Lung Cancer Screening CT Protocols Version 4.

0 2/23/16

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 Lung Cancer Screening CT Protocols Version 4.0 2/23/16

LUNG CANCER SCREENING CT

NOTE: The Lung Cancer Screening Protocols described in this document are a set of reasonable
protocols developed by the AAPM’s Working Group on Standardization of CT Nomenclature and
Protocols that are to be used in the specific context of Lung Cancer Screening. These protocols
were based in part on manufacturers’ Low Dose Chest protocols, but were adapted based on the
Working Group’s experience with the National Lung Screening Trial and other screening studies.

The primary goal of lung cancer screening CT is to detect abnormalities that may represent lung
cancer and may require further diagnostic evaluation. In addition, examinations should be reviewed
for other abnormalities in accordance with the ACR–SCBT-MR–SPR Practice Parameter for the
Performance of Thoracic Computed Tomography (CT).

This document is ONLY meant to describe the technical elements of a lung cancer screening
CT exam. It is NOT intended to be a comprehensive description of the elements of a
screening program (e.g. who should and should not be screened, the patient
management process for following up a positive screen test). Some examples of guidance
in such a program are the ACR–STR Practice Parameter for the Performance and Reporting of
Lung Cancer Screening Thoracic Computed Tomography (CT), the USPSTF recommendations
and the CMS Decision Memo on Lung Cancer Screening; these provide information on eligibility
criteria, exam specifications, interpretation and reporting of these exams. Additional resources
are available on the ACR Lung Cancer Screening Resources webpage.

Indications For individuals with no known signs or symptoms of lung cancer that have
appropriate risk factors, such as those recommended by professional societies and health care
organizations. See the ACR Lung Cancer Screening Resources webpage for more information.

Diagnostic Tasks (include but are not limited to)

• The primary goal of lung cancer screening CT is to detect abnormalities that may
represent lung cancer and may require further diagnostic evaluation.
• Therefore, the primary task is to detect nodules or masses, and characterize their size,
shape and relationships to organs;

Key Elements
• One breath-hold (thoracic motion is problematic);
• Thin image thicknesses (≤2.5 mm, ≤1.0 mm preferred); reconstruction of coronal and
sagittal reformations as well as MIPS may be helpful and are encouraged.
• CTDIvol < 3.0 mGy for a standard sized patient (see table), with adjustments made for
smaller and larger patients.
• This typically requires a 16 detector row (or greater) scanner to meet these requirements.

Contrast
• These studies are performed without any contrast:
• Oral: None.
• Injected: None.

Patient Positioning
• Center the patient within the gantry; this is critical for proper functioning of AEC systems.
• Patient supine, arms above head;
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Scan Range
• From top of lungs through the bottom of lungs.

Suspension of Respiration
• Patient should be instructed to hold his/her breath at end of inspiration during entire scan.

Additional Image Reconstructions

• Coronal and sagittal planar MPRs as well as axial MIPS may be helpful and are encouraged.
• Very thin images (approximately ≤ 1 mm) may need to be reconstructed to serve as source
images for the sagittal and/or coronal reformatted images.
• Creation, use, and archival of these additional images are at the discretion of the supervising
radiologist and/or departmental policy. Very large datasets may result from these additional
reconstructions.

Radiation Dose Management

• CTDIvol must be ≤ 3.0 mGy for a standard sized patient, as measured using the 32-cm
diameter CTDI phantom. By definition, a standard sized patient is approximately 5'7" and
155 pounds or 170 cm and 70 kg, with a BMI ≈ 24.
• Some form of scanner output adjustment for patient size must be used. This
adjustment may be accomplished through either:
• Use of automatic methods, such as automatic exposure control (AEC) and/or
automatic kV selection
• Use of a manual technique chart that prescribes different tube current and/or
kV values as a function of patient size.
• Examples of manual adjustment may include (but are not limited to):
• Reducing the mAs for small patients (defined below) by 50%
• Increasing the mAs for large patients (defined below) by 50-100%
• Either technique (automatic or manual) can be used effectively, but the automatic
methods will adjust the CT scanner output based on the patient size (as measured
on the CT localizer radiograph).
• IT SHOULD BE NOTED that in this version, there are two sets of protocols provided
for GE scanners:
• One with automatic methods (AutomA/SmartmA)
• One with manual methods (fixed tube current scans, but with mA values
that can be adjusted to account for patient size).

