Tracking and Resolving CT Dose Metric Outliers Using Root-Cause Analysis

PurposeThe aim of this study was to examine the frequency and type of outlier dose metrics for three common CT examination types on the basis of a root-cause analysis (RCA) approach.MethodsInstitutional review board approval was obtained for this retrospective observational study. The requirement to obtain informed consent was waived. Between January 2010 and December 2013, radiation dose metric data from 34,615 CT examinations, including 26,878 routine noncontrast CT head, 2,992 CT pulmonary angiographic (CTPA), and 4,745 renal colic examinations, were extracted from a radiation dose index monitoring database and manually cleaned. Dose outliers were identified on the basis of the statistical distribution of volumetric CT dose index and dose-length product for each examination type; values higher than the 99th percentile and less than the 1st percentile were flagged for RCA.ResultsThere were 397 noncontrast CT head, 52 CTPA, and 80 renal colic outliers. Root causes for high-outlier examinations included repeat examinations due to patient motion (n = 122 [31%]), modified protocols mislabeled as “routine” (n = 69 [18%]), higher dose examinations for patients with large body habitus (n = 27 [7%]), repeat examinations due to technical artifacts (n = 20 [5%]), and repeat examinations due to suboptimal contrast timing (CTPA examinations) (n = 18 [5%]). Root causes for low-outlier examinations included low-dose protocols (n = 112 [29%]) and aborted examinations (n = 8 [2%]). On the basis of examination frequency over a 3-month period, the 90th and 10th percentile values were set in the radiation dose index monitoring database as thresholds for sending notifications to staff members responsible for outlier investigations.ConclusionsSystematic RCA of dose outliers identifies sources of variation and dose excess and pinpoints specific protocol and technical shortcomings for corrective action.     

A Comprehensive CT Radiation Dose Reduction and Protocol Standardization Program in a Complex,Tertiary Hospital System

PurposeTo present our experience in reducing CT radiation doses in a complex tertiary health system through CT protocol standardization and optimization.MethodsA CT radiation task force was created to reduce CT protocol heterogeneity and radiation doses. Redundant protocols were eliminated. By an iterative process, protocols with least radiation dose were identified. Radiation dose tracking software was used to store and analyze radiation doses. CT protocols were published in an intranet site after training of technologists. SOPs were established for maintaining and changing protocols. The radiation doses for each CT protocol before and after optimization were compared using geometric means.ResultsA total of 222 CT protocols were reviewed, with elimination of 86 protocols. One-year follow-up showed homogeneous protocols with lower radiation doses. The improvement in radiation doses ranged from 23% to 58% (P< 0.001).ConclusionCT radiation dose reduction of up to 58% can be achieved by homogenizing and optimizing CT protocols through a comprehensive CT operations program.     

Iterative reconstruction and automatic tube voltage selection reduce clinical CT radiation doses and image noise

IntroductionComputed Tomography (CT) use has increased in recent years with trends indicating increasing population doses as a result. Optimization of clinical radiation doses through technological developments has demonstrated potential to reduce patient dose from CT. This study aimed to quantify these dose reductions across a large clinical cohort.MethodsPatient cohort was divided into three groups, assigned by CT optimisation technique. Group one underwent scanning with automated tube current modulation only. Group two underwent scanning with automated tube current modulation and iterative reconstruction and group three underwent scanning with automated tube current modulation, iterative reconstruction and automatic tube voltage modulation. Patient dose length product doses were retrospectively collected for the three groups. Clinical radiation doses between the groups were compared for four common CT examinations (Brain, pulmonary angiography, abdomen and thorax abdomen pelvis scans).ResultsOf 4011 patients, group one comprised of 1643 patients (40.96%), group two 1077 patients (26.85%) and group three 1291 patients (32.19%). No differences were found when comparing AP diameter between groups (p ≥ 0.05). Statistically significant dose reductions of 16–31% were achieved using iterative reconstruction alone (p = 0.001) and 24–42% with both iterative reconstruction and automatic tube voltage selection (p = 0.001). Objective noise improved when iterative reconstruction was used (p < 0.05).ConclusionThe application of optimization software confers significant dose savings during routine clinical CT examinations. Figures are based on a large clinical cohort, with equipment, staff and procedural protocols remaining consistent throughout. Dose reductions are likely to reflect the clinical dose reducing potential of the optimization software investigated.     

