Individually Adapted Examination Protocols for Reduction of Radiation Exposure in Chest CT

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Abstract
Wildberger JE, Mahnken AH, Schmitz-Rode T, et al. Individually adapted examination protocols for reduction of radiation exposure in chest CT. Invest Radiol 2001;36:604–611. To develop a simple directive for the reduction of radiation exposure without loss of diagnostic information in routine chest CT examinations. Two hundred fifty adult patients (164 male, 86 female) were entered into a prospective trial. All examinations were performed with a multislice CT technique (Somatom Volume Zoom, Siemens). Four groups of 50 patients each were scanned with patient-related specific parameters: individual mA-s values were derived from the estimated body weight: kilograms + 10, ± 0, − 10, and − 20 mAs. The results were compared with those of 50 patients who were examined by a standard chest protocol by using the parameters 120 mAs and 140 kV. All other parameters including the tube voltage were kept constant. Subjective image quality was rated on a three-point scale: 1 = excellent, 2 = fair, 3 = nondiagnostic. In addition, objective criteria based on signal-to-noise measurements were assessed by using a region-of-interest methodology. Image quality was sufficient in all cases. Mean subjective gradings of image quality, based on soft-tissue window settings, were 1.1 for the 120-mAs protocol, 1.1 for the (body weight [kg] + 10) mAs protocol, 1.1 for the (body weight [kg] ± 0) mAs protocol, 1.3 for the (body weight [kg] − 10) mAs protocol, and 1.2 for the (body weight [kg] − 20) mAs protocol. Objective criteria based on noise measurements showed mean ± standard deviation values of 5.7 ± 0.8 Hounsfield units (HU) for the 120-mAs protocol. For the reduced-dose protocols, values were calculated as 7.6 ± 1.2 HU (group + 10), 7.9 ± 1.3 HU (group ± 0), 8.7 ± 1.2 HU (group − 10), and finally 9.1 ± 1.3 HU (group − 20). The best correlation for an entire subgroup was achieved with the − 10 protocol (body weight [kg] − 10) mAs, with nearly constant noise related to body weight in all patients. By deriving mAs values from body weight estimation, an individually adapted protocol for chest CT can be recommended and easily employed in a clinical setting. With an adaptation of the tube current–time product based on the estimated body weight of the patient − 10 (body weight [kg] − 10 mAs), a well-balanced examination without significant loss of information, even in soft-tissue window settings, can be performed with this particular scanner. For this adapted mAs protocol, a mean reduction of radiation exposure of 45% was achievable, compared with the standard protocol. A maximum decrease per case down to 31 mAs was obtained, without relevant loss of image quality. Therefore, for other types of CT scanners, analogous protocols may be adapted.