小林 正尚

This study aimed to assess fetal radiation exposure in pregnant women undergoing computed tomography (CT) and rotational angiography (RA) examinations for the diagnosis of pelvic trauma. In addition, this study aimed to compare the dose distributions between the two examinations. Surface and average fetal doses were estimated during CT and RA examinations using a pregnant phantom model and real-time dosemeters. The pregnant model phantom was constructed using an anthropomorphic phantom, and a custom-made abdominal phantom was used to simulate pregnancy. The total average fetal dose received by pregnant women from both CT scans (plain, arterial and equilibrium phases) and a single RA examination was ~60 mGy. Because unnecessary repetition of radiographic examinations, such as CT or conventional 2D angiography can increase the radiation risk, the irradiation range should be limited, if necessary, to reduce overall radiation exposure.

This study evaluated the validity of pharyngeal 2D area measurements acquired from the lateral view for predicting the actual 3D volume in healthy adults during swallowing. Seventy-five healthy adults (39 females, 36 males; mean age 51.3 years) were examined using 320-row area detector computed tomography (320-ADCT). All participants swallowed a 10 mL honey-thick barium bolus upon command while seated in a 45° semi-reclining position. Multi-planar reconstruction images and dynamic 3D-CT images were obtained using Aquilion ONE software. Pharyngeal 2D area and 3D volume measurements were taken before swallowing and at the frame depicting maximum pharyngeal constriction. Pharyngeal volume before swallowing (PVhold) was accurately predicted by 2D area (R2 = 0.816). Adding height and sex to the model increased R2 to 0.836. Regarding pharyngeal volume during maximum constriction (PVmax), 2D area also exhibited acceptable predictive power (R2 = 0.777). However, analysis of statistical residuals and outliers revealed a greater tendency for prediction errors when there is less complete constriction of the pharynx as well as asymmetry in bolus flow or movement. Findings highlight the importance of routinely incorporating anterior-posterior views during VFSS exams. Future work is needed to determine clinical utility of pharyngeal volume measurements derived from 320-ADCT.

PURPOSE: Organ dose evaluation is important for optimizing cone beam computed tomography (CBCT) scan protocols. However, an evaluation method for various CBCT scanners is yet to be established. In this study, we developed scanner-independent conversion coefficients to estimate organ doses using appropriate peak dose (f(0)) indices. METHODS: This study included various scanners (angiography scanners and linear accelerators) and protocols for the head and body (thorax, abdomen, and pelvis) scan regions. f(0) was measured at five conventional positions (center position (f(0)c) and four peripheral positions (f(0)p) at 90° intervals) in the CT dose index (CTDI) phantom. To identify appropriate measurement positions for organ dose estimation, various f(0) indices were considered. Organ doses were measured by using optically stimulated luminescence dosimeters positioned in an anthropomorphic phantom. Thereafter, the conversion coefficients were calculated from each obtained f(0) value and organ or tissue dose using a linear fit for all scanners, and the coefficient of variation (CV) of the conversion coefficients was calculated for each organ or tissue. The f(0) index with the minimum CV value was proposed as the appropriate index. RESULTS: The appropriate f(0) index was determined as f(0)c for the body region and a maximum of four f(0)p values for the head region. Using the proposed conversion coefficients based on the appropriate f(0) index, the organ/tissue doses were well estimated with a mean error of 14.2% across all scanners and scan regions. CONCLUSIONS: The proposed scanner-independent coefficients are useful for organ dose evaluation using CBCT scanners.

Abstract During fetal computed tomography (CT) imaging, because of differences in the pregnancy period and scanning conditions, different doses of radiation are absorbed by the fetus. We propose a correction coefficient for determining the fetal size-specific dose estimate (SSDE) from the CT dose index (CTDI) displayed on the console at tube voltages of 80–135 kVp. The CTDIs corresponding to pregnant women and fetuses were evaluated using a Monte Carlo (MC) simulation, and the ratio of these CTDIs was defined as the Fetus-factor. When the effective diameter of a fetus was approximately 10 cm, the Fetus-factor was 1.0. The estimated pregnant SSDE was multiplied by the Fetus-factor to estimate the fetal SSDE, which was compared with the fetal dose obtained by the MC simulation of the image of the fetal CT examination. The fetal dose could be estimated with an error of 31.5% in fetal examinations conducted using helical CT.

To develop a convolutional neural network-based method for the subjective evaluation of computed tomography (CT) images having low-contrast resolution due to imaging conditions and nonlinear image processing. Four radiological technologists visually evaluated CT images that were reconstructed using three nonlinear noise reduction processes (AIDR 3D, AIDR 3D Enhanced, AiCE) on a CT system manufactured by CANON. The visual evaluation consisted of two items: low contrast detectability (score: 0-9) and texture pattern (score: 1-5). Four AI models with different convolutional and max pooling layers were constructed and trained on pairs of CANON CT images and average visual assessment scores of four radiological technologists. CANON CT images not used for training were used to evaluate prediction performance. In addition, CT images scanned with a SIEMENS CT system were input to each AI model for external validation. The mean absolute error and correlation coefficients were used as evaluation metrics. Our proposed AI model can evaluate low-contrast detectability and texture patterns with high accuracy, which varies with the dose administered and the nonlinear noise reduction process. The proposed AI model is also expected to be suitable for upcoming reconstruction algorithms that will be released in the future.