Organizational Factors and Quality Improvement Strategies Associated With Lower Radiation Dose From CT Examinations

PurposeThe aim of this study was to identify organizational factors and quality improvement strategies associated with lower radiation doses from abdominal CT.MethodsCross-sectional survey was administered to radiology leaders, along with simultaneous measurement of CT radiation dose among 19 health care organizations with 100 imaging centers throughout the United States, Europe, and Japan, using a common dose management software system. After adjusting for patient age, gender, and size, quality improvement strategies were tested for association with mean abdominal CT radiation dose and the odds of a high-dose examination.ResultsCompleted surveys were received from 90 imaging centers (90%), and 182,415 abdominal CT scans were collected during the study period. Radiation doses varied considerably across organizations and centers. Univariate analyses identified eight strategies and systems that were significantly associated with lower average doses or lower frequency of high doses for abdominal CT examinations: tracking patient safety measures, assessing the impact of CT changes, identifying areas for improvement, setting specific goals, organizing improvement teams, tailoring decisions to sites, testing process changes before full implementation, and standardizing workflow. These processes were associated with an 18% to 37% reduction in high-dose examinations (P < .001-.03). In multivariate analysis, having a tracking system for patient safety measures, supportive radiology leaders, and obtaining clear images were associated with a 47% reduction in high-dose examinations.ConclusionsThis documentation of the relation between quality improvement strategies and radiation exposure from CT examinations has identified important information for others interested in reducing the radiation exposure of their patients.     

Radiation Dose Reduction in Kidney Stone CT: A Randomized,Facility-Based Intervention

ObjectiveKidney stones are common, tend to recur, and afflict a young population. Despite evidence and recommendations, adoption of reduced-radiation dose CT (RDCT) for kidney stone CT (KSCT) is slow. We sought to design and test an intervention to improve adoption of RDCT protocols for KSCT using a randomized facility-based intervention.MethodsFacilities contributing at least 40 KSCTs to the American College of Radiology dose index registry (DIR) during calendar year 2015 were randomized to intervention or control groups. The Dose Optimization for Stone Evaluation intervention included customized CME modules, personalized consultation, and protocol recommendations for RDCT. Dose length product (DLP) of all KSCTs was recorded at baseline (2015) and compared with 2017, 2018, and 2019. Change in mean DLP was compared between facilities that participated (intervened-on), facilities randomized to intervention that did not participate (intervened-off), and control facilities. Difference-in-difference between intervened-on and control facilities is reported before and after intervention.ResultsOf 314 eligible facilities, 155 were randomized to intervention and 159 to control. There were 25 intervened-on facilities, 71 intervened-off facilities, and 96 control facilities. From 2015 to 2017, there was a drop of 110 mGy ∙ cm (a 16% reduction) in the mean DLP in the intervened-on group, which was significantly lower compared with the control group (P < .05). The proportion of RDCTs increased for each year in the intervened-on group relative to the other groups for all 3 years (P < .01).DiscussionThe Dose Optimization for Stone Evaluation intervention resulted in a significant (P < .05) and persistent reduction in mean radiation doses for engaged facilities performing KSCTs.     

