNER SLICES.
• MULTIPLE SLICE EXAMINATIONS USING
OVERLAPPING SLICES WILL PRODUCE A HIGHER
OVERALL DOSE, WHEREAS GAPPED SLICES WILL
PRODUCE A LOWER OVERALL DOSE
 5. PITCH
• THE SPACING OF CT SLICES OBTAINED WITH A SPIRAL (OR HELICAL) SCAN
PROCESS IS CALLED PITCH.
• THE PITCH IS DEFINED AS THE TABLE DISTANCE TRAVELLED IN ONE 360°
ROTATION DIVIDED BY THE COLLIMATED WIDTH OF THE X-RAY BEAM. FOR A
SINGLE SLICE HELICAL CT, A PITCH OF 1 MEANS THAT THE SLICES ARE
ADJACENT AND NOT OVERLAPPED.
• SELECTING A PITCH GREATER THAN 1 WILL SPREAD THE RADIATION MORE
THINLY OVER THE SLICES.
• THE PITCH HAS A DIRECT INFLUENCE ON PATIENT RADIATION DOSE
BECAUSE AS PITCH INCREASES, THE TIME THAT ANY ONE POINT IN SPACE
SPENDS IN THE X-RAY BEAM IS DECREASED.
 6. SCAN FIELD DIAMETER
• THE SCAN FIELD DIAMETER AFFECTS THE DOSE.
• PHANTOMS OF TWO DIAMETERS,16 AND 32 CM ARE USED TO
SIMULATE HEAD AND BODY SCANS, RESPECTIVELY AND
MEASURE RADIATION DOSE.
• HOLDING ALL TECHNICAL FACTORS CONSTANT, A SCAN OF
THE HEAD PHANTOM WILL RESULT IN A HIGHER RADIATION
DOSE THAN THAT OF THE BODY PHANTOM.
• THUS, SMALLER PATIENTS WOULD BE EXPECTED TO ABSORB
MUCH HIGHER AMOUNTS OF RADIATION THAN LARGER
PATIENTS.
• THIS EFFECT IS PRIMARILY ATTRIBUTED TO THE FACT
THAT TOTAL EXPOSURE IS MADE UP OF BOTH
ENTRANCE RADIATION AND EXIT RADIATION.
• FOR SMALLER PATIENTS, THE PATIENT HAS LESS
TISSUE TO ATTENUATE THE BEAM, WHICH RESULTS IN
A MUCH MORE UNIFORM DOSE DISTRIBUTION.
CONVERSELY, FOR A LARGER PATIENT, THE EXIT
RADIATION IS MUCH LESS INTENSE AS A RESULT OF
ITS ATTENUATION THROUGH MORE TISSUE.
 7. RADIOGRAPHIC TECHNIQUE

• THE RELATIONSHIP BETWEEN MAS AND DOSE IS LINEAR.

• WITH THE MAS KEPT CONSTANT, CHANGING FROM 120
KVP TO 140 KVP INCREASES THE RADIATION DOSE
APPROXIMATELY 30% TO 45%
• THE HIGHER THE MAS AND KVP SETTINGS USED TO
CREATE THE IMAGE, THE HIGHER THE DOSE TO THE
PATIENT.
 8. PATIENT SIZE AND BODY PART
THICKNESS
• LARGE PATIENTS OR THICK BODY PARTS REQUIRE
RADIOGRAPHIC TECHNIQUES THAT INCREASE THE
RADIATION DOSE TO AVOID AN UNACCEPTABLE LEVEL
OF IMAGE NOISE.
• IN ADDITION, THE PATIENT SIZE AND BODY
COMPOSITION MAY AFFECT THE DEGREE OF SCATTER
RADIATION.
 9. REPEAT SCANS
• AREAS OF THE PATIENT THAT ARE RESCANNED TO
VISUALIZE VARIOUS STAGES OF INTRAVENOUS
CONTRAST ENHANCEMENT OR FOR OTHER TECHNICAL
OR CLINICAL REASONS RECEIVE ADDITIONAL
RADIATION.
• THE EFFECT IS CUMULATIVE.
 10. COLLIMATION
• LEAD COLLIMATORS ARE USED NEAR THE X-RAY TUBE TO
CONTROL THE SIZE OF THE BEAM STRIKING THE PATIENT.
• IF THE BEAM WERE NOT CONTROLLED TO MATCH THE
DETECTOR SIZE, THERE WOULD BE ADDITIONAL SCATTER
RADIATION TO DEGRADE THE IMAGE
• THIS SCENARIO WOULD RESULT IN A HIGHER RADIATION DOSE
TO THE PATIENT. COLLIMATORS MAY ALSO BE USED NEAR THE
DETECTORS FOR SCATTER REJECTION AND APERTURE USE
 11. LOCALIZATION SCANS
• THE LOCALIZATION SCAN PERFORMED BEFORE
SCANNING, WHICH IS OFTEN REFERRED TO AS THE
SCOUT IMAGE, DELIVERS A VERY LOW DOSE.
• THE RADIATION DOSE FOR THE SCOUT IMAGE IS
MUCH LOWER THAN THAT USED TO PRODUCE
CROSS-SECTIONAL SLICES.
 12. TUBE CURRENT

