Article published online: 2021-08-02

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11-175

Achieving reduced radiation doses for CT examination of

the brain using optimal exposure parameters
RS LIVINGSTONE, A EAPEN, NB DIP, N HUBERT

Abstract
Objectives: Examinations performed using CT scanners impart high radiation dose to patients and use of this
modality is on the increase in the present day scenario. This study was intended to evaluate and optimize
radiation dose imparted to patients during CT examination of brain performed using spiral CT scanner.
Materials and Methods: One hundred and one patients who underwent CT examination of brain were included
in the study. The effective dose to patients was calculated using volume computed tomography dose index
(CTDIvol) and dose length product (DLP) values. Patients were categorized according to the type of examination
involved. Patients who underwent a complete examination of brain (non-contrast as well as contrast) were
categorized in Group A and patients who underwent either a non-contrast or contrast examination were
categorized as Group B.
Results: The effective dose to patients ranged from 0.65 mSv to 0.93 mSv for Group A patients and 0.28 mSv
to 0.53 mSv for Group B patients.
Conclusion: There was a reduction of doses imparted to patients undergoing CT examination of the brain
using optimized exposure parameters without any loss of diagnostic information.

Ind J Radiol Imag 2006 16:2:247-251

Keywords: Effective dose, dose length product, CTDIvol computed tomography (CT)

Introduction collective dose from CT [3]. The CT dose index (CTDI)

and dose length product (DLP) have been proposed as
The role of computed tomography has been of tremendous the appropriate dose quantities for the establishment of
value since its inception in diagnostic radiology. Though diagnostic reference levels for optimizing patient exposure
there are other imaging modalities such as MRI and [4]. Integral dose quantities such as DLP and effective
ultrasonography which are also widely used in the present dose are the descriptors of the total amount of radiation
scenario, CT imaging still continues to be on the increase absorbed by taking into account the extent of the body
due to its varied advantages despite the large radiation region being irradiated. The DLP plays an important role
dose imparted to patients. Because of its widespread as an indicator of radiation dose of the patient [5].
use, CT contributes a large fraction of man-made radiation
dose to the human population; radiation dose to patients The number of CT examinations on brain was higher than
from this modality should be optimized [1]. Spiral CT is a examinations such as abdomen and chest performed
specialized imaging modality in which there is continuous using CT scanner in the institution where the study was
rotation of x-ray tube coupled with linear translatory conducted. Reduction of radiation doses is possible by
movement of the patient through the gantry aperture in implementing dose auditing strategies during CT
order to achieve volumetric data acquisition (helical CT). examinations. The current study intends to evaluate
Advent of x-ray tubes of enhanced heat capacity, radiation dose imparted to patients during CT examination
development of slip rings, advances in detector technology, of brain using reduced current and tube potentials without
and improvements in computers have permitted rapid sub- sacrificing image quality.
second axial and helical CT scans [2].
Materials & Methods
Tremendous effort has been expended in reducing patient
doses from other radiological procedures with considerable Computed tomography examinations of the brain were
success, but much of the collective dose reduction performed using a Siemens Somatom Emotion CT
achieved has been offset by a concurrent increase in the machine (Erlangen, Germany). This state of art, sub-
From the Department of Radiodiagnosis, Christian Medical College, Vellore 632004, India

Request for Reprints: ROSHAN S. LIVINGSTONE, Department of Radiodiagnosis, Christian Medical College, Vellore 632004,
India

Received 15 November 2005; Accepted 12 April 2006

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248 RS Livingstone et al IJRI, 16:2, May 2006