Objective: Some patients with cleft palate (CP) need secondary surgery to improve functionality. Although 4-dimensional assessment of velopharyngeal closure function (VPF) in patients with CP using computed tomography (CT) has been existed, the knowledge about quantitative evaluation and radiation exposure dose is limited. We performed a qualitative and quantitative assessment of VPF using CT and estimated the exposure doses. Design: Cross-sectional. Setting: Computed tomography images from 5 preoperative patients with submucous CP (SMCP) and 10 postoperative patients with a history of CP (8 boys and 7 girls, aged 4-7 years) were evaluated. Patients: Five patients had undergone primary surgery for SMCP; 10 received secondary surgery for hypernasality. Main Outcome Measures: The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area (CSA) of VPI was evaluated via CT findings. Organ-absorbed radiation doses were estimated in 5 of 15 patients. The differences between cleft type and VPI, VPC patterns, and CSA of VPI were evaluated. Results: All patients had VPI. The VPC patterns (SMCP/CP) were evaluated as coronal (1/4), sagittal (0/1), circular (1/2), and circular with Passavant’s ridge (2/2); 2 patients (1/1) were unevaluable because of poor VPF. The CSA of VPI was statistically larger in the SMCP group ( P = .0027). The organ-absorbed radiation doses were relatively lower than those previously reported. Conclusions: Four-dimensional CT can provide the detailed findings of VPF that are not possible with conventional CT, and the exposure dose was considered medically acceptable.

This study aimed to compare the dose and noise level of four tube voltages in abdominal computerized tomography (CT) examinations in different abdominal circumference sizes of pregnant women. Fetal radiation doses were measured with two anthropomorphic pregnant phantoms and real-time dosimeters of photoluminescence sensors using four tube voltages for abdominal CT. The noise level was measured at the abdomen of two anthropomorphic pregnant phantoms. In the large pregnant phantom, the mean fetal doses performed using 120 and 135 kV were statistically significantly lower than the lower tube voltages (P < 0.05). In the small pregnant phantom, the mean fetal dose performed by 100, 120, and 135 kV was significantly lower than the lowest tube voltage tested (P < 0.05). The ratios of the peripheral mean dose to the centric mean dose showed that the ratios of 80 kV were the highest and those for 135 kV were the lowest in both pregnant phantoms. The ratios of the peripheral mean dose to the centric mean dose decreased as the tube voltage increased. Compared with low tube voltages, high tube voltages such as 120 and 135 kV could reduce radiation doses to the fetus without compromising the image uniformity in abdominal CT examinations during pregnancy. On low tube voltage protocols, the dose near the maternal skin surface may be increased in large pregnant women because of reduced penetration of the x rays.

PURPOSE: The conventional weighted computed tomography dose index (CTDIw) may not be suitable for cone-beam computed tomography (CBCT) dosimetry because a cross-sectional dose distribution is angularly inhomogeneous owing to partial angle irradiations. This study was conducted to develop a new dose metric (f(0)CBw) for CBCT dosimetry to determine a more accurate average dose in the central cross-sectional plane of a cylindrical phantom using Monte Carlo simulations. METHODS: First, cross-sectional dose distributions of cylindrical polymethyl methacrylate phantoms over a wide range of phantom diameters (8-40 cm) were calculated for various CBCT scan protocols. Then, by obtaining linear least-squares fits of the full datasets of the cross-sectional dose distributions, the optimal radial positions, which represented measurement positions for the average phantom dose, were determined. Finally, the f(0)CBw method was developed by averaging point doses at the optimal radial positions of the phantoms. To demonstrate its validity, the relative differences between the average doses and each dose index value were estimated for the devised f(0)CBw, conventional CTDIw, and Haba's CTDIw methods, respectively. RESULTS: The relative differences between the average doses and each dose index value were within 4.1%, 16.7%, and 11.9% for the devised, conventional CTDIw, and Haba's CTDIw methods, respectively. CONCLUSIONS: The devised f(0)CBw value was calculated by averaging four "point doses" at 90° intervals and the optimal radial positions of the cylindrical phantom. The devised method can estimate the average dose more accurately than the previously developed CTDIw methods for CBCT dosimetry.

<title>Abstract</title> Background The aims of this study were to perform a four-dimensional assessment of velopharyngeal closure function in pediatric patients with cleft palate using 320-row area detector computed tomography (CT), and to estimate the organ-absorbed doses using Monte Carlo simulation. Methods We evaluated CT image data obtained between July 2018 and August 2019 from five pediatric patients with cleft palate (four boys and one girl; age range, 4–7 years) at Fujita Health University Hospital. The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area of VPI were evaluated. In addition, organ-absorbed doses were assumed in the Monte Carlo simulation. However, we did not perform statistical analysis because of the insufficient number of patients enrolled in this study. Results The existence of VPI and hypernasality were completely concordant. The VPC patterns were circular (two patients), circular with Passavant’s ridge (one patient), and unevaluable (two patients). The organ-absorbed doses were relatively lower than those in past reports. Conclusions Our method could be an alternative for patients who refuse the conventional nasopharyngoscopic evaluation.