CT Dose Reduction Workshop: An Active Educational Experience

PurposeImproving patient safety by minimizing CT radiation dose, while maintaining diagnostic image quality, has become an important skill in diagnostic radiology. The aim of this study was to examine the value of an educational workshop for optimizing CT protocols in an academic department, and to assess its impact on resident education.MethodsThe CT Dose Reduction Workshop met monthly for 1 year, to teach and implement dose reduction strategies. Changes were made to CT protocols through group consensus while participants kept up to date with current literature. A survey was sent to 48 radiology residents and 32 attending radiologists in the department, including both participants and nonparticipants, after completion of the workshop, to assess its utility. The survey used a 5-point Likert-type scale. Average doses for a specific CT protocol before and after the workshop were compared.ResultsAbout 80% of respondents agreed or strongly agreed that the workshop was essential. Workshop participants expressed greater confidence in their knowledge of dose reduction techniques, with a mean score of 3.74 (95% confidence interval, 3.35-4.13), compared with nonparticipants, who had a mean score of 3.00 (95% confidence interval, 2.64-3.36) (P < .01). Dose reductions were established across numerous CT protocols. For instance, the average total dose-length product in renal mass protocol CT examinations decreased by 54% (P < .0001).ConclusionsA CT dose reduction workshop increases participants’ confidence in knowledge of dose reduction techniques, fosters a culture of safety and quality improvement in the department, and reduces radiation dose to patients.     

Patient dose from CT: a literature review

CONTEXT: Computed tomography (CT) exams are increasingly common and account for a significant portion of individuals' mounting exposure to medical radiation. OBJECTIVE: To explore issues surrounding patient radiation dose, including techniques for minimizing dose and the feasibility of tracking lifetime exposure to medical radiation from CT and other imaging exams. METHODS: The authors conducted a review of the recent literature to assess current knowledge of dose levels, protocols for minimizing patient dose and possible systems for tracking cumulative dose. RESULTS: Currently, no regulations are in place to track cumulative patient radiation dose. However, the authors discuss possible means of recording, tracking and storing this data, such as standardizing its inclusion in DICOM headers and transmitting it to electronic personal health records. CONCLUSION: More research is needed to develop and implement uniform dose tracking procedures and protocols for minimizing patient dose.     

Radiation dose differences between thoracic radiotherapy planning CT and thoracic diagnostic CT scans

PurposeTo compare the absorbed dose from computed tomography (CT) in radiotherapy planning (RP-CT) against those from diagnostic CT (DG-CT) examinations and to explore the possible reasons for any dose differences.MethodTwo groups of patients underwent CT-scans of the thorax with either DG-CT (n = 55) or RP-CT (n = 55). Patients from each group had similar weight and body mass index (BMI) and were divided into low (<25) and high BMI (>25). Parameters including CTDIvol, DLP and scan-length were compared.ResultsThe mean CTDIvol and DLP values from RP-CT (38.1 mGy, 1472 mGy cm) are approximately four times higher than for DG-CT (9.63 mGy, 376.5 mGy cm). For low BMI group, the CTDIvol in the RP-CT scans (36.4 mGy) is 6.3 times higher than the one in the DG-CT scans (5.8 mGy). For the high BMI group, the CTDIvol in the RP-CT (39.6 mGy) is 2.5 times higher than the one in the DG-CT scans (15.8 mGy). In the DG-CT scans a strong negative linear correlation between noise index (NI) and mean CTDIvol was observed (r = −0.954, p = 0.004); the higher NI, the lower CTDIvol. This was not the case in the RP-CT scans.ConclusionThe absorbed radiation dose is significantly higher and less BMI dependent for RP-CT scans compared to DG-CT. Image quality requirements of the examinations should be researched to ensure that radiation doses are not unnecessarily high.     

