Reduction of patient radiation dose with a new organ based dose modulation technique for thoraco-abdominopelvic computed tomography (CT) (Liver dose right index)

Purpose

To evaluate the radiation dose reduction, image quality and diagnostic confidence with thoraco-abdominopelvic computed tomography (TACT) using a new organ based dose modulation system (liver dose right index [Liver DRI]), compared to TACT using a standard automatic exposure control adjusting mA according to attenuation.

Methods

A total of 37 patients who had two TACT examinations on 2 different CT scanners, one using standard automatic exposure control (combination of a DoseRight automatic current selection and Z modulation) and one using Liver DRI were included. There were 19 men and 18 women with a mean age of 67.6 ± 11.7 (SD) years (range: 36–85 years) For each patient, volume CT dose index (CTDIvol), size-specific dose estimates (SSDE) and signal-to-noise ratio (SNR) were evaluated at each anatomic level (lung, breast, liver and pelvis area) for each protocol. Two radiologists assessed independently image quality, artifacts and diagnostic confidence.

Results

The radiation dose decreased significantly using Liver DRI compared to standard automatic exposure control on the total scan length, lung, breast and pelvis area, with a significant CTDIvol reduction of 27% (P = 0.0001), 23% (P = 0.0002), 24% (P = 0.0002) and 31% (P = 0.0001), respectively; and a significant SSDE reduction of 23% (P = 0.0001), 28% (P = 0.0001), 23% (P = 0.0002) and 29% (P = 0.0001), respectively. No significant SNR reductions were observed in all measured tissues at the level of the aortic arch, celiac trunk and iliac bifurcation, except in the muscle (P = 0.0013) and fat tissue (P = 0.0052) at the level of the ureteral meatus. No significant differences were noted between both protocols in overall image quality, artifacts and diagnostic confidence with an excellent inter observer agreement between radiologists (Kappa values of 0.83, 0.85 and 0.88, respectively).

Conclusion

Liver DRI organ based dose modulation technique allows significant dose reduction compared to standard automatic exposure control while preserving diagnostic image quality in all thoraco-abdominopelvic areas.