Diagnostic reference levels (DRLs 2015) in Japan were first published in 2017, on the Japan Network for Research and Information on Medical Exposures network. Medical facilities in Japan are now presumably reconsidering radiation doses at their facilities and approaching protection optimisation through the application of DRLs 2015. However, since more than 3 years have elapsed since publication, radiation doses received by patients in Japan may have diverged from DRLs 2015. We therefore undertook the present study. Based on our questionnaire survey implemented in 2017, we estimated the entrance skin dose (ESD) under general radiography fields and the mean glandular dose (MGD) under mammography, to compile a report on the doses received by patients under general radiography fields and mammography, and to propose new DRLs as replacements for DRLs 2015. Radiation doses under general radiography fields and mammography were estimated from the results of the 2017 questionnaire survey and applied to determine new DRLs at 75% values of dose distributions in general radiography fields and at 95% values of dose distributions in mammography. Among all the modes for general radiography fields and mammography, median ESD and MGD were significantly smaller with flat panel detector systems than with computed radiography systems. Comparison of the results with DRLs 2015 values showed a trend toward decreases in all imaging methods of the general radiography fields and mammography ranging from 5.0% (child chest radiography) to 31.7% (skull radiography). Moreover, responses showed that DRLs 2015 were recognised and used for comparison at many facilities. We have described the doses received by patients in general radiography fields and mammography in 2017 and proposed new DRLs as replacements for DRLs 2015. The DRLs we proposed for general radiography fields and mammography were determined to be lower than DRLs 2015 for all modes.

The aim of this study was to investigate differences in volume computed tomography dose index (CTDIvol) and dose-length product (DLP) values according to facility size in Japan. A questionnaire survey was sent to 3000 facilities throughout Japan. Data from each facility were collected including bed number, computed tomography (CT) scan parameters employed and the CTDIvol and/or DLP values displayed on the CT scanner during each examination. The CTDIvol and DLP for 11 adult and 6 paediatric CT examinations were surveyed. Comparison of CTDIvol and DLP values of each examination according to facility size revealed key differences in CT dose between small and large facilities. This study highlights the importance of lowering the dose of coronary artery examination with contrast agent in smaller facilities and of lowering the dose of adult and paediatric head CT without contrast agent in larger facilities. The results of this study are valid in Japan.

【目的】前舌保持嚥下法(THS)が嚥下時の咽頭腔に与える影響について,320列面検出器型CT(CT)を用いて3次元的に運動学的解析を行った.THSでは咽頭腔体積が唾液嚥下(SS)に比べ減少する,つまり咽頭がより縮小すると仮説を立てた.【方法】言語聴覚士6名(22-29歳)を対象とした.SSとTHSをCTにて撮影し,咽頭腔体積,舌骨喉頭の運動距離,食道入口部(UES)の開大面積を計測し,SSとTHSで比較した.【結果】嚥下中の咽頭腔体積はSSに比しTHSで縮小する例だけでなく,拡大する例も認めた.嚥下開始時の舌骨,および最大上方位の舌骨喉頭はTHSで有意に高かった.UES面積はTHSで有意に大きかった.【考察】THSによる咽頭腔体積への影響は一定の傾向を認めなかった.今後,挺舌長などTHSの方法論について検討する必要が示唆された.また舌骨喉頭挙上およびUES開大にも寄与する可能性が示された.(著者抄録)

Advancements in and increasing usage of complex diagnostic examinations with interventional procedures and surgeries has led to an increase in the occupational radiation doses received by physicians and other medical staff. Measuring the scattered radiation doses received by these staff is vital for the development-effective radiation protection programs. In this study, we measured scattered doses during angiography and digital breast tomosynthesis examinations with small-type dosimeters using our jungle gym (JG) method with measurement points at 50-cm intervals. The results were compared with measurements taken using the conventional ion chamber method. The JG method uses paper pipe tubes and a plastic joint structure and allows measurements at different points inside an examination room. The difference between measurements can be attributed to the radiation absorption characteristics of the components used in the JG method. A maximum radiation dose reduction of 20% was observed due to absorption by the JG components. This effect was smaller than the measurement error produced because of reproducibility issues and other limitations of the conventional method. The conventional measurement has disadvantages that are associated with the reproducibility of measurement points, equipment load, and the radiation exposure experienced by the measurer. The proposed JG method exhibits significant improvements in all these aspects. Furthermore, the measurer does not have to be present in the measurement room; therefore, the JG method is extremely safe and useful for radiation protection.