• When AEC is used, careful attention must be paid to the values selected to define the
desired level of image quality (e.g., Noise Index, Quality Reference mAs, Standard
Deviation, Dose Right Index).
• Each manufacturer may have recommendations unique to their systems and system
features. Be sure to work with your CT equipment manufacturer and a qualified medical
physicist to ensure safe and appropriate operation of AEC systems.
• If more than one CT localizer radiograph is acquired, AEC systems from different
manufacturers can differ with respect to which one is used to determine mA and/or kV
settings. Please refer to individual manufacturer protocol instructions.
• AEC systems also may differ in response when the prescribed scan range extends
beyond the boundaries of the CT localizer radiograph; please consult the user manual to
identify how the AEC system will respond when this occurs.
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 Lung Cancer Screening CT Protocols Version 4.0 2/23/16

Effective Dose
Effective dose is defined in ICRP 103 as a population dose metric and should not be used to estimate
dose or risk to an individual. From a screening population point of view, one method to estimate the
effective dose is to calculate the Dose Length Product (DLP) and then apply a conversion factor
described in AAPM TG Report 96 to estimate the effective dose. For an idealized standard sized
patient (defined above) and a 25 cm scan length, and using the k factor of 0.014 mSv/mGy*cm; these
protocols should result in an effective dose below 1 mSv (see table below).

Dose values for an idealized standard sized patient (NOT for any individual)
Dose Descriptor Value Reported at Scanner (Y/N)
CTDIvol* ≤ 3.0 mGy Y
DLP* ≤ 75 mGy*cm Y
Effective Dose (DLP x .014)** ≤ 1.0 mSv N**
* The CTDIvol and DLP values in this table are for an idealized patient only; individual patients
may have higher or lower values to reflect adjustment for patient size.
** Effective Dose is calculated for a population and should NOT be reported for an individual

CTDI measurements and calculations

• Some manufacturers utilize a z-axis “flying focal spot”, in which two unique projections
are acquired at the same z-axis table position. When this technique is used, we identify it
with **. The CTDIvol on the console accurately accounts for use of this feature.

Approximate Volume CT Dose Index (CTDIvol) Values

• Approximate values for CTDIvol are listed for three different patient sizes:
Approx. Weight (kg) Approx. Weight (lbs) Approx. CTDIvol (mGy)
Small Patient 50-70 110-155 0.25 - 2.8
Average Patient 70-90 155-200 0.5 - 4.3
Large Patient 90-120 200-265 1.0 – 5.6

The approximate CTDIvol values are for reference only, and represent a dose to the 32-cm diameter
CTDI phantom under very specific conditions. The CTDIvol displayed on the scanner for a patient of a
given size should be similar, but not necessarily an exact match, to those listed in the above table.

It is essential that users recognize that, when using automatic exposure control, the CTDIvol values
reported on the user console prior to acquiring CT localizer radiographs on a particular patient do not
represent the CTDIvol that will be delivered during that patient’s scan. CT systems rely on the CT
localizer radiograph to 1) estimate the patient’s size, 2) determine the tube current settings for each
tube angle and table position that will yield the requested level of image quality, and 3) calculate the
average CTDIvol for the patient over the prescribed scan range. Until the CT localizer radiograph is
acquired, the reported CTDIvol is not patient-specific, but is based on a generic patient size.

The CTDIvol values provided here are approximate, and are intended only to provide reference
ranges for the user to consider.

In this document, a small patient is considered to be approximately 50-70 kg (110-155 lbs), an

average patient approximately 70-90 kg (155-200 lbs), and a large patient 90-120 kg (200-265 lbs).
However, weight is not a perfect indication of patient size. A person’s height, gender and distribution
of weight across the body also must be taken into account. The thickness of the body over the area to
be scanned is the best indication of patient size. Body mass index (BMI) may also be considered:
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 Lung Cancer Screening CT Protocols Version 4.0 2/23/16

• Underweight = BMI <18.5

• Normal weight = BMI of 18.5–24.9
• Overweight = BMI of 25–29.9
• Obesity = BMI of 30 or greater
It is recognized that the median (50th percentile) patient size for adults in the USA is larger than 70 kg.
However, the 70 kg patient represents the “Reference Man”, as defined by the International
Commission on Radiation Protection (ICRP), upon which AEC systems and tissue weighting factors
(used for effective dose estimation) are based.