second spiral scanner had a speed capability ranging E = DLP × k

-1 -1
from 0.8s to 1.5s per rotation and acquisition capability Where k (mSv mGy cm ) is dependent upon the body
of 80s at uninterrupted spiral mode. The tube potentials region, its value for head according to the 'European
-1
ranged from 80 kV to 130 kV with minimum total filtration guidelines on quality criteria of CT' is 0.0023 mSv mGy
-1
of 6.4 mm Al equivalence. The size of focal spot for small cm [6].
focus was 0.8 mm x 0.4 mm and for large focus it was
0.8 mm x 0.7 mm in dimensions as specified by the Results
manufacturer. The tube potentials and the tube current
used along with dose indices were displayed on the control All examinations reported in this study were performed
console of the scanner. Various other parameters such on adult patients. Of the hundred and one patients included
as the total time duration of the scan, field of view and in this study, twenty eight patients were in Group A and
pitch selection were also displayed on the console. All seventy three in Group B. For Group A patients, the tube
images were reviewed by a team of expert radiologists. potential of 110 kV was invariably selected during the entire
examination (non-contrast as well as contrast studies)
During CT examination of the brain, sequential mode (no whereas the selection of slice thickness and mAs differed.
involvement of pitch factor) was selected and the number In the initial non-contrast examination, 100 mAs with 10
of slices acquired was at the discretion of personnel mm slice thickness were selected and for the contrast
performing the examination. The scanner facilitated examination, 80 mAs with slice thickness of 5 mm were
preprogrammed protocols designed for quick and easy selected. The total number of slices acquired ranged from
workflow. These protocols involved a complete 28 to 51 and results of these are shown in Table 1. The
examination of the region of interest along with a topogram, tube potential of 110 kV and mAs of 100 with slice
spiral or sequential ranges and reconstruction modes. thickness of 5mm were invariably selected for Group B
Personnel involved in operating the machine had the option patients.
to change the preprogrammed protocols if there was a
need. The preprogrammed scan protocols used were based Radiation dose imparted to patients during CT examination
on recommended exposure factors specified by the of brain are given in Table 2. The CTDIvol used in the
manufacturers as a starting point for clinical work. During study varied according to the exposure factors selected.
the current study, optimized exposure parameters set by For Group A patients, during the non-contrast examination,
personnel performing the examination were used. the CTDIvol was 15.3 mGy and during the contrast
Selection of factors below the set optimized parameters examination, it was 12.24 mGy. The resultant DLP was a
resulted in mottled images. The study was divided into contribution from both the non-contrast as well as contrast
two categories depending upon the type of examination examinations and the average DLP was 356.09 mGy cm.
performed on patients For Group B patients, the CTDIvol value of 15.3 mGy was
invariably selected since the exposure factors were same
Group A: Patients who underwent non-contrast as well for all patients and the mean DLP value for CT of brain
as contrast CT of brain was 191.61 mGy cm. The effective dose for Group B
Group B: Patients who underwent either non-contrast or patients ranged from 0.28 mSv to 0.53 mSv.
contrast CT of brain
The mean DLP of 356.09 mGy cm reported in the current
Dosimetry study from Group A category was lower than the European
reference dose levels of 1050 mGy cm [6]. Table 3 shows
The CTDIvol values were displayed on the control console the comparison of DLP and effective doses from Group A
of the CT scanner. These values were based on weighted patients with previously reported studies in the literature.
CTDI (CTDIw) values obtained using Polymethyl The mean effective dose reported in the current study
methacrylate (PMMA) head and body phantoms. The was 0.82 mSv and this was lower than effective doses
CTDIvol is the parameter that best estimates the average reported by majority of studies in the literature. The effective
dose at a point with the scan volume for a particular scan dose of 0.98 mSv estimated by using DLP reported by
protocol since the CTDI, CTDIw are only indicators of the Hidajat et al., [7], was comparable to the maximum
level of local dose in the irradiated slice. The CTDIvol was effective dose of 0.93 mSv reported in the current study.
used in calculating the DLP which gave an indication of
the energy imparted for a particular scan and is given as Discussion
DLP = CTDIvol (mGy) × scan length (cm)
There is a risk of imparting high radiation doses to patients
The scan length depended upon the number of slices during examinations performed using CT with multiple
and slice thickness. The effective doses were estimated exposures inherent in the examination. Modern CT
using DLP values and appropriate conversion factors. The scanners are versatile in their operation and with a wide
formula for calculating the effective dose is given below; range of facilities available on these scanners; there is an
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IJRI, 16:2, May 2006 Achieving reduced radiation doses for CT examination 249

Table 1. Exposure parameterus used during CT of brain examinations

No. of kV mAs No. of slices Slice
Groups cases Mean (Range) thick-ness (mm)
A 28 110 100, 80 37,57 (28 - 51) 10, 5
B 73 110 100 25.22 (16 - 30) 5

Table 2. CTDL vol, DLP and effective dose values during CT of brain examination
DLP mGy cm Effective dose mSv
Groups CTDL vol Mean ± S.E. Mean ± S.E
mGy Range Range

A 15.3, 12.24 356.09 ± 5,63 0.82 ± 0.01

(283.05 - 405.45) (0.65 - 0.93)

B 15.3 191.61 ± 2.07 0.44 ± 0.005

(122.4 - 229.5) (0.28 - 0.53)

Table 3. Comparison of DLP and effective doses during CT examination of the brain with previously
reported studies
Studies Routine Head
DLP mGy cm Effective dose mSv