This study sought to optimise the swallowing computed tomography (SCT) scan protocol for use with the new wide-area detector-row CT (ADCT) scanner and to estimate patient dose in terms of the organ-absorbed dose and the effective dose. The conventional ADCT (ADCTViSION) and the new ADCT (ADCTGENESIS) scanner were compared using: (1) the organ-absorbed dose and the effective dose, with a phantom study, (2) the detailed organ-absorbed doses of the neck region, using a Monte Carlo simulation and (3) a relative visual quality analysis. The effective energy differed significantly between the ADCTViSION (50 keV) and the ADCTGENESIS (57 keV). The effective doses were 2.9 and 1.9 mSv, respectively. Compared with the ADCTViSION, the absorbed dose was reduced by 34% with the ADCTGENESIS. With the ADCTGENESIS, the tube current could be reduced from 40 to 30 mA. With the optimised scan protocol, a further 25% dose reduction can be achieved.

Size-specific dose estimate (SSDE) was proposed by the American Association of Physicists in Medicine (AAPM) Task Group 204 to consider the effect of patient size in the x-ray CT dose estimation. Size correction factors to calculate SSDE were derived based on the conventional weighted CT dose index (CTDIw) equation. This study aims to investigate the influence of Bakalyar's and the authors' own CTDIw equations on the size correction factors described by the AAPM Task Group 204, using Monte Carlo simulations. The simulations were performed by modeling four types of x-ray CT scanner designs, to compute the dose values in water for cylindrical phantoms with 8-40 cm diameters. CTDI100 method and the AAPM Task Group 111's proposed method were employed as the CT dosimetry models. Size correction factors were obtained for the computed dose values of various phantom diameters for the conventional, Bakalyar's, and the authors' weighting factors. Maximum difference between the size correction factors for the Bakalyar's weighting factor and those of the AAPM Task Group 204 was 27% for a phantom diameter of 11.2 cm. On the other hand, the size correction factors calculated for the authors' weighting factor were in good agreement with those from the AAPM Task Group 204 report with a maximum difference of 17%. The results indicate that the SSDE values obtained with the authors' weighting factor can be evaluated by using the size correction factors reported by the AAPM Task Group 204, which is currently accepted as a standard.

OBJECTIVE:: To propose a new set of Japanese diagnostic reference levels (DRLs) and achievable doses (ADs) for 2017 and to verify the usefulness of Japanese DRLs (DRLs 2015) for CT, by investigating changes in the volume CT dose index (CTDIvol) from 2014 to 2017. METHODS:: Detailed information on the CT scan parameters used throughout Japan were obtained by questionnaire survey. The CTDIvol and dose-length product for the 11 commonest adult and 6 commonest paediatric CT examinations were surveyed and compared with 2014 data and DRLs 2015. RESULTS:: Evaluations of adult head (helical), and abdomen and pelvis without contrast agent, paediatric chest without contrast agent, and abdomen and pelvis without contrast agent showed a slightly lower mean CTDIvol in 2017 than in 2014 (t-test, p < 0.05). The interquartile range of CTDIvol for all 2017 examinations was lower than in 2014. CONCLUSIONS:: This study verified the lower mean, 75th percentile, and interquartile range by investigating changes in the CTDIvol from 2014 to 2017. The DRLs 2015 contributed to CT radiation dose reduction. ADVANCES IN KNOWLEDGE:: The widespread implementation of iterative reconstruction algorithms and low-tube voltage in CT scanners is likely to facilitate further reduction in the CT radiation dose used in Japan. Although radiological technologists may require further education on appropriate CTDIvol and DLP usage, the DRLs 2015 greatly contributed to the reduction of the CT radiation dose used in Japan.

Swallowing computed tomography (SCT) is a relatively new technique for the morphological and kinematic analyses of swallowing. However, no optimal scan protocols are available till date. We conducted the present SCT study to estimate the patient dose at various patient reclining positions. A RANDO phantom with a thermoluminescent dosemeter was placed on a hard Table board in a semi-reclining position at the centre and off-centre. According to predetermined scan protocols, irradiation was performed to acquire scanograms at reclining angles of 55° and 65°. The effective dose was the lowest at the centre 45° (3.8 mSv) reclining angle. Comparison between the off-centre (4.6 mSv at 55°, 6.8 mSv at 65°) and centre (4.5 mSv, 5.8 mSv) values suggested that the off-centre position is undesirable with regard to the patient dose. Accordingly, we believe that SCT methods must be revised on the basis of these factors.