References

ACR–STR Practice Parameter for the Performance and Reporting of Lung Cancer Screening
Thoracic Computed Tomography (CT). Available at:
http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/LungScreening.pdf

United States Preventive Services Task Force (USPSTF) Recommendations on Lung Cancer
Screening using Low Dose CT. Available at:
http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-
cancer-screening

CMS (Medicare) Decision Memo for Screening for Lung Cancer with Low Dose Computed
Tomography (LDCT) (CAG-00439N)
http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274

ACR Lung Cancer Screening Resources. Available at:

http://www.acr.org/Quality-Safety/Resources/Lung-Imaging-Resources

ICRP Report 103

International Commission on Radiological Protection, “The 2007 Recommendations of the
International Commission on Radiological Protection,” ICRP Publication 103 International
Commission on Radiological Protection, Essen, 2007.

AAPM TG Report 96:

American Association of Physicists in Medicine, “The Measurement, Reporting and Management of
Radiation Dose in CT: Report of AAPM Task Group 23”. ISBN: 9781888340730
http://www.aapm.org/pubs/reports/RPT_96.pdf

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 Lung Cancer Screening CT Protocols Version 4.0 2/23/16

INDEX OF LUNG CANCER SCREENING PROTOCOLS (by manufacturer)

GE with Auto/Smart mA
GE with constant mA
Hitachi
Neusoft
Philips
Siemens
Toshiba

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 Lung Cancer Screening CT Protocols Version 4.0 2/23/16

LUNG CANCER SCREENING CT (Selected GE scanners) with Auto/Smart mA (Back to INDEX)

SCOUT: AP S60-I400; scan from top of shoulder through mid-liver, if automatic exposure control is used.
PA scout if manual mA is used.

Discovery
LightSpeed 16 BrightSpeed 16 Optima 660 LightSpeed VCT
GE CT750 HD
Scan Type Helical Helical Helical Helical Helical
Rotation Time (s) 0.5 0.5 0.5 0.5 0.5
Beam Collimation (mm) 10/20 20 40 40 40
Detector Configuration 16x0.625/16x1.25 16x1.25 64x0.625 64x0.625 64x0.625
Pitch 1.375 1.375 0.984 0.984 0.984
Speed (mm/rot) 13.75/27.50 27.50 39.36 39.36 39.36
kV 120 120 120 120 120
min mA 40 40 30 30 30
max mA 130 130 110 110 110
Noise Index
32 32 32 32 37
(Auto/Smart mA)1
SFOV Large Body Large Body Large Body Large Body Large Body

CTDIvol2 2.6 / 2.4 mGy 2.4 mGy 2.2 mGy 2.2 mGy 2.2 mGy

1
Noise Index value of 32 ONLY applies if the 2.5 mm reconstructed image thickness is selected as the first
reconstruction; if other slice thicknesses (e.g. 0.625 mm or 1.25 mm) are selected for the first reconstruction, then a
different Noise Index value must be chosen in order to achieve the CTDIvol values described here. This is because
the Noise Index value is related to the image thickness of the first reconstruction.
2
For standard sized patient, defined as 5’7”, 155 pounds
RECON 1
Plane Axial Axial Axial Axial Axial
3
Algorithm Lung or Bone Lung or Bone Lung or Bone Lung or Bone Lung or Bone
Recon Mode Full or Plus Full or Plus Full or Plus Full or Plus Full or Plus
Thickness (mm) 2.5 2.5 2.5 2.5 2.5
Interval (mm) 1.25 1.25 1.25 1.25 1.25
ASiR (if used) SS70 SS70 SS70
RECON 2
Plane Axial Axial Axial Axial Axial
Algorithm 3 Lung or Bone Lung or Bone Lung or Bone Lung or Bone Lung or Bone
Thickness (mm) 0.625/1.25 1.25 0.625 0.625 0.625
Interval (mm) 0.4/0.625 0.625 0.4 0.4 0.4
ASiR (if used) SS70 SS70 SS70
RECON 3
Algorithm 3 MIP MIP MIP MIP MIP
Thickness (mm) 6 6 6 6 6
Interval (mm) 3 3 3 3 3
RECON 4
Algorithm 4 5
Veo/TX/RP05
Thickness (mm) 0.625
Interval (mm) 0.4

3
MIP: Maximum Intensity Projection
4
Veo/TX/RP05 if Veo is available

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LUNG CANCER SCREENING CT (Selected GE scanners) with constant mA (Back to INDEX)

SCOUT: AP S60-I400; scan from top of shoulder through mid-liver, if automatic exposure control is used.
PA scout if manual mA is used.

