In recent years, a new dedicated spiral breast CT (SBCT) with photon-counting technology has been developed that offers clear advantages over established methods such as mammography and tomosynthesis, as well as the existing cone-beam breast CT (CBBCT) without a direct-conversion detector, particularly due to its unique feature of three-dimensional visualization of microcalcifications. Microcalcifications cannot be visualized using non-X-ray-based methods such as ultrasound and MRI. However, microcalcifications are particularly noticeable in 70% to 90% of DCIS cases 1 2 .Our experimental phantom study shows for the first time that the newly developed SBCT-compatible biopsy unit closes the previous diagnostic gap and enables both vacuum-assisted biopsy (VAB) and the marking of detected findings (especially microcalcifications and round foci) after precise three-dimensional target planning with the help of SBCT.

Objectives To prospectively compare the diagnostic performance of contrast-enhanced spiral photon-counting dedicated breast CT (CE-SBCT) with breast MRI for breast cancer detection. Materials and Methods In this single-centre substudy as part of the prospective multicentre trial "ldBCT-MRI-C" (Trial registration ClinicalTrials.gov: NCT05989022, registered 08/14/2023), 136 women (mean age 53 ± 13 years) underwent CE-SBCT and MRI within one week (December 2023–December 2025). Three blinded readers independently assigned BI-RADS categories per breast (265 total). Diagnostic performance was evaluated using ROC analysis, multireader–multicase (MRMC) mixed-effects modelling, conditional logistic regression (CLR), and case-resampling bootstrap analysis (1,000 iterations). Histopathology and clinical imaging served as the reference standard. Results Among 265 breasts, 67 malignancies were confirmed. CE-SBCT and MRI demonstrated equivalent diagnostic performance (pooled AUC 0.92 for both; MRMC β = 0.001, p = 0.94; CLR Odds Ratio = 1.02, p = 0.91). Pooled bootstrap-derived sensitivity, specificity, PPV, and NPV were 93%, 93%, 74%, and 99% for CE-SBCT, and 91%, 92%, 71%, and 97% for MRI, respectively. In dense breasts (ACR C/D; n = 168, 35 malignancies), sensitivity and specificity were 92% for both modalities. Inter-reader agreement was substantial (CE-SBCT κ = 0.76; MRI κ = 0.81). Background parenchymal enhancement was lower on CE-SBCT than on MRI, despite strong inter-modality correlation (Spearman ρ = 0.66, p < 0.0001). Conclusion CE-SBCT demonstrated diagnostic performance equivalent to MRI for breast cancer detection, including in dense breasts, with substantial inter-reader agreement.

Objectives Photon-counting spiral breast computed tomography (SBCT) has been introduced as a promising fully three-dimensional imaging system capable of providing enhanced lesion detection and characterization. The aim of this study was to evaluate technical feasibility and usability for photon-counting SBCT-guided interventions in a pre-clinical setting using a newly developed biopsy suite and anthropomorphic compressible breast phantoms. Materials and Methods The clinically certified SBCT device has been updated by the vendor to additionally allow for image-guided minimally invasive interventional procedures of the breast. The biopsy unit allows for grid-based localization method in vacuum-assisted biopsy (VAB). New scan protocols and reconstruction profiles were provided to allow for fast and accurate navigation to user-defined target lesions of all types. Six deformable, anthropomorphic, and biopsy-compatible breast phantoms of different sizes were used in this study. A total of 30 lesions (low-contrast mass lesions and clusters of calcifications of 125 µm in size) were biopsied by four clinical users employing certified third-party VAB system and equipment. Technical feasibility and usability were assessed based on the lesion targeting success rate, intervention time, and mean glandular dose. Results The rate of success in needle navigation was 100%, regardless of lesion type, size, and location. The total intervention time and mean glandular dose for the VAB procedure consisting of one planning scan followed by two control scans were 9.68 ± 1.05 min (range: 7.82–12.35 min) and 11.34 ± 1.50 mGy (range: 7.81–13.75 mGy), respectively. The investigators reported no device-related events, device deficiencies, or difficulties in performing the biopsy procedure. Conclusions This phantom-based pre-clinical study showed that photon-counting SBCT with biopsy functionality enables accurate and fast true three-dimensional guidance of minimally invasive interventional procedures in the breast at very low radiation dose. It could be a valuable tool for taking samples of lesions that are difficult or impossible to detect in conventional breast imaging.

