Scanning beyond anatomic limits of the thorax in chest CT: findings, radiation dose, and automatic tube current modulation.

OBJECTIVE Our objective was to determine additional radiation dose associated with scanning beyond the anatomic limits of the thorax in chest CT protocol and to assess the effect of z-axis modulation on the additional radiation dose associated with the scanning protocol. MATERIALS AND METHODS "Extra" images for routine chest CT were defined as those above lung apices (supraapical) and those caudal to the lowermost portion of lung parenchyma (infrapulmonary), including images obtained beyond the adrenal glands (infraadrenal). One hundred and forty-eight consecutive chest CT examinations (70 men, 78 women; age range, 15-90 years) performed September 13-25, 2003, were reviewed to determine the number of supraapical, infrapulmonary, and infraadrenal extra images. All examinations were performed using z-axis modulation (n = 70) or fixed tube current (n = 78). The CT dose index volume and dose-length product (DLP) values for the extra images were calculated. Two radiologists reviewed these extra images for pathologic findings. Student's t test was used to perform the statistical analysis. RESULTS One hundred forty-four (97%) examinations had supraapical extra images and 145 (98%) had infrapulmonary extra images. A total of 31 additional findings were observed in extra images. Most clinically important findings were identified in patients with a history of malignancy. With z-axis modulation, the mean DLP for supraapical and infrapulmonary extra images was 39.98 mGy x cm and 132.59 mGy x cm, respectively. With fixed tube current, the mean DLP for supraapical and infrapulmonary extra images was 30.31 mGy x cm and 95.91 mGy x cm, respectively. CONCLUSION A substantial number of extra images are acquired during chest CT that do not add clinically important information in patients with nonmalignant indications. The use of z-axis modulation increased radiation dose for the extra images.

[1]  B. Yankaskas,et al.  Sensitivity and specificity of computed tomography for the detection of adrenal metastatic lesions among 91 autopsied lung cancer patients , 1990, Cancer.

[2]  Ulrich Baum,et al.  Dose reduction in CT examination of children by an attenuation-based on-line modulation of tube current (CARE Dose) , 2002, European Radiology.

[3]  TNM staging in lung cancer: role of computed tomography. , 1982 .

[4]  P. Gevenois,et al.  Dose reduction in multidetector CT using attenuation-based online tube current modulation. , 2003, AJR. American journal of roentgenology.

[5]  James H Thrall,et al.  Clinical comparison of standard-dose and 50% reduced-dose abdominal CT: effect on image quality. , 2002, AJR. American journal of roentgenology.

[6]  M. Kalra,et al.  Techniques and applications of automatic tube current modulation for CT. , 2004, Radiology.

[7]  M. Kalra,et al.  Strategies for CT radiation dose optimization. , 2004, Radiology.

[8]  C A Kelsey,et al.  CT scanning: patterns of use and dose , 2000, Journal of radiological protection : official journal of the Society for Radiological Protection.

[9]  G. Starck,et al.  A method to obtain the same levels of CT image noise for patients of various sizes, to minimize radiation dose. , 2002, The British journal of radiology.

[10]  M. Bernardino,et al.  Isolated adrenal masses in nonsmall-cell bronchogenic carcinoma. , 1984, Radiology.

[11]  Thomas L Toth,et al.  Can noise reduction filters improve low-radiation-dose chest CT images? Pilot study. , 2003, Radiology.

[12]  H. Greess,et al.  Dose reduction in computed tomography by attenuation-based on-line modulation of tube current: evaluation of six anatomical regions , 2000, European Radiology.