LightSpeed 16 Discovery
Optima 660 LightSpeed VCT
GE BrightSpeed 16 CT750 HD
Scan Type Helical Helical Helical Helical
Rotation Time (s) 0.5 0.6 0.5 0.5
Beam Collimation (mm) 10/20 40 40 40
Detector Configuration 16x0.625/ 16x1.25 64x0.625 64x0.625 64x0.625
Pitch 1.375 1.375 0.984 0.984
Speed (mm/rot) 13.75/ 27.50 55.0 39.37 39.37
kV* 120 120 120 120
mA* 60 50 50 50
SFOV Large Body Large Body Large Body Large Body

CTDIvol* 2.3/ 2.0 mGy 1.8 mGy 1.9 mGy 1.9 mGy

RECON 1
Plane Axial Axial Axial Axial
Algorithm Bone or Lung Bone or Lung Bone or Lung Bone or Lung
Recon Mode Full Full Full Full
Thickness (mm) 1.25 or 2.5 1.25 or 2.5 1.25 or 2.5 1.25 or 2.5
Interval (mm)
1.25 or 2.5 1.25 or 2.5 1.25 or 2.5 1.25 or 2.5
(should be ≤ slice width)

ASIR (if used) SS50 SS50 SS50 SS50

RECON 2

***Axial DMPR- **Axial DMPR- **Axial DMPR- **Axial DMPR-create

Plane create Sag/Cor create Sag/Cor create Sag/Cor
Sag/Cor reformats
reformats reformats reformats
Algorithm Bone or Lung Bone or Lung Bone or Lung Bone or Lung
Recon Mode Full Full Full Full
Thickness (mm) 0.625 0.625 0.625 0.625
Interval (mm) 0.625 0.625 0.625 0.625

ASIR (if used) SS50 SS50 SS50 SS50

* For standard sized patient, defined as 5’7”, 155 pounds. For small patients, mA may be reduced by as much as 50%; for large
patients, mA may be increased by 50-100%.

** These protocols use direct multi-planar reconstruction (DMPR) on Recon 2 to automatically create Sagittal and Coronal
reformats. The user may select the thickness of the Sagittal and Coronal images to be 1.25 - 5mm.

***For LightSpeed 16/BrightSpeed 16 and depending on system configuration, DMPR could be used if available. If DMPR is not
available, user will need to create Sag/Cor images manually in Reformat, using an image thickness of 1.25 - 5mm.

Approx. Weight (kg) Approx. Weight (lbs) mA Approx. CTDIvol (mGy)

Small Patient 50-70 110-155 25-50 0.9-2.3
Avg. Patient 70-90 155-200 50-75 1.8-3.6
Large Patient 90-120 200-265 75-100 2.7-4.6
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LUNG CANCER SCREENING CT (selected HITACHI scanners) (Back to INDEX)

SCANOGRAM: PA; scan from top of shoulder through mid-liver.

HITACHI ECLOS 16 SCENARIA 64 SCENARIA 128

Scan Type Volume Volume Volume
Rotation Time (s) 0.8 0.5 0.5
Detector Collimation- T 1.25 mm 0.625 mm 0.625 mm
Number of Active Channels 16 64 64
Detector Configuration 1.25 x 16 0.625 x 64 0.625 x 64
Mode (thick/ pitch/ speed) 1.25/ 1.3125/ 26.25 0.625/ 0.8281/ 33.13 0.625/ 0.8281/ 33.13
Pitch 1.3125 0.8281 0.8281
Speed (mm/rot) 26.25 33.13 33.13
kV* 120 120 120
mA* 50 50 50
Adaptive mA/IntelliEC No No No
SFOV 500 500 500
CTDIvol* 2.6 2.7 2.7

RECON 1
Series Description Lung Lung Lung
Type Axial Axial Axial
Filter 21 Lung 21 Lung 21 Lung
Thickness (mm) 1.25 1 1
Interval (mm) 0.625 0.5 0.5
RECON 2
Series Description Soft Tissue Soft Tissue Soft Tissue
Type Axial Axial Axial
Filter 31 Soft tissue 31 Soft tissue 31 Soft Tissue
Thickness (mm) 1.25 1 1
Interval (mm) 0.625 0.5 0.5

* For standard sized patient, defined as 5’7”, 155 pounds. For small patients, mA may be reduced by as much as 50%; for large
patients, mA may be increased by 50-100%.

Approx. Weight (kg) Approx. Weight (lbs) mA Approx. CTDIvol (mGy)

Small Patient 50-70 110-155 25-50 1.3-2.7
Avg. Patient 70-90 155-200 50-75 2.6-4.1
Large Patient 90-120 200-265 75-100 3.9-5.4

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LUNG CANCER SCREENING CT (selected NEUSOFT scanners) (Back to INDEX)

SCOUT: PA, scan from top of shoulder through mid-liver. Adjust Displayed FOV to 1 cm beyond the rib cage.