Abstract Background Dedicated photon-counting breast CT is an emerging imaging technology for imaging the breast without the need for compression of the breast and with a radiation dose comparable to that of mammography. In this study, we assessed the feasibility of using breast CT to confirm the accurate placement of localization markers in nonpalpable breast tumors before breast-conserving surgery. Methods We first evaluated the artifacts caused by 5 different metallic markers in 2 different phantoms and applied a computer algorithm to effectively remove the beam hardening artifacts. Next, we tested the potential of dedicated photon-counting breast CT combined with the artifact-removing algorithm to assess accurate marker placement in 5 patients with nonpalpable breast tumors. Results In the phantoms, all markers caused beam-hardening artifacts, but the computer algorithm successfully removed them. In the patients, the correct placement of the markers was visualized with breast CT and confirmed postsurgery, as all markers and tumors were present in the surgical specimen. Conclusion Dedicated photon-counting breast CT is an effective modality for demonstrating accurate placement of localization markers.

BACKGROUND:Spiral breast computed tomography (BCT) equipped with a photon-counting detector (PCD) is a new radiological modality allowing for the compression-free acquisition of high-resolution 3-D datasets of the breast. Optimized dose exposu04170/re setups according to breast size were previously proposed but could not effectively be applied in a clinical environment due to ambiguity in measuring breast size. PURPOSE:This study aims to report the standard radiation dose values in a large cohort of patients examined with BCT, and to provide a mathematical model to estimate radiation dose based on morphological features of the breast. METHODS:This retrospective study was conducted on 1657 BCT examinations acquired between 2018 and 2021 from 829 participants (57 ± 10 years, all female). Applying a dedicated breast tissue segmentation algorithm and Monte Carlo (MC) simulation, mean absorbed dose (MAD), mean glandular dose (MGD), mean skin dose (MSD), maximum glandular dose (maxGD), and maximum skin dose (maxSD) were calculated and related to morphological features such as breast volume, effective diameter, breast length, skin volume, and glandularity. Effective dose (ED) was calculated by applying the corresponding beam and tissue weighting factors, 1 Sv/Gy and 0.12 per breast. Relevant morphological features predicting dose values were identified based on the Spearman's rank correlation coefficient. Exponential or bi-exponential models predicting the dose values as a function of morphological features were fitted by using a non-linear least squares (LS) method. The models were validated by assessing R2 and residual standard error (RSE). RESULTS:The most relevant morphological features for radiation dose estimation were the breast volume (correlation coefficient: -0.8), diameter (-0.7), and length (-0.6). The glandularity presented a weak-positive correlation (0.4) with MGD and maxGD due to the inhomogeneous distribution of the glandularity and absorbed dose in the 3-D breast volume. The standard MGDs were calculated to be 7.3 ± 0.7, 6.5 ± 0.3, and 5.9 ± 0.3 mGy, MADs to 7.6 ± 0.8, 6.8 ± 0.3, and 6.2 ± 0.3 mGy, maxSDs to 19.9 ± 1.6, 19.5 ± 0.5, and 18.9 ± 0.5 mGy, and EDs to 0.88 ± 0.08, 0.78 ± 0.04, and 0.72 ± 0.04 mSv for small, medium, and large breasts with average breast lengths of 5.9 ± 1.6, 8.7 ± 1.3, and 12.2 ± 2.0 cm, respectively. The estimated glandularity - 23.1 ± 16.9, 12.5 ± 11.4, and 6.9 ± 7.3% from small to large breasts. The mathematical models were able to estimate the MAD, MGD, MSD, and maxSD as a function of each morphological feature with only upto 0.5 mGy RSE. CONCLUSION:We presented the typical morphological features and standard dose values according to the breast size acquired from a large patient cohort. We established radiation dose estimation models allowing accurate estimation of dose values including MGD with an acceptable RSE based on each of the easily measured morphological features of the breast. Clinicians could use the breast length to operate as a dosimetric alert of the scanner prior to a BCT scan. Radiation exposure for BCT was lower than diagnostic mammography (MG) and cone-beam breast CT (BCT).