• TUBE CURRENT IN CT IS THE AMOUNT OF X-RAYS

PRODUCED IN THE X-RAY TUBE.
• MA AND MAS HAVE A LINEAR RELATIONSHIP WITH
RESPECT TO CT RADIATION DOSE.
• WHEN ALL OTHER TECHNICAL FACTORS ARE KEPT THE
SAME, AND MAS IS LOWERED , THE RADIATION DOSED IS
ALSO LOWERED.
 13. PEAK TUBE VOLTAGE (KVP)
• THIS IS THE PEAK POTENTIAL DIFFERENCE BETWEEN THE
ANODE AND CATHODE IN THE X-RAY TUBE.
• IT CAUSES ACCELERATION OF THE ELECTRONS TOWARDS
THE ANODE TO PRODUCE X-RAYS.
• THE MOST COMMON RANGE OF KVP USED IN CT ARE 80 -140.
• THE OUTPUT OF AN X-RAY TUBE IS APPROXIMATELY
PROPORTIONAL TO KVP SQUARED . THEREFORE IF KVP IS
DOUBLED THE RADIATION DOSE INCREASE BY A FACTOR OF 4
.
WAYS TO REDUCE
RADIATION DOSE
 1. REDUCING THE MILLIAMPERE-SECONDS
VALUE:

• RADIATION DOSE IS DIRECTLY PROPORTIONAL TO THE

MILLIAMPERE-SECONDS VALUE WHEN ALL OTHER
FACTORS ARE HELD CONSTANT.
• IF THE MILLIAMPERE-SECONDS VALUE IS REDUCED BY 50%,
THE RADIATION DOSE WILL BE REDUCED BY THE SAME
AMOUNT. HOWEVER, THIS REDUCTION WILL INCREASE
IMAGE NOISE BY 1/√(MAS), WHICH MEANS THAT A 50%
REDUCTION IN THE MILLIAMPERE-SECONDS VALUE
RESULTS IN A NOISE INCREASE OF 41%.
• DEPENDING ON THE REQUIREMENTS OF THE CLINICAL
APPLICATION, THIS REDUCTION MAY BE READILY
ACCEPTED AS IT MAY COMPROMISE THE DIAGNOSTIC
QUALITY OF THE IMAGING EXAMINATION:
• FOR EXAMPLE, DETECTION OF HIGH-CONTRAST OBJECTS
IN THE LUNG MAY NOT REQUIRE A LOW-NOISE IMAGING
PROTOCOL AND THE REDUCTION IN MILLIAMPERE-
SECONDS MAY BE WELL TOLERATED. ON THE OTHER
HAND, IMAGING LOW-CONTRAST LESIONS IN THE LIVER
DOES REQUIRE A LOW-NOISE IMAGING PROTOCOL AND
THE REDUCTION IN MILLIAMPERE-SECONDS MAY LIMIT
 2. INCREASING PITCH
• THE RADIATION DOSE IS INVERSELY PROPORTIONAL TO PITCH WHEN
ALL OTHER FACTORS ARE HELD CONSTANT.
• THEREFORE, INCREASING PITCH IS ONE CONSISTENT WAY TO REDUCE
RADIATION DOSE.
• THE TRADE-OFF IN INCREASING PITCH IS AN INCREASE IN EFFECTIVE
SECTION THICKNESS, WHICH RESULTS IN INCREASED VOLUME
AVERAGING, WHICH IN TURN MAY REDUCE THE IMAGE SIGNAL
(CONTRAST BETWEEN SOME OBJECT AND BACKGROUND).
• THE ABILITY TO USE THIS TYPE OF DOSE REDUCTION AGAIN DEPENDS
ON THE CLINICAL APPLICATION.
 3. VARYING THE MILLIAMPERE-SECONDS VALUE BY
PATIENT SIZE
• CT IS AN EXAMPLE OF A DIGITAL MODALITY IN WHICH THE IMAGE
QUALITY CONTINUES TO IMPROVE AS THE EXPOSURE INCREASES.
• THIS IS CONTRASTED WITH ANALOG PROJECTIONAL FILM, IN
WHICH TOO HIGH OF AN EXPOSURE RESULTS IN AN OVEREXPOSED
(TOO DARK) FILM. THUS, WHEN PEDIATRIC PATIENTS OR SMALL
ADULT PATIENTS ARE IMAGED WITH CT USING FULL-SIZED ADULT
TECHNIQUES, THERE IS NO PENALTY TO IMAGE QUALITY; IN FACT,
THE IMAGE QUALITY IS BETTER UNDER THESE CONDITIONS, AS
MORE PHOTONS REACH THE DETECTOR AND IMAGE NOISE IS
REDUCED.
• HOWEVER, THE RADIATION DOSE TO THE SMALLER PATIENT IS
POTENTIALLY HIGHER THAN IS NECESSARY TO OBTAIN A
DIAGNOSTIC IMAGE.
• THEREFORE, SIGNIFICANT EFFORT HAS RECENTLY BEEN PUT INTO
DEVELOPING SIZE- AND WEIGHT-BASED IMAGING PROTOCOLS TO
REDUCE RADIATION DOSE TO PEDIATRIC PATIENTS AND SMALL
ADULT PATIENTS, SO THAT RADIATION DOSE CAN BE REDUCED
WHILE STILL ACHIEVING SUFFICIENT DIAGNOSTIC IMAGE QUALITY.
• THIS HAS TYPICALLY BEEN IN THE FORM OF A REDUCED
MILLIAMPERE-SECONDS VALUE FOR REDUCED PATIENT SIZE AND
HAS LED TO THE DEVELOPMENT OF SUGGESTED TECHNIQUE
CHARTS FOR PEDIATRIC PATIENTS.
 4. NEWER RECONSTRUCTION METHODS.
• NEWER METHOD OF IMAGE RECONSTRUCTION SUCH AS ITERATIVE RECONSTRUCTION HAS
BEEN RECENTLY INTRODUCED FOR THE USE IN CT IMAGE RECONSTRUCTION.
• IF COMPARED WITH STANDARD FILTERED BACK-PROJECTION METHODS, IT CAN REDUCE THE
DOSE BY AS MUCH AS 50%.
 5. LIMIT THE USE OF THIN SLICES