Shrimpton et al (15) - 1.78 (0.46 - 4.940

Geleijns et al, (10) - 1-2
Atherton and Huda (16) - 9.1
Poletti (17) - 1.8
Chamberlain et al., (18) - 1-2
European Commission (RDL) (6) 1050 -
Goddard and Al-Farsi (13) 603 (413 - 702) 2.4 (0.3 - 8.2)
Hidajat et al., (7) 349 0.98
Clarke et al., (19) - 1.6
Hiles et al., (12) 731 (306 - 1417) -
Huda (20) - 1
Current study 356. 09 (283.05 - 405.45) 0.82 (0.65 - 0.93)
RDL - reference dose levels

increasing need to assess the dose delivered during enhanced CT scan was invariably performed on patients
routine CT examinations [8]. The spiral CT scanners have on whom presence of space occupying lesion or acute
the potential to offer adequate image quality with moderate central nervous system (CNS) infection was suspected.
radiation dose for the majority of clinical protocols [9].
For evaluating radiation dose to patients in the current Table 1 shows the exposure parameters used during CT
study, it was necessary to categorize patients into groups examination of the brain. For Group B patients, tube
according to the type of protocol involved. For Group A potential of 110 kV and 100 mAs was invariably selected
patients, a plain non-enhanced study was performed first by personnel performing the examination. It is noteworthy
followed by injection of contrast medium and an enhanced in this context that, use of 80 mAs for a contrast
scan. These patients were mostly those who presented examination in Group A patients yielded necessary
with seizures and headaches. The necessity of performing information as those obtained using 100 mAs performed
this examination was at the discretion of the clinician on Group B patients. Exposure parameters of 120 kV
and the radiologist. Non-contrast CT examinations were and 363 mAs as reported by Geleijns et al., [10] was
performed for Group B patients who reported with trauma higher than the exposure factors used in the current study.
or stroke (where intracranial infarction and extracranial or Another study reported by McNitt-Gray [11] showed that
intracranial haemorrage were to be excluded). Contrast the tube potential used for a typical head scan was 120
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250 RS Livingstone et al IJRI, 16:2, May 2006

kV, the mAs was 300 and slice thickness selected was as specified by the manufactures for various anatomical
5 mm. The tube potentials ranging from 120 kV to 142 kV regions, care should be taken by personnel in the selection
and mAs ranging from 200 to 500 for CT of brain as of appropriate exposure parameters. It should also be
reported by Scheck et al., [9] was also higher than the noted that the images acquired using low dose protocols
exposure parameters used in the current study. be reviewed by a team of expert radiologists and put into
practice. Radiologists are responsible for medical radiation
Table 2 shows the radiation dose imparted to both group doses to their patients, and it is imperative that they
of patients who underwent CT examination of the brain. understand the relationship between radiation dose and
The CTDIvol for exposure factors of 110 kV and 100 mAs image quality [21].
was 15.3 mGy and for 110 kV and 80 mAs, it was 12.24
mGy. For Group A patients the mean DLP (contribution The results from this study showed that dose reduction
of radiation dose from both non-contrast and contrast was achieved in CT examination of brain with the use of
examination) was 356.09 mGy cm. Mean DLP of 191.61 reduced tube current and tube potentials without
mGy cm was reported for Group B patients. The DLP sacrificing diagnostic value. On account of the continuous
value reported by Hiles et al., [12], was 731 mGy cm and increase in the number of CT scanners and their use in
this was higher than those reported in the current study. most of the hospitals currently, it is recommended that
the DLP and CTDIvol values be monitored during CT
Table 3 shows DLP and effective doses for CT examination examinations in order to obtain radiation doses as low as
of the brain in comparison with other studies in literature. reasonable practicable without sacrificing image quality.
A survey of radiation doses from CT was reported by Therefore, standard protocols with optimized exposure
Goddard and Al-Farsi [13] which was done at six hospitals, parameters should be designed and adhered to in order
the mean DLP reported in their study was 374 mGy cm that radiation doses may be reduced in the future [13].
(range: 296 mGy cm to 614 mGy cm]. Results in the
present study shows that the DLP values were well within Acknowledgement: Authors would like to express their
those reported by Goddard and Al-Farsi [13]. The mean gratitude to Atomic Energy Regulatory Board of India for
effective dose of 0.82 mSv for Group A patients was lower having provided financial support to this work.
than effective dose ranging from 1 mSv to 2 mSv reported
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