PurposeContrast‐enhanced imaging of the breast is frequently used in breast MRI and has recently become more common in mammography. The purpose of this study was to make single‐scan contrast‐enhanced imaging feasible for photon‐counting breast CT (pcBCT) and to assess the spectral performance of a pcBCT scanner by evaluating iodine maps and virtual non‐contrast (VNC) images.MethodsWe optimized the settings of a pcBCT to maximize the signal‐to‐noise ratio between iodinated contrast agent and breast tissue. Therefore, an electronic energy threshold dividing the x‐ray spectrum used into two energy bins was swept from 23.17 keV to 50.65 keV. Validation measurements were performed by placing syringes with contrast agent (2.5 mg/ml to 40 mg/ml) in phantoms with 7.5 cm and 12 cm in diameter. Images were acquired at different tube currents and reconstructed with 300 μm isotropic voxel size. Iodine maps and VNC images were generated using image‐based material decomposition. Iodine concentrations and CT values were measured for each syringe and compared to the known concentrations and reference CT values.ResultsMaximal signal‐to‐noise ratios were found at a threshold position of 32.59 keV. Accurate iodine quantification (average root mean square error of 0.56 mg/ml) was possible down to a concentration of 2.5 mg/ml for all tube currents investigated. The enhancement has been sufficiently removed in the VNC images, so they can be interpreted as unenhanced CT images. Only minor changes of CT values compared to a conventional CT scan were observed. Noise was increased by the decomposition by a factor of 2.62 and 4.87 (7.5 cm and 12 cm phantoms) but did not compromise the accuracy of the iodine quantification.ConclusionsAccurate iodine quantification and generation of VNC images can be achieved using contrast‐enhanced pcBCT from a single CT scan in the absence of temporal or spatial misalignment. Using iodine maps and VNC images, pcBCT has the potential to reduce dose, shorten examination and reading time, and to increase cancer detection rates.

X-ray computed tomography (CT) has been proposed and evaluated multiple times as a potentially alternative method for breast imaging. All efforts shown so far have been criticized and partly disapproved because of their limited spatial resolution and higher patient dose when compared to mammography. Our concept for a dedicated breast CT (BCT) scanner therefore aimed at novel apparatus and detector design to provide high spatial resolution of about 100 μm and average glandular dose (AGD) levels of 5 mGy or below. Photon-counting technology was considered as a solution to reach these goals. The complete concept was previously evaluated and confirmed by simulations and basic experiments on laboratory setups. We here present measurements of dose, technical image quality parameters and surgical specimen results on such a scanner. For comparison purposes, the specimens were also imaged with digital mammography (DM) and breast tomosynthesis (BT) apparatus. Results show that photon-counting BCT (pcBCT) at 5 mGy AGD offers sufficiently high 3D spatial resolution for reliable detectability of calcifications and soft tissue delineation.