• USING A LARGE NUMBER OF THIN ADJACENT CT SLICES RESULTS IN 30% TO 50%

MORE RADIATION DOSE TO THE PATIENT THAN USING FEWER THICKER SLICES TO
SCAN THE SAME ANATOMY.
 6. LIMIT REPEAT SCANS

• BECAUSE OF THE EFFECTS OF REPEAT SCANS OF THE SAME AREA, MULTIPHASE

STUDIES SHOULD BE PERFORMED ONLY WHEN CLINICALLY INDICATED.
• NUMEROUS AUTHORS HAVE SHOWN THAT DETECTION OF LIVER LESIONS CAN BE
IMPROVED BY MULTIPLE SCANS TAKEN DURING DIFFERENT PHASES OF CONTRAST
INJECTION. ALTHOUGH MULTIPHASIC STUDIES ARE CLEARLY INDICATED TO
EVALUATE FOR LIVER ABNORMALITIES, THEY SHOULD NOT BE DONE IN ALL
CIRCUMSTANCES.
• ADDITIONALLY, IT HAS BEEN RECOMMENDED A TRIPLE-PHASE STUDFOR THE
EVALUATION OF KIDNEY LESIONS IN PATIENTS.
• IN CONCLUSION IT IS OF UTTERMOST
IMPORTANCE TO UNDERSTAND THE CONCEPT
OF RADIATION DOSIMETRY IN CT AS THIS
HELPS TO OPTIMIZE PATIENT SAFETY AND
DOSE MANAGEMENT
 REFERENCES

1. Health Physics Society. 2013. http://hps.org/publicinformation/ate/faqs/whatisradiation.html [2 June

2014].
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effects/measuring-radiation.html [02 June 2014].
3. United States Environmental Protection Agency. 2012.
http://www.epa.gov/rpdweb00/understand/health_effects.html [02 June 2014].
4. NDT Resource Center. 2013.
https://www.ndeed.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. 2 nd ed. Philadelphia: Lippincott Williams &
Wilkins.
8. Romans J, 2010; Computed Tomography for Technologists. Pg 165-6
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