Computed tomography diagnostic reference levels for adult brain,chest and abdominal examinations: A systematic review

ObjectivesRadiation dose variation within and among Computed Tomography (CT) centres is commonly reported. This work systematically reviewed published articles on adult Diagnostic Reference Levels (DRLs) for the brain, chest and abdomen to determine the causes and extent of variation. A systematic literature search and review was performed in selected databases containing leading journals in radiography, radiology and medical physics using carefully defined search terms related to CT and DRLs. The quality of the included articles was determined using the Effective Public Health Practise Project tool for quantitative studies.Key findingsThe 54 articles reviewed include: 45 studies using human data, 8 studies using phantom data, and one study with both human and phantom data. The main comparator in between studies was the dose indices used in reporting DRLs. DRL variations of up to a factor of 2 for the same procedure were noted in phantom studies, and up to a factor of 3 in human studies. Sources of variation include the type of scanner, the age of the scanner, differences in protocols, variations in patients, as well as variations in study design. Different combinations of dose indices were reported: volume computed tomography dose index (CTDIvol) and dose length product (DLP) (59%); DLP only (11%); weighted computed tomography dose index (CTDIw) and DLP (9%); CTDIvol only (7%); CTDIvol, DLP and effective dose (ED) (6%); CTDIw only (4%); CTDIvol, DLP and size specific dose estimate (SSDE) (1%) and CTDIw, CTDIvol and DLP (1%). The use of different dose indices limited dose comparison between studies.ConclusionThe study noted a 2–3 fold variation in DRLs between studies for the same procedure. The causes of variation are reported and include study design, scanner technology and the use of different dose indices.Implications for practiceThere is a need for standardisation of CT DRLs in line with the International Commission on Radiological Protection recommendations to reduce dose variation and facilitate dose comparison.     

Optimal abdominal CT protocol for obese patients

IntroductionThis study investigated the impact of different protocols on radiation dose and image quality for obese patients undergoing abdominal CT examinations.MethodsFive abdominal/pelvis CT protocols employed across three scanners from a single manufacturer in a single centre used a variety of parameters (kV: 100/120, reference mAs: 150/190/218/250/300, image reconstruction: filtered back projection (FBP)/iterative (IR)). The routine protocol employed 300 reference mAs and 120 kV. Data sets resulting from obese patient examinations (n = 42) were assessed for image quality using visual grading analysis by three experienced radiologists. Objective assessment (noise, signal/contrast-noise ratios) and radiation dose was compared to determine optimal protocols for prospective testing on a further sample of patients (n = 47) for scanners using FBP and IR techniques.ResultsCompared to the routine protocol, mean radiation dose was reduced by 60% when using 100 kV and SAFIRE technique strength 3 (p = 0.001). Reduction of up to 30% in radiation dose was noted for the FBP protocol: 120 kV and 190 reference mAs (p = 0.008). Subjective and objective image quality for both protocols were comparable to that of the routine protocol (p > 0.05). An overall improvement in image quality with increasing strength of SAFIRE was noted. Upon clinical implementation of the optimal dose protocols, local radiology consensus deemed image quality to be acceptable for the participating obese patient cohort.ConclusionRadiation dose for obese patients can be optimised whilst maintaining image quality. Where iterative reconstruction is available relatively low kV and quality reference mAs are also viable for imaging obese patients at 30–60% lower radiation doses.     

Evaluation of Radiation Exposure of Medical Staff During CT-Guided Interventions

PurposeThe purpose of this prospective study was to investigate absolute radiation exposure values and factors that influence radiation exposure of interventionists during CT-guided interventions (CTGIs). To our knowledge, no data exist regarding the radiation dose to which the interventionist is exposed during these procedures.MethodsAbsolute radiation dose values from a total of 131 CTGIs were analyzed. Radiation dose values were collected by thermoluminescent dosimeters that were positioned above the lead protection being worn, on the forehead, thyroid, chest, gonads, and right and left hand and foot.The radiation doses were analyzed with respect to the experience level of the person performing the procedure, the degree of difficulty measured on a 4-point Likert scale, the lesion size measured on a 3-point Likert scale, and the CT system used.ResultsMedian whole-body dose was 12 μSv. With the exception of the forehead, all whole-body radiation doses were statistically significantly lower in CTGIs performed using the modern dual-source CT system compared with the 16-slice multi-detector CT. For CTGIs rated as more complex, the radiation exposure of the radiologist performing the procedure was statistically significantly higher, with the exception of the left hand. A statistically significantly lower median whole-body dose was measured for inexperienced compared with experienced radiologists. However, a few dose measurements of more than 1 mSv were found at the right hand.ConclusionsRadiation exposure measured during CTGIs is low (<50 μSv). Because the radiation dose was higher in more-complex interventions and for 16-slice multi-detector row CT, inexperienced radiologists should focus on less-complex procedures.     