NeuViz64i/ NeuViz64i/
NEUSOFT NeuViz 16 NeuViz 16
NeuViz64e NeuViz64e
Scan Type Helical Helical Helical Helical
Patient size Small-Med Large (≥38cm) Small-Med Large (≥40cm)
Rotation Time (s) 0.6 0.6 0.5 0.5
Collimation 16 x 1.5 16 x 1.5 64 x 0.625* 64 x 0.625*
kVp 120 140 100 120
Reference mAs 35 35 40 50
Pitch 1.2 1.2 1.2 1.2
Displayed
300 350 300 350
FOV(mm)
Resolution Standard Standard Standard Standard
Dose Modulation ACS & DOM ACS & DOM O-Dose O-Dose
ClearView N/A N/A 20% 30%
SNR Level N/A N/A 1 1
CTDIvol* 2.8*mGy 4.3**mGy 1.9*mGy 3.3**mGy
RECON 1 Thin Lung
Type Axial Axial Axial Axial
Filter EA EA Lung20 Lung20
Thickness (mm) 1.5 1.5 1 1
Increment (mm) 0.75 0.75 0.5 0.5
ClearView N/A N/A 20% 30%
RECON 2 Thin Mediastinum
Type Axial Axial Axial Axial
Filter SB SB F20 F20
Thickness (mm) 1.5 1.5 1 1
Increment (mm) 0.75 0.75 0.5 0.5
ClearView N/A N/A 20% 30%
RECON 3 Coronal & Axial 8 x 4 MIPS Lung
Type MIP MIP MIP MIP
Thickness (mm) 8 8 8 8
Increment (mm) 4 4 4 4

* For standard sized patient, defined as 5’7”, 155 pounds.

** Because this technique is for a large patient, the CTDIvol exceeds 3.0 mGy
*** Indicates that a z-axis “flying focal spot” technique is used to obtain twice as many projections per rotation as detector rows.

Approx. Weight (kg) Approx. Weight (lbs) Approx. CTDIvol (mGy)

Small Patient 50-70 110-155 1.0-2.8
Avg. Patient 70-90 155-200 1.9-4.3
Large Patient 90-120 200-265 3.3-5.6

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Lung Cancer Screening CT (selected PHILIPS scanners) (Back to INDEX)

SURVIEW: PA; scan from top of shoulder through mid-liver.

Brilliance Brilliance Ingenuity CT

PHILIPS
16 slice 64 slice Ingenuity CT w/iPatient
Scan Type Helical Helical Helical Helical
Rotation Time (s) 0.5 0.5 0.4 0.4
Collimation 16 × 1.5 mm 64 × 0.625 mm 64 × 0.625 mm 64 × 0.625 mm
Coverage (mm) 24 40 40 40
kV 120 120 120 120
DoseRight DoseRight DoseRight DoseRight
mAs (mAs/slice) @ water 26 mAs @ 33 cm 26 mAs @ 33 cm 26 mAs @ 33 cm 26 mAs @ 29 cm
equivalent diameter
reference* reference* reference* ref., DRI = 6
Tube current modulation ZDOM ZDOM ZDOM 3D Modulation
Pitch 1.0 1.0 1.1 1.1
CTDIvol** 1.8 mGy 1.7 mGy 1.7 mGy 1.7 mGy

RECON 1 – Axial Lung

Type Axial Axial Axial Axial
Filter YA YA YA YA
Thickness (mm) 2 1 1 1
Increment (mm) 1 0.5 0.5 0.5
Matrix 7682 7682 7682 7682
4
iDose Level 5 5 5 5

RECON 2 – Axial Soft tissue

Type Axial Axial Axial Axial
Filter A A A A
Thickness (mm) 3 3 3 3
Increment (mm) 1.5 1.5 1.5 1.5
Matrix 5122 5122 5122 5122
iDose4 Level 5 5 5 5

* For scanners without the iPatient interface, the default water equivalent diameter is 33 cm for all protocols, unless
otherwise defined by the user with a manual DoseRight reference image.

** For standard sized patient, defined as 5’7”, 155 pounds

Approx. Weight (kg) Approx. Weight (lbs) Approx. CTDIvol (mGy)

Small Patient 50-70 110-155 0.9-1.8
Avg. Patient 70-90 155-200 1.7-2.7
Large Patient 90-120 200-265 2.7-3.6

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Lung Cancer Screening CT (selected PHILIPS scanners) (Back to INDEX)

SURVIEW: PA; scan from top of shoulder through mid-liver.