Objectives The performance of metal artifact reduction (MAR) methods in x-ray computed tomography (CT) suffers from incorrect identification of metallic implants in the artifact-affected volumetric images. The aim of this study was to investigate potential improvements of state-of-the-art MAR methods by using prior information on geometry and material of the implant. Materials and Methods The influence of a novel prior knowledge–based segmentation (PS) compared with threshold-based segmentation (TS) on 2 MAR methods (linear interpolation [LI] and normalized-MAR [NORMAR]) was investigated. The segmentation is the initial step of both MAR methods. Prior knowledge–based segmentation uses 3-dimensional registered computer-aided design (CAD) data as prior knowledge to estimate the correct position and orientation of the metallic objects. Threshold-based segmentation uses an adaptive threshold to identify metal. Subsequently, for LI and NORMAR, the selected voxels are projected into the raw data domain to mark metal areas. Attenuation values in these areas are replaced by different interpolation schemes followed by a second reconstruction. Finally, the previously selected metal voxels are replaced by the metal voxels determined by PS or TS in the initial reconstruction. First, we investigated in an elaborate phantom study if the knowledge of the exact implant shape extracted from the CAD data provided by the manufacturer of the implant can improve the MAR result. Second, the leg of a human cadaver was scanned using a clinical CT system before and after the implantation of an artificial knee joint. The results were compared regarding segmentation accuracy, CT number accuracy, and the restoration of distorted structures. Results The use of PS improved the efficacy of LI and NORMAR compared with TS. Artifacts caused by insufficient segmentation were reduced, and additional information was made available within the projection data. The estimation of the implant shape was more exact and not dependent on a threshold value. Consequently, the visibility of structures was improved when comparing the new approach to the standard method. This was further confirmed by improved CT value accuracy and reduced image noise. Conclusions The PS approach based on prior implant information provides image quality which is superior to TS-based MAR, especially when the shape of the metallic implant is complex. The new approach can be useful for improving MAR methods and dose calculations within radiation therapy based on the MAR corrected CT images.

Poster: ECR 2016 / C-0367 / Photon-counting breast CT (pcBCT) performance tests on specimens in comparison with digital mammography and breast tomosynthesis by: A.-C. Rosler, E. Wenkel, C. Steiding, V. Ruth, S. Kratz, R. Schulz-Wendtland, C. Preuss, D. Kolditz, W. A. Kalender; Erlangen/DE

INTRODUCTION:Recent studies have shown a substantial reduction of radiation dose from computed tomography (CT) scans down to 0.1 mSv for lung cancer screening and cardiac examinations, when applying optimization techniques. Hence, CT localizer radiographs (LRs) might now be considered a significant contributor to the total dose of the CT examination. We investigated in our study the potential for reducing dose of the LRs by adapting the patient-specific acquisition parameters of the LR.MATERIALS AND METHODS:Localizer radiographs covering the lungs were acquired on 2 clinical scanners (64 slices, conventional detector [CD]; 96 slices, fully integrated detector [ID]) for 3 semianthropomorphic phantoms, representing a slim, a normal, and an obese adult. Starting at 120-kV tube voltage and 250-mA current were reduced until the image quality of the LR, and thereby the accuracy of the automatic exposure control was compromised; this was defined as a deviation of measured attenuation values in the center of the LR of more than 5% from the reference values measured at the highest tube voltage and current. Subsequent Monte Carlo calculations on anthropomorphic phantoms were performed to calculate organ and effective dose values for the respective optimal settings. In addition, effective dose values normalized to CTDIvol for tube voltages ranging from 60 to 160 kV were determined for the different combinations of phantom sizes, sexes, and LR views to evaluate dose efficiency.RESULTS:For the CD scanner, the optimal LR settings depended strongly on phantom size. Higher tube voltage and current were necessary for the larger phantoms. The ID scanner showed uncompromised LR quality for all phantoms using the lowest possible tube voltage-tube current combination of 80 kV and 20 mA. Depending on patient size and LR direction, effective dose values for the optimal settings ranged from 6 to 53 μSv and 3 to 11 μSv for the CD and ID scanner, respectively. For the example of an anterior-posterior LR on a normal patient, using the optimal settings instead of the standard settings on the ID scanner reduced LR dose from 53 μSv (120 kV, 30 mA) to 10 μSv (80 kV, 20 mA). The simulations for the different tube voltages show that effective dose and CTDIvol behave similarly for different views and patient sizes. However, the tube voltage level itself impacts the relationship between CTDIvol and effective dose, by up to a factor of 2.DISCUSSION:Dose from LRs may contribute significantly to the total effective dose of low-dose CT examinations such as lung cancer screening. Optimal LR settings can reduce LR dose substantially, but adaptations have to consider scanner characteristics, detector technology, and patient size. Thus, for low-dose CT examinations, such as cardiac examinations and lung cancer screening, LR optimization may result in a significant dose reduction and thereby in a substantial reduction of total dose.