PURPOSE: The weighted computed tomography dose index (CTDIw ) uses measured CTDI values at the center and periphery of a cylindrical phantom. The CTDIw value is calculated using conventional, Bakalyar's, and Choi's weighting factors. However, these weighting factors were produced from only 16- and 32-cm-diameter cylindrical phantoms. This study aims to devise new weighting factors to provide more accurate average dose in the central cross-sectional plane of cylindrical phantoms over a wide range of object diameters, by using Monte Carlo simulations. METHODS: Simulations were performed by modeling a Toshiba Aquilion ONE CT scanner, in order to compute the cross-sectional dose profiles of polymethyl methacrylate (PMMA) cylindrical phantoms of each diameter (8-40 cm at 4-cm steps), for various tube voltages and longitudinal beam widths. Two phantom models were simulated, corresponding to the CTDI100 method and the method recommended by American Association of Physicists in Medicine (AAPM) task group 111. The dose-computation PMMA cylinders of 1 mm diameter were located between the phantom surfaces and the centers at intervals of 1 mm, from which cross-sectional dose profiles were calculated. By using linear least-squares fits to the obtained cross-sectional dose profiles data, we determined new weighting factors to estimate more accurate average doses in the PMMA cylindrical phantoms by using the CTDIw equation: CTDIw = Wcenter ・ CTDIcenter + Wperiphery ・ CTDIperiphery . In order to demonstrate the validity of the devised new weighting factors, the percentage difference between average dose and CTDIw value was evaluated for the weighting factors (conventional, Bakalyar's, Choi's, and devised new weighting factors) in each calculated cross-sectional dose profile. RESULTS: With the use of linear least-squares techniques, new weighting factors (Wcenter = 3/8 and Wperiphery = 5/8 where Wcenter and Wperiphery are weighting factors for CTDIcenter and CTDIperiphery ) were determined. The maximum percentage differences between average dose and CTDIw value were 16, -12, -8, and -6% for the conventional, Bakalyar's, Choi's, and devised new weighting factors, respectively. CONCLUSIONS: We devised new weighting factors (Wcenter = 3/8 and Wperiphery = 5/8) to provide more accurate average dose estimation in PMMA cylindrical phantoms over a wide range of diameter. The CTDIw equation with devised new weighting factors could estimate average dose in PMMA cylindrical phantoms with a maximum difference of -6%. The results of this study can estimate the average dose in PMMA cylindrical phantoms more accurately than the conventional weighting factors (Wcenter = 1/3 and Wperiphery = 2/3).

PURPOSE: We have proposed a method for determining the half-value layers (HVL) in dual-source dual-energy computed tomography (DS-DECT) scans without the need for the X-ray tubes to be fixed. METHODS: A custom-made lead-covered case and an ionizing chamber connected with a multi-function digitizer module (a real-time dosimeter) were used. The chamber was placed in the center of the case, and aluminum or copper filters were placed in front of the aperture. The HVL was measured using aperture widths of 1.0, 2.0, and 3.0 cm for tube potentials of 80, 120, and 150 kV in single-source single-energy CT (SS-SECT) scans and was calculated from the peak air kerma rate (peak method) and the integrated air kerma rate (integrating method); the obtained values were compared with those from a conventional non-rotating method performed using the same procedure. The HVL was then measured using an aperture width of 1.0 cm for tube potential combinations of 70/Sn150 kV and 100/Sn150 kV in DS-DECT scans using the peak method. RESULTS: In the SS-SECT scans, the combination of a 1.0-cm aperture and the peak method was adequate due to the small differences in the HVL values obtained for the conventional non-rotating method. The method was also found to be applicable for the DS-DECT scans. CONCLUSIONS: Our proposed method can determine the HVL in SS-SE and DS-DECT scans to a good level of accuracy without the need for the X-ray tubes to be fixed. The combination of a 1.0-cm aperture and the peak method was adequate.

This study aimed to examine the relationship between fetal dose and the dose-length product, and to evaluate the impact of the number of rotations on the fetal doses and maternal effective doses using a 320-row multidetector computed tomography unit in a wide-volume mode. The radiation doses for the pregnant woman and the fetus were estimated using ImPACT CT Patient Dosimetry Calculator software for scan lengths ranging from 176 to 352 mm, using a 320-row unit in a wide-volume mode and an 80-row unit in a helical scanning mode. In the 320-row unit, the fetal doses in all scan lengths ranged from 3.51 to 6.52 mGy; the maternal effective doses in all scan lengths ranged from 1.05 to 2.35 mSv. In the 80-row unit, the fetal doses in all scan lengths ranged from 2.50 to 3.30 mGy; the maternal effective doses in all scan lengths ranged from 0.83 to 1.68 mSv. The estimated conversion factors from the dose-length product (mGy・cm) to fetal doses (mGy) for the 320-row unit in wide-volume mode and the 80-row unit in helical scanning mode were 0.06 and 0.05 (cm-1 ) respectively. While using a 320-row MDCT unit in a wide-volume mode, operators must take into account the number of rotations, the beam width as automatically determined by the scanner, the placement of overlap between volumetric sections, and the ratio of overlapping volumetric sections.

