"S'59PM_ Non 11Nov < CT Physics Part-2 Q CT PHYSICS — Part 2 7 (CT DOSE MEASUREMENT AND REDUCTION * (a) Window Width: The range of CT numbers that is selected to demonstrate grey scale is called window width and represents the measure of the range of CT numbers that an. image contains. A wider window width (2000 HU), therefore, wil display a wider range Of CT numbers. Decreasing window width increases contrast in image, whereas: increasing window width allows structures with a large pixel range to be viewed. + (b) Window Level: It is the midpoint of the range of the CT numbers that are being displayed and should be set as close as possible to the CT number of the tissue to be pamined CCtnumbors Image gy scale Ar =1000 + G. 19.10 Windowing (window width and window level) and grey scale PATIENT EXPOSURE * Patient Dose is intrinsically related to contrast resolution and spatial resolution. Contrast resolution improves by taking into account more X-ray photons which means a higher patient dose. Improvement of spatial resolution demands a smaller pixel size, which. eventually means a smaller voxel size. Decreasing the volume of tissue from which a 1"© Improvement of both contrast resolution and spatial resolution | ‘patient dose. optimized patient radiation dose, Radiation dose descriptors in computed tomography © CTDI vol is measured in mGy, and it represents average dose within each slice, * DLP is product of CTD! vol (mGy) and length of scanned area (cm). It represents th integrated dose over the entire scanned area, the unit of DLP is mGy.cm. ‘* The CTDIvol and DLP do not represent patient-specific dose. © CT dose-related quantities are attached with certain limitations such as it pro 491-8459431049 = phantom dose and does not account for actual patient body size. Therefore, CTDI vol value is underestimated for small patients and overestimated for large patients. Similarly, it does not account for body compensation. + Size-specific dose estimation (SSDE) for CT. SDE helps convert CTDI vol into patient-size- specific doses using conversion fa c tors and therefore extends the application of CTDIvol. to patient size beyond 16 and 32 cm. Such factor is especially important for paediatric CT or when small adults are scanned. SSDE still does not account for patient composition and does not represent actual organ dose, like CTDI vol."various size and shape phantoms, when phantom miscentered, the sur phantom and image noise increased, To understand reasons for the afor ‘one need to understand the physics of bow tie filter and of CT scanners. Bow tie filter In CT scanners, a bow-tie-shaped filter is used to shape and reduces the intensity incident X-ray beam in the periphery of the X-ray field where the attenuation path through the patient is generally thinner. This tends to equalize or flatten the X-ray intensity that reaches the detector array. Bow tie filter presumes that the centre of the body region being scanned coincides or approximates with the gantry isocentre. Off centering of patient messes up beam bow tie filter function and leads to asymmetric 7 distribution of noise. ‘Automatic exposure control © Uniform current value throughout the patient body scan would not provide constant image contrast Therefore, the X-ray tube current value needs to be modulated based on the size, ‘attenuation characteristics of the body part to be scanned. Such tube current modulation technique is called AEC. AEC technique employs tube current based on beam attenuation data ob ‘the localizer radiographs during scout scan of the patient. If the patientis: ‘couch, CT assumes the patient is larger and uses higher-exposurTechnologist and radiologists may not be aware ‘Suboptimal use of laser-assisted centering Increasing workload of multidetector row CT scanners with expanding applications: related factors such as those Who cannot lie flat, Who cannot raise their arms sufficient above their heads? Who have spinal curvature abnormalities or need to elevate their head or chest relati Je caudal portion of their body, on life support systems, Who are referred with emergency clinical indications.1a to tube current. For 4, Tube Potential ‘* Tube potential affects both the quality and quantity of generated X-ray spectra, '* Unlike mA, there is nonlinear relationship between kV and dose. are held constant. © Most CT scanners require the user to specify a fixed KV value for CT protocol. Generally, smaller patients (particularly children) should be scanned at low kV (70-100 kV). Similarly, CT angiography or contrast- enhanced CT can be performed at low kV (80-100 kV). ‘The kV reduction improves image contrast while reducing the dose but avoid low kV in large size patients or patients with large shoulders undergoing neck CT or CT angiography, which will result in poor image quality. ‘One needs to bear in mind that inappropriate reduction in kV increases image noise, © Some CT scanners have automatic kV selection where CT scanner picks up theor uncooperative patients and moving organs. 6. Scan length ‘After taking the scout image, the scan length must be restricted to what is to image. Dose to the patient increases with increase in scan length. it is commonly observed that CT abdomen has extra images acquired beyond the interest. Limit scan to intended anatomical area can cut dose by significant amount. For s Similarly, for routine chest CT, the area should be set from apex to adrenals. Itis imperative to minimize overlap when scanning of two contiguous body regions. Radiologist may discuss with technologist for establishing scan length protocols for” optimization of dose. 7. Slice thickness and interval Slice thickness (mm) represents nominal width of reconstructed image in the longitudin al Slice interval (mm) represents distance between two consecutive reconstructed images; Choice of slice thickness depends on the clinical indications and body region being st Thin slice implies higher noise, higher contrast and less partial volume artifacts, Thislower than FBP. It is important to note that iterative technique does not reduce dose by itself but rather user to reduce dose compared with FBP. 9. Pitch Dose inversely related to pitch image quality control are being discussed below. Linearity different plastic material with known physical and X-ray attenuation properties posit water bath, There should be a linear relationship between the CT numbe