移动CT头部扫描辐射剂量场的空间分布

目的 初步探究移动CT在进行头部扫描时产生的杂散辐射在空间中的分布,以期为移动CT的辐射防护提供科学依据。方法 选择CareTom移动式多排CT头部序列进行单次扫描,用TLD（LiF：Mg,Cu,P）型热释光探测器测得辐射剂量值,并用Matlab软件绘制出辐射剂量场的空间分布。结果 移动CT前方的辐射剂量稍高于后方,周围空间辐射剂量场则大致呈从前向后的“倒三角”形分布。最大数值出现在中心水平层面,移动CT正前方距离扫描孔中心最近的测量点（距中心0.5 m）,为0.255 mGy。结论 移动CT头部扫描产生的杂散辐射剂量较低,但为了避免长期低剂量辐射的损伤,检查技师和其他医护人员应尽量站在移动CT机的侧面和后方2 m以外的地方,并在扫描时尽可能地配置放射防护装备。     

腹部CT低剂量扫描自动管电流调制技术的应用价值

 目的 探讨自动管电流调制技术(automatic tube current modulation, ATCM)对腹部CT图像质量及辐射剂量的影响。方法 随机抽取2018-09至2019-09部队查体时180名官兵,分成对照组40名,采用固定管电流400 mA进行CT扫描;实验组140名,采用ATCM进行CT扫描。分别记录两组扫描方案的辐射剂量指标:容积CT剂量指数(volumetric CT dose index, CTDIvol)、剂量长度积(dose length product, DLP)、个体化剂量估计值(size specific dose estimates, SSDE)、有效剂量(effective dose, ED)。此外,测量各组图像中阑尾、腰大肌及皮下脂肪CT值,计算得到图像质量客观评价指标:同层皮下脂肪CT值标准差(standard deviation, SD)、阑尾和腰大肌信噪比(signal to noise ratio, SNR)。由两名从事影像诊断工作15年以上医师对两组图像资料进行主观评价并记录评分。对两组辐射剂量、图像质量的比较使用单因素方差分析;对NI值与CTDIvol、DLP的相关性采用Pearson相关分析。2位影像科医师对各组CT图像质量评分的一致性分析使用Kappa检验。结果 两组CTDIvol_m、DLP_m、SSDE_m、ED_m的检验值F分别为3.14、8.75、1.82、7.34,差异有统计学意义(P<0.05),实验组较对照组有明显辐射剂量下降;图像质量有一定程度的下降,两组SD、SNR_A、SNR_PM的统计学检验值F分别为1.22、2.93、5.38,差异有统计学意义(P<0.05)。两组图像评分对比检验值F=1.34,P=0.176,差异无统计学意义;NI值与CTDIvol、DLP成呈显著性负相关(r=-0.919,P<0.05);2名影像科医师对CT图像评分具有较强的一致性(Kappa=0.675)。结论 ATCM扫描对腹部CT检查诊断效果可靠,且可大幅度降低辐射剂量,建议推广。     