The purposes of this study were (1) to compare the radiation doses for 320- and 80-row fetal-computed tomography (CT), estimated using thermoluminescent dosimeters (TLDs) and the ImPACT Calculator (hereinafter referred to as the "CT dosimetry software"), for a woman in her late pregnancy and her fetus and (2) to estimate the overlapped fetal radiation dose from a 320-row CT examination using two different estimation methods of the CT dosimetry software. The direct TLD data in the present study were obtained from a previous study. The exposure parameters used for TLD measurements were entered into the CT dosimetry software, and the appropriate radiation dose for the pregnant woman and her fetus was estimated. When the whole organs (e.g., the colon, small intestine, and ovaries) and the fetus were included in the scan range, the difference in the estimated doses between the TLD measurement and the CT dosimetry software measurement was <1 mGy (<23 %) in both CT units. In addition, when the whole organs were within the scan range, the CT dosimetry software was used for evaluating the fetal radiation dose and organ-specific doses for the woman in the late pregnancy. The conventional method using the CT dosimetry software cannot take into account the overlap between volumetric sections. Therefore, the conventional method using a 320-row CT unit in a wide-volume mode might result in the underestimation of radiation doses for the fetus and the colon, small intestine, and ovaries.

We developed a k-factor-creator software (kFC) that provides the k-factor for CT examination in an arbitrary scan area. It provides the k-factor from the effective dose and dose-length product by Imaging Performance Assessment of CT scanners and CT-EXPO. To assess the reliability, we compared the kFC-evaluated k-factors with those of the International Commission on Radiological Protection (ICRP) publication 102. To confirm the utility, the effective dose determined by coronary computed tomographic angiography (CCTA) was evaluated by a phantom study and k-factor studies. In the CCTA, the effective doses were 5.28 mSv in the phantom study, 2.57 mSv (51%) in the k-factor of ICRP, and 5.26 mSv (1%) in the k-factor of the kFC. Effective doses can be determined from the kFC-evaluated k-factors in suitable scan areas. Therefore, we speculate that the flexible k-factor is useful in clinical practice, because CT examinations are performed in various scan regions.

Adequate dose management during computed tomography is important. In the present study, the dosimetric application software ImPACT was added to a functional calculator of the size-specific dose estimate and was part of the scan settings for the auto exposure control (AEC) technique. This study aimed to assess the practicality and accuracy of the modified ImPACT software for dose estimation. We compared the conversion factors identified by the software with the values reported by the American Association of Physicists in Medicine Task Group 204, and we noted similar results. Moreover, doses were calculated with the AEC technique and a fixed-tube current of 200 mA for the chest-pelvis region. The modified ImPACT software could estimate each organ dose, which was based on the modulated tube current. The ability to perform beneficial modifications indicates the flexibility of the ImPACT software. The ImPACT software can be further modified for estimation of other doses.

The American Association of Physicists in Medicine (AAPM) task group 204 has recommended the use of size-dependent conversion factors to calculate size-specific dose estimate (SSDE) values from volume computed tomography dose index (CTDIvol) values. However, these conversion factors do not consider the effects of 320-detector-row volume computed tomography (CT) examinations or the new CT dosimetry metrics proposed by AAPM task group 111. This study aims to investigate the influence of these examinations and metrics on the conversion factors reported by AAPM task group 204, using Monte Carlo simulations. Simulations were performed modelling a Toshiba Aquilion ONE CT scanner, in order to compute dose values in water for cylindrical phantoms with 8-40-cm diameters at 2-cm intervals for each scanning parameter (tube voltage, bow-tie filter, longitudinal beam width). Then, the conversion factors were obtained by applying exponential regression analysis between the dose values for a given phantom diameter and the phantom diameter combined with various scanning parameters. The conversion factors for each scanning method (helical, axial, or volume scanning) and CT dosimetry method (i.e., the CTDI100 method or the AAPM task group 111 method) were in agreement with those reported by AAPM task group 204, within a percentage error of 14.2 % for phantom diameters ≥11.2 cm. The results obtained in this study indicate that the conversion factors previously presented by AAPM task group 204 can be used to provide appropriate SSDE values for 320-detector-row volume CT examinations and the CT dosimetry metrics proposed by the AAPM task group 111.

OBJECTIVE: The purpose of this study was to compare the effects of tube current modulation between single- and dual-energy CT with a second-generation dual-source scanner. MATERIALS AND METHODS: Custom-made elliptic polymethylmethacrylate phantoms for slim and large patients were used. Absorbed radiation dose at the central point of the phantoms was measured with a solid-state detector while the phantoms were scanned in single-energy (120 kV) and dual-energy (100/Sn140, 80/Sn140, and 140/80 kV) modes with a second-generation dual-source CT scanner. Tube current modulation was activated in both modes, and quality reference tube current-time settings of 150, 300, 450, and 600 mAs were selected. Scanning was performed three times under the same conditions, and image noise was evaluated by measuring the SD of CT numbers in four separate regions of three adjacent images of the phantoms. RESULTS: Absorbed dose increased and image noise decreased with an increase in quality reference tube current-time setting when the slim phantom was scanned. For the large phantom, the radiation dose and noise level reached a plateau above quality reference tube current-time settings of 300 mAs for 100/Sn140 kV and 450 mAs for 120 kV. The radiation dose was small and the noise level was large with 80/Sn140 kV compared with that obtained with 120 and 100/Sn140 kV at all quality reference tube current-time settings. CONCLUSION: When a large phantom is scanned with 100/Sn140 kV, exposure demand for tube current modulation exceeds system limits at a lower quality reference tube current-time setting than for scanning 120 kV.