RATIONALE AND OBJECTIVES:This study compared a novel photon-counting breast computed tomography (pcBCT) system with digital mammography (DM) and digital breast tomosynthesis (DBT) systems. For this reason, surgical specimens were examined with all three techniques and rated by three observers.MATERIALS AND METHODS:A total of 30 surgical specimens were investigated with DM, DBT, and pcBCT; the associated images were shown to three experienced radiologists. Findings (22 microcalcifications and 23 mass lesions) were recorded and compared to the results of the pathological examination. Sensitivity and specificity for detection of microcalcifications and lesions were calculated and displayed using receiver operating characteristic curves.RESULTS:Sensitivity for microcalcifications was 82% for DM, 70% for DBT, and 85% for pcBCT. Specificity for microcalcifications was 71% for DM, 75% for DBT, and 83% for pcBCT. Sensitivity for lesions was 45% for DM, 62% for DBT, and 65% for pcBCT. Specificity for lesions was 76% for DM, 62% for DBT, and 76% for pcBCT.CONCLUSIONS:pcBCT showed a comparable or superior performance compared to the clinically approved DM and DBT systems. Mass lesion detectability can be increased further by the use of contrast media.

OBJECTIVES:Spectral optimization of x-ray computed tomography (CT) has led to substantial radiation dose reduction in contrast-enhanced CT studies using standard iodinated contrast media. The purpose of this study was to analyze the potential for further dose reduction using high-atomic-number elements such as hafnium and tungsten. As in previous studies, spectra were determined for which the patient dose necessary to provide a given contrast-to-noise ratio (CNR) is minimized.MATERIALS AND METHODS:We used 2 different quasi-anthropomorphic phantoms representing the liver cross-section of a normal adult and an obese adult patient with the lateral widths of 360 and 460 mm and anterior-posterior heights of 200 and 300 mm, respectively. We simulated and measured on 2 different scanners with x-ray spectra from 80 to 140 kV and from 70 to 150 kV, respectively. We determined the contrast for iodine-, hafnium-, and tungsten-based contrast media, the noise, and 3-dimensional dose distributions at all available tube voltages by measurements and by simulations. The dose-weighted CNR was determined as optimization parameter.RESULTS:Simulations and measurements were in good agreement regarding their dependence on energy for all parameters investigated. Hafnium provided the best performance for normal and for obese patient phantoms, indicating a dose reduction potential of 30% for normal and 50% for obese patients at 120 kV compared with iodine; this advantage increased further with higher kV values. Dose-weighted CNR values for tungsten were always slightly below the hafnium results. Iodine proved to be the superior choice at voltage values of 80 kV and below.DISCUSSION:Hafnium and tungsten both seem to be candidates for contrast-medium-enhanced CT of normal and obese adult patients with strongly reduced radiation dose at unimpaired image quality. Computed tomography examinations of obese patients will decrease in dose for higher kV values.

Purpose: To investigate the dose saving potential of direct-converting CdTe photon-counting detector technology for dedicated breast CT.Materials and methods: We analyzed the modulation transfer function (MTF), the noise power spectrum (NPS) and the detective quantum efficiency (DQE) of two detector technologies, suitable for breast CT (BCT): a flat-panel energy-integrating detector with a 70 mm and a 208 mm thick gadolinium oxysulfide (GOS) and a 150 mm thick cesium iodide (CsI) scintillator and a photon-counting detector with a 1000 mm thick CdTe sensor.Results: The measurements for GOS scintillator thicknesses of 70 mm and 208 mm delivered 10% pre-sampled MTF values of 6.6 mm(-1) and 3.2 mm(-1), and DQE(0) values of 23% and 61%. The 10% pre-sampled MTF value for the 150 mm thick CsI scintillator 6.9 mm(-1), and the DQE(0) value was 49%. The CdTe sensor reached a 10% pre-sampled MTF value of 8.5 mm(-1) and a DQE(0) value of 85%.Conclusion: The photon-counting CdTe detector technology allows for significant dose reduction compared to the energy-integrating scintillation detector technology used in BCT today. Our comparative evaluation indicates that a high potential dose saving may be possible for BCT by using CdTe detectors, without loss of spatial resolution