Brilliance iCT
PHILIPS Brilliance iCT Brilliance iCT
SP SP w/ iPatient Brilliance iCT w/ iPatient
Scan Type Helical Helical Helical Helical
Rotation Time (s) 0.4 0.4 0.4 0.4
Collimation 64 × 0.625 mm 64 × 0.625 mm 128 × 0.625 mm 128 × 0.625 mm
Coverage (mm) 40 40 80 80
kV 120 120 120 120
DoseRight DoseRight DoseRight DoseRight
mAs (mAs/slice) @ water
equivalent diameter 23 mAs @ 33 cm 23 mAs @ 29 cm 23 mAs @ 33 cm 23 mAs @ 29 cm
reference* ref., DRI = 5 reference* ref., DRI = 5
Tube current modulation ZDOM 3D Modulation ZDOM 3D Modulation
Pitch 1.0 1.0 0.9 0.9
CTDIvol** 1.7 mGy 1.7 mGy 1.6 mGy 1.6 mGy

RECON 1 - Lung
Type Axial Axial Axial Axial
Filter YA YA YA YA
Thickness (mm) 1 1 1 1
Increment (mm) 0.5 0.5 0.5 0.5
Matrix 7682 7682 7682 7682
iDose4 Level 5 5 5 5

RECON 2 – Soft tissue

Type Axial Axial Axial Axial
Filter A A A A
Thickness (mm) 3 3 3 3
Increment (mm) 1.5 1.5 1.5 1.5
Matrix 5122 5122 5122 5122
iDose4 Level 5 5 5 5

* For scanners without the iPatient interface, the default water equivalent diameter is 33 cm for all protocols, unless
otherwise defined by the user with a manual DoseRight reference image.

** For standard sized patient, defined as 5’7”, 155 pounds

Approx. Weight (kg) Approx. Weight (lbs) Approx. CTDIvol (mGy)

Small Patient 50-70 110-155 0.8-1.7
Avg. Patient 70-90 155-200 1.6-2.6
Large Patient 90-120 200-265 2.4-3.4

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LUNG CANCER SCREENING CT (selected SIEMENS scanners) (Back to INDEX)

TOPOGRAM: PA; scan from top of shoulder through mid-liver.

Sensation 64/
SIEMENS Sensation 16 Emotion 16 Perspective 64 a
Definition DS (64)
Software version VB30 VB42 VC28 VB42/VA40
Scan Mode Spiral Spiral Spiral Spiral
Rotation Time (s) 0.5 0.6 0.6 0.5 / 0.33
Detector *64 x 0.6 mm *64 × 0.6 mm
16 x 0.75 mm 16 x 0.6 mm
Configuration (32 x 0.6 mm = 19.2 mm) (32 x 0.6 mm = 19.2 mm)
Pitch 1.2 1.0 1.2 1.0
kV 120 110 110 120
Quality ref. mAs 25 20 25 25
CARE Dose4D ON ON ON ON
CARE kV NA NA NA OFF

CTDIvol*** 1.9 mGy 1.6 mGy 2.0 mGy 1.8 / 1.7 mGy

RECON 1
Type Axial Axial Axial Axial
B50 B50
Kernel B50 B50
I50, strength = 2** I50, strength = 2**
Slice (mm) 1.0 1.0 1.0 1.0
Increment (mm) 0.7 0.7 0.7 0.7
RECON 2
Type Axial MIP Axial MIP Axial MIP Axial MIP
B50 B50
Kernel B50 B50
I50, strength = 2** I50, strength = 2**
Slice (mm) 20 20 20 20
Increment (mm) 2.5 2.5 2.5 2.5
RECON 3
Type Axial Axial Axial Axial
B31 B31
Kernel B31 B31
I31, strength = 2** I31, strength = 2**
Slice (mm) 1.0 1.0 1.0 1.0
Increment (mm) 0.7 0.7 0.7 0.7
RECON 4
Type Axial MIP Axial MIP Axial MIP Axial MIP
B31 B32
Kernel B31 B31
I31, strength = 2** I31, strength = 2**
Slice (mm) 20 20 20 20
Increment (mm) 2.5 2.5 2.5 2.5
* Indicates that a z-axis “flying focal spot” technique is used to obtain twice as many projections per rotation as detector
rows. This is referred to as IVR (Interleaved Volume Reconstruction) on the Perspective system.
** With SAFIRE.
*** For standard sized patient, defined as 5’7”, 155 pounds. Do not adjust the Quality Reference mAs as patient size varies.
CAREDose4D adjusts for patient size automatically
a
With exception of rotation time, a Definition DS operated in single source mode can use the same protocol as a Sensation 64.
b
The tube potential selected by CARE kV can differ from exam to exam if patient positioning or size changes substantially. Because
it is important to use the same tube potential on serial (follow up) exams, manual kV selection is recommended.
Approx. Weight (kg) Approx. Weight (lbs) Approx. CTDIvol (mGy)
Small Patient 50-70 110-155 0.8-2.5
Avg. Patient 70-90 155-200 1.6-3.8
Large Patient 90-120 200-265 2.4-5.0