The primary study objective was to assess radiation doses using a modified form of the Imaging Performance Assessment of Computed Tomography (CT) scanner (ImPACT) patient dosimetry for cardiac applications on an Aquilion ONE ViSION Edition scanner, including the Ca score, target computed tomography angiography (CTA), prospective CTA, continuous CTA/cardiac function analysis (CFA), and CTA/CFA modulation. Accordingly, we clarified the CT dose index (CTDI) to determine the relationship between heart rate (HR) and X-ray exposure. As a secondary objective, we compared radiation doses using modified ImPACT, a whole-body dosimetry phantom study, and the k-factor method to verify the validity of the dose results obtained with modified ImPACT. The effective dose determined for the reference person (4.66 mSv at 60 beats per minute (bpm) and 33.43 mSv at 90bpm) were approximately 10% less than those determined for the phantom study (5.28 mSv and 36.68 mSv). The effective doses according to the k-factor (0.014 mSv•mGy-1•cm-1; 2.57 mSv and 17.10 mSv) were significantly lower than those obtained with the other two methods. In the present study, we have shown that ImPACT, when modified for cardiac applications, can assess both absorbed and effective doses. The results of our dose comparison indicate that modified ImPACT dose assessment is a promising and practical method for evaluating coronary CTA.

PURPOSE: Patient dose estimation in X-ray computed tomography (CT) is generally performed by Monte Carlo simulation of photon interactions within anthropomorphic or cylindrical phantoms. An accurate Monte Carlo simulation requires an understanding of the effects of the bow-tie filter equipped in a CT scanner, i.e. the change of X-ray energy and air kerma along the fan-beam arc of the CT scanner. To measure the effective energy and air kerma distributions, we devised a pin-photodiode array utilizing eight channels of X-ray sensors arranged at regular intervals along the fan-beam arc of the CT scanner. METHODS: Each X-ray sensor consisted of two plate type of pin silicon photodiodes in tandem - front and rear photodiodes - and of a lead collimator, which only allowed X-rays to impinge vertically to the silicon surface of the photodiodes. The effective energy of the X-rays was calculated from the ratio of the output voltages of the photodiodes and the dose was calculated from the output voltage of the front photodiode using the energy and dose calibration curves respectively. RESULTS: The pin-photodiode array allowed the calculation of X-ray effective energies and relative doses, at eight points simultaneously along the fan-beam arc of a CT scanner during a single rotation of the scanner. CONCLUSIONS: The fan-beam energy and air kerma distributions of CT scanners can be effectively measured using this pin-photodiode array.

With the objective of reducing patient exposure to radiation, we conducted a questionnaire survey regarding radiographic conditions in 2014. Here we report estimates of dose exposure in general radiography and mammography through an investigation and comparison of present patient exposure conditions. Questionnaires were sent to 3000 facilities nationwide in Japan. Surveys asked questions on a total of 16 items related to general radiography, including the chest, abdomen, and breast. Output data from x-ray tubes measured in the Chubu area of Japan were used as the mean in these estimates. The index of patient exposure was adopted as the entrance skin dose (ESD) for general radiography and as the mean glandular dose (MGD) for mammography. The response rate for this survey was 21.9%. Our results showed that doses received through the use of flat-panel detector (FPD) devices were lower than those received through computed radiography devices, except for the ankle joint (e.g. in chest examination, the dose from FPD and CR was 0.24 mGy, 0.31 mGy on the average, respectively). These results suggest that more widespread use of FPD devices could lead to decreases in the ESD and MGD, thereby reducing patient exposure.

The purpose of this study was to evaluate the maternal and foetal effective doses during foetal computed tomography (CT) and to compare the radiation dose, dose profile and image noise on 80-row CT in helical scanning mode and 320-row CT in wide-volume scanning mode. The radiation doses were measured using thermoluminescent dosemeters implanted at various organ sites of an anthropomorphic pregnant phantom. The foetal doses in the 320-row multi-detector CT (MDCT) and 80-row MDCT units were higher than the volume CT dose index (CTDIvol). The dose profile in the 320-row MDCT overlapped in two places but showed no overlap in the 80-row MDCT. There were no significant differences in image noise between the two scanning modes. The foetal dose evaluation by CTDIvol may underestimate the foetal radiation risk. When using the wide-volume mode, operators must take into account the number of scans and overlap between volumetric sections.

The aim of this study was to propose a calibration method for small dosimeters to measure absorbed doses during dual- source dual-energy computed tomography (DECT) and to compare the axial dose distribution, eye lens dose, and image noise level between DE and standard, single-energy (SE) head CT angiography. Three DE (100/Sn140 kVp 80/Sn140 kVp, and 140/80 kVp) and one SE (120 kVp) acquisitions were performed using a second-generation dual-source CT device and a female head phantom, with an equivalent volumetric CT dose index. The axial absorbed dose distribution at the orbital level and the absorbed doses for the eye lens were measured using radiophotoluminescent glass dosimeters. CT attenuation numbers were obtained in the DE composite images and the SE images of the phantom at the orbital level. The doses absorbed at the orbital level and in the eye lens were lower and standard deviations for the CT attenuation numbers were slightly higher in the DE acquisitions than those in the SE acquisition. The anterior surface dose was especially higher in the SE acquisition than that in the DE acquisitions. Thus, DE head CT angiography can be performed with a radiation dose lower than that required for a standard SE head CT angiography, with a slight increase in the image noise level. The 100/Sn140 kVp acquisition revealed the most balanced axial dose distribution. In addition, our proposed method was effective for calibrating small dosimeters to measure absorbed doses in DECT.