MSCT低剂量扫描技术在踝关节隐匿性骨折中的应用

目的:探讨64层CT低剂量扫描技术在踝关节隐匿性骨折中的应用。方法:68例常规X线检查阴性、临床高度怀疑骨折的患者行64层CT低剂量扫描和常规剂量扫描,并行MPR、VR后处理,比较2组扫描图像质量、诊断准确率及辐射剂量。结果:低剂量组与常规剂量组相比,CT图像质量及对踝关节隐匿性骨折的诊断准确率差异无统计学意义(P>0.05)。低剂量组辐射剂量较常规剂量明显下降,CT容积剂量指数和剂量长度乘积均降低了56%左右。结论:踝关节低剂量CT扫描能准确诊断踝关节隐匿性骨折,同时降低了患者的辐射剂量,完全能够取代常规剂量扫描。     

Estimating cancer induction risk from abdominopelvic scanning with 6- and 16-slice computed tomography

Purpose: The biological effects of ionizing radiation (BEIR VII) report estimates that the risk of getting cancer from radiation is increased by about a third from current regulation risk levels. The propose of this study was to estimate cancer induction risk from abdominopelvic computed tomography (CT) scanning of adult patients using 6- and 16-slice CT scanners.

Materials and methods: A cross-sectional study on 200 patients with abdominopelvic CT scan in 6- and 16-slice scanners was conducted. The dose-length product (DLP) and volume CT Dose Index (CTDI_vol) values from the scanners as well as the effective dose values from the ImPACT CT patient dosimetry calculator with the biological effects of ionizing radiation (BEIR VII) method were used to estimate the cancer induction risk.

Results: The mean (and standard deviation) values of CTDI_vol and DLP were 6.9 (±1.07) mGy and 306.44 (±?60.57) mGy.cm for 6-slice, and 5.19 (±0.91) mGy and 219.7 (±49.31) mGy.cm for 16-slice scanner, respectively. The range of effective dose in the 6-slice scanner was 2.61–8.15 mSv and, in the 16-slice scanner, it was 1.47–4.72 mSv. The mean and standard deviation values of total cancer induction risk in abdominopelvic examinations were 0.136?±?0.059% for men and 0.135?±?0.063% for women in the 6-slice CT scanner. The values were 0.126?±?0.051% for men and 0.127?±?0.056% for women in the 16-slice scanner.

Conclusions: The cancer induction risk of abdominopelvic scanning was noticeable. Therefore, radiation dose should be minimized by optimizing the protocols and applying appropriate methods.     

Reduction of radiation dose estimates in cardiac 64-slice CT angiography in patients after coronary artery bypass graft surgery

OBJECTIVES: The objectives of this prospective investigation in patients after bypass graft surgery were (1) to estimate radiation dose for routine bypass graft computed tomography (CT) angiography, (2) to study the impact of anatomically adapted and ECG-controlled tube current modulation on radiation dose estimates, and (3) effects on qualitative and quantitative image quality parameters. METHODS: Radiation dose was estimated for 194 consecutive patients undergoing 64-slice CT angiography (Somatom Sensation 64 Cardiac, Siemens Medical Solutions). The impact of anatomically adapted tube current modulation was studied in 2 consecutive patients groups. Furthermore, the impact of ECG-controlled tube current modulation, applied as indicated, was evaluated in both groups. RESULTS: Mean radiation dose estimate for a 64-slice CT bypass graft study was 18.9 +/- 6.0 mSv (CTDIvol 42.3 +/- 12.9 mGy). The application of anatomically adapted tube current modulation had no effect on dose parameters (CTDIvol 43.3 +/- 13.2 vs. 40.1 +/- 12.1 mGy for those with versus those without anatomically adapted tube current modulation, P = 0.1). Additional implementation of ECG-controlled tube current modulation resulted in reduced dose parameters (CTDIvol of 32.9 +/- 2.6 vs. 58.9 +/- 3.9 mGy and radiation dose estimates: 14.7 +/- 1.9 mSv vs. 26.5 +/- 2.1 mSv for those with versus those without ECG pulsing, both P < 0.01). There was no deterioration in image quality with use of tube current modulation algorithms. CONCLUSIONS: The radiation burden associated with 64-slice bypass graft CT angiographies is substantial. Anatomically adapted tube current modulation does not reduce radiation dose parameters, whereas ECG-controlled tube current modulation was associated with a 45% reduction in dose estimates. Application of both tube current modulation algorithms did not result in reduced image quality.     