13
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Copyright © February 23, 2016 by AAPM. All rights reserved
 Lung Cancer Screening CT Protocols Version 4.0 2/23/16

LUNG CANCER SCREENING CT (selected SIEMENS scanners, continued) (Back to INDEX)

TOPOGRAM: PA; scan from top of shoulder through mid-liver.

Definition AS+ Definition Flash Definition Force
SIEMENS
(128-slice) (Dual source 128-slice) (Dual source 192-slice)
Software version VA44 VA44 VA50
Scan Mode Spiral Spiral Spiral
Rotation Time (s) 0.33 or 0.30 0.28 0.25
Detector *128 × 0.6 mm *128 × 0.6 mm *192 × 0.6 mm
Configuration (64 x 0.6 mm = 38.4 mm) (64 x 0.6 mm = 38.4 mm) (96 x 0.6 mm = 57.6 mm)
Pitch 1.0 1.0 1.0
kV 120 120 100Snc
Quality ref. mAs 25 25 150c
CARE Dose4D ON ON ON
CARE kV OFF OFF Not applicable

CTDIvol*** 1.7 mGy 1.7 mGy 0.5 mGy

RECON 1
Type Axial Axial Axial
B50 B50
Kernel Bv49, strength = 2**
I50, strength = 2** I50, strength = 2**
Slice (mm) 1.0 1.0 1.0
Increment (mm) 0.7 0.7 0.7
RECON 2
Type Axial MIP Axial MIP Axial MIP
B50 B50
Kernel Br54, strength = 2**
I50, strength = 2** I50, strength = 2**
Slice (mm) 20 20 20
Increment (mm) 2.5 2.5 2.5
RECON 3
Type Axial Axial Axial
Kernel B31 B31 Br40, strength = 2**
Slice (mm) 1.0 1.0 1.0
Increment (mm) 0.7 0.7 0.7
RECON 4
Type Axial MIP Axial MIP Axial MIP
Kernel B31 B31 Br40, strength = 2**
Slice (mm) 20 20 20
Increment (mm) 2.5 2.5 2.5
* Indicates that a z-axis “flying focal spot” technique is used to obtain twice as many projections per rotation as detector
rows. This is referred to as IVR (Interleaved Volume Reconstruction) on the Perspective system.
** With SAFIRE or ADMIRE
*** For standard sized patient, defined as 5’7”, 155 pounds. Do not adjust the Quality Reference mAs as patient size varies.
CAREDose4D adjusts for patient size automatically
a
With exception of rotation time, a Definition DS operated in single source mode can use the same protocol as a Sensation 64.
b
The tube potential selected by CARE kV can differ from exam to exam if patient positioning or size changes substantially. Because it
is important to use the same tube potential on serial (follow up) exams, manual kV selection is recommended.
c
100Sn = 100 kV with 0.6 mm tin (Sn) filtration. This removes lower energy photons and hence a higher Quality ref. mAs is required.
Approx. Weight (kg) Approx. Weight (lbs) Approx. CTDIvol (mGy)
Small Patient 50-70 110-155 0.25 -1.7
Avg. Patient 70-90 155-200 0.5- 2.7
Large Patient 90-120 200-265 1.0 -3.4

14
The disclaimer found on page 1 is an integral part of this document.
Copyright © February 23, 2016 by AAPM. All rights reserved
 Lung Cancer Screening CT Protocols Version 4.0 2/23/16

Lung Cancer Screening CT (selected Toshiba scanners) (Back to INDEX)

Scanogram: PA and LAT dual Scanogram; scan from top of shoulder through mid-liver.

Aq PRIME Aq PRIME
TOSHIBA Aq RXL Aq ONE/Premium Aq ONE Vision
(40 Rows) (80 Rows)
Scan Type Helical Helical Helical Helical Helical
Rotation Time
0.5 0.35 0.35 0.35 0.275
(s)
Detector
16 x 0.5 mm 40 x 0.5 mm 80 x 0.5 mm 80 x 0.5 mm 80 x 0.5 mm
Configuration
Pitch Fast (1.434) Standard (0.825) Standard (0.813) Standard (0.813) Standard (0.813)
kV 120 120 120 120 120
Minimum & Min mA = 20 / Min mA = 20 / Min mA = 20 / Min mA = 20 / Min mA = 20 /
Maximum mA Max mA = 110 Max mA = 120 Max mA = 120 Max mA = 120 Max mA = 150
SURE Body Std Axial Body Std Axial Body Std Axial Body Std Axial Body Std Axial
IQ Setting
(5 mm Target Slice) (5 mm Target Slice) (5 mm Target Slice) (5 mm Target Slice) (5 mm Target Slice)
SURE
Exposure ON ON ON ON ON
*SD 25* 25* 25* 25* 25*
**CTDIvol 1.8 1,8 1.8 1.7 1.6
* Create a new SureExp setting using Body Std Axial SureIQ with 5 mm Target Slice and the given SD, min and max mA values.
** For standard sized patient, defined as 5’7”, 155 pounds. Do not adjust the SD as patient size varies. SureExposure
modulates mA automatically based on patient size.

Recon 1 – Axial Soft Tissue

Type Axial Axial Axial Axial Axial
SURE
IQ Setting Body Std Axial Body Std Axial Body Std Axial Body Std Axial Body Std Axial
AIDR 3D AIDR 3D STD AIDR 3D STD AIDR 3D STD AIDR 3D STD AIDR 3D STD
Thickness (mm) 1 1 1 1 1
Interval (mm) 1 1 1 1 1

Recon 2 – Axial Lung

Type Axial Axial Axial Axial Axial
SURE
IQ Setting Lung Std Axial Lung Std Axial Lung Std Axial Lung Std Axial Lung Std Axial
AIDR 3D AIDR 3D STD AIDR 3D STD AIDR 3D STD AIDR 3D STD AIDR 3D STD
Thickness (mm) 1 1 1 1 1
Interval (mm) 1 1 1 1 1

Recon 3 – MPR Soft Tissue

Volume***
Type Volume*** Volume*** Volume*** Volume*** Volume***
SURE
IQ Setting Body Std Volume Body Std Volume Body Std Volume Body Std Volume Body Std Volume
AIDR 3D AIDR 3D STD AIDR 3D STD AIDR 3D STD AIDR 3D STD AIDR 3D STD
Thickness (mm) 0.5 0.5 0.5 0.5 0.5
Interval (mm) 0.3 0.3 0.3 0.3 0.3
Multiview
Type Sagittal/Coronal Sagittal/Coronal Sagittal/Coronal Sagittal/Coronal Sagittal/Coronal
SURE
IQ Setting Body Std Volume Body Std Volume Body Std Volume Body Std Volume Body Std Volume
Thickness (mm) 1 1 1 1 1
Interval (mm) 1 1 1 1 1
*** Volume reconstructions are required in order to create Multiplanar reconstructions.

15
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 Lung Cancer Screening CT Protocols Version 4.0 2/23/16

Recon 4 – MPR Lung

Volume ***
Type Volume*** Volume*** Volume*** Volume*** Volume***
SURE
IQ Setting Lung Std Volume Lung Std Volume Lung Std Volume Lung Std Volume Lung Std Volume
AIDR 3D AIDR 3D STD AIDR 3D STD AIDR 3D STD AIDR 3D STD AIDR 3D STD
Thickness (mm) 0.5 0.5 0.5 0.5 0.5
Interval (mm) 0.3 0.3 0.3 0.3 0.3
Multiview
Type Sagittal/Coronal Sagittal/Coronal Sagittal/Coronal Sagittal/Coronal Sagittal/Coronal
SURE
IQ Setting Lung Std Volume Lung Std Volume Lung Std Volume Lung Std Volume Lung Std Volume
Thickness (mm) 1 1 1 1 1
Interval (mm) 1 1 1 1 1
*** Volume reconstructions are required in order to create Multiplanar reconstructions.

Approx. Weight (kg) Approx. Weight (lbs) Approx. CTDIvol (mGy)

Small Patient 50-70 110-155 0.8-1.8
Avg. Patient 70-90 155-200 1.6-2.7
Large Patient 90-120 200-265 2.4-3.6

16
The disclaimer found on page 1 is an integral part of this document.
Copyright © February 23, 2016 by AAPM. All rights reserved