OBJECTIVE: The aims of this study were to estimate the effective radiation doses from CT examinations of both adults and children in Japan and to study the impact of various scan parameters on the effective doses. METHODS: A questionnaire, which contained detailed questions on the CT scan parameters employed, was distributed to 3000 facilities throughout Japan. For each scanner protocol, the effective doses for head (non-helical and helical), chest and upper abdomen acquisitions were estimated using ImPACT CT Patient Dosimetry Calculator software v. 1.0.4 (St George's Hospital, London, UK). RESULTS: The mean effective doses for chest and abdominal examinations using 80-110 kV were significantly lower than those using 120 kV. However, there was no statistically significant difference in the mean effective doses for head scans between facilities employing 80-110 kV and 120 kV. In chest and abdominal examinations, the mean effective doses using CT scanners from Western manufacturers [Siemens (Forchheim, Germany), Philips (Eindhoven, Netherlands) and GE Medical Systems (Milwaukee, WI)] were significantly lower than those of examinations using Japanese scanners [Hitachi (Kashiwa, Japan) and Toshiba (Otawara, Tochigi, Japan)], except for in paediatric chest examinations. CONCLUSION: The mean effective doses for adult head, chest and abdominal CT examinations were 2.9, 7.7 and 10.0 mSv, respectively, whereas the corresponding mean effective doses for paediatric examinations were 2.6, 7.1 and 7.7 mSv, respectively. ADVANCES IN KNOWLEDGE: Facilities using CT scanners by Western manufacturers commonly adopt low-tube-voltage techniques, and low-tube-voltage CT may be useful for reducing the radiation doses to the patients, particularly for the body region.

The relationship between heart rate (HR) and computed tomography dose index (CTDI) was evaluated using an electrocardiogram (ECG) gate scan for scan applications such as prospective triggering, Ca scoring, target computed tomography angiography (CTA), prospective CTA and retrospective gating, continuous CTA/CFA (cardiac functional analysis) and CTA/CFA modulation. Even in the case of a volume scan, doses for the multiple scan average dose were similar to those for CTDI. Moreover, it was found that the ECG gate scan yields significantly different doses. When selecting the optimum scan, the doses were dependent on many factors such as HR, scan rotation time, active time, prespecified cardiac phase and modulation rate. Therefore, it is necessary to take these results into consideration when selecting the scanning parameters.

The purpose of this study was to evaluate the effect of tube current modulation for dose estimation of a body computed tomography (CT) examination using a simulation tool. The authors also compared longitudinal variations in tube current values between iterative reconstruction (IR) and filtered back-projection (FBP) reconstruction algorithms. One hundred patients underwent body CT examinations. The tube current values around 10 organ regions were recorded longitudinally from tube current information. The organ and effective doses were simulated by average tube current values and longitudinal modulated tube current values. The organ doses for the bladder and breast estimated by longitudinal modulated tube current values were 20 % higher and 25 % lower than those estimated using the average tube current values, respectively. The differences in effective doses were small (mean, 0.7 mSv). The longitudinal variations in tube current values were almost the same for the IR and FBP algorithms.

Objective: The aims of this study are to propose a new set of Japanese diagnostic reference levels (DRLs) for 2014 and to study the impact of tube voltage and the type of reconstruction algorithm on patient doses. The volume CT dose index (CTDIvol) for adult and paediatric patients is assessed and compared with the results of a 2011 national survey and data from other countries. Methods: Scanning procedures for the head (non-helical and helical), chest and upper abdomen were examined for adults and 5-year-old children. A questionnaire concerning the following items was sent to 3000 facilities: tube voltage, use of reconstruction algorithms and displayed CTDIvol. Results: The mean CTDIvol values for paediatric examinations using voltages ranging from 80 to 100 kV were significantly lower than those for paediatric examinations using 120 kV. For adult examinations, the use of iterative reconstruction algorithms significantly reduced the mean CTDIvol values compared with the use of filtered back projection. Paediatric chest and abdominal scans showed slightly higher mean CTDIvol values in 2014 than in 2011. The proposed DRLs for adult head and abdominal scans were higher than those reported in other countries. Conclusion: The results imply that further optimization of CT examination protocols is required for adult head and abdominal scans as well as paediatric chest and abdominal scans. Advances in knowledge: Low-tube-voltage CT may be useful for reducing radiation doses in paediatric patients. The mean CTDIvol values for paediatric scans showed little difference that could be attributed to the choice of reconstruction algorithm.