Low-dose dental computed tomography: significant dose reduction without loss of image quality

Purpose: To measure and reduce the patient dose during computed tomography (CT) for dental applications. Material and Methods: Lithium fluoride thermoluminescent dosimeters were implanted in a tissue-equivalent humanoid phantom (Alderson-Rando-Phantom) to determine doses to the thyroid gland, the active bone marrow, the salivary glands, and the eye lens. Dental CT was performed with spiral CT and a dental software package. The usual dental CT technique was compared with a new dose-reduced protocol, which delivered best image quality at lowest possible radiation dose, as tested in a preceding study. Image quality was analysed using a human anatomic head preparation. In addition, the radiation dose was compared with panoramic radiography and digital volume tomography (DVT). Eight radiologists evaluated all images in a blinded fashion. A Wilcoxon rank pair test was used for statistical evaluation. Results: Radiation dose could be reduced by a factor of 9 (max.) with the new dose-reduced protocol (e.g. bone marrow dose from 23.6 mSv to 2.9 mSv; eye lens from 0.5 mSv to 0.3 mSv; thyroid gland from 2.5 mSv to 0.5 mSv; parotid glands from 2.3 mSv to 0.4 mSv). Dose reduction did not reduce image quality or diagnostic information. Conclusion: A considerable dose reduction without loss of diagnostic information is achievable in dental CT. As radiation exposure of the presented low-dose protocol is expected to be in the same range as DVT, low-dose dental CT might be superior to DVT, because CT can be used to evaluate soft tissues as well.     

Optimizing radiation exposure in screening of body packing: image quality and diagnostic acceptability of an 80 kVp protocol with automated tube current modulation

The aim of this study was to evaluate the objective and subjective image quality of a novel computed tomography (CT) protocol with reduced radiation dose for body packing with 80 kVp and automated tube current modulation (ATCM) compared to a standard body packing CT protocol. 80 individuals who were examined between March 2012 and July 2015 in suspicion of ingested drug packets were retrospectively included in this study. Thirty-one CT examinations were performed using ATCM and a fixed tube voltage of 80 kVp (group A). Forty-nine CT examinations were performed using a standard protocol with a tube voltage of 120 kVp and a fixed tube current time product of 40 mAs (group B). Subjective and objective image quality and visibility of drug packets were assessed. Radiation exposure of both protocols was compared. Contrast-to-noise ratio (group A: 0.56 ± 0.36; group B: 1.13 ± 0.91) and Signal-to-noise ratio (group A: 3.69 ± 0.98; group B: 7.08 ± 2.67) were significantly lower for group A compared to group B (p < 0.001). Subjectively, image quality was decreased for group A compared to group B (2.5 ± 0.8 vs. 1.2 ± 0.4; p < 0.001). Attenuation of body packets was higher with the new protocol (group A: 362.2 ± 70.3 Hounsfield Units (HU); group B: 210.6 ± 60.2 HU; p = 0.005). Volumetric Computed Tomography Dose Index (CTDIvol) and Dose Length Product (DLP) were significantly lower in group A (CTDIvol 2.2 ± 0.9 mGy, DLP 105.7 ± 52.3 mGycm) as compared to group B (CTDIvol 2.7 ± 0.1 mGy, DLP 126.0 ± 9.7 mGycm, p = 0.002 and p = 0.01). The novel 80 kVp CT protocol with ATCM leads to a significant dose reduction compared to a standard CT body packing protocol. The novel protocol led to a diagnostic image quality and cocaine body packets were reliably detected due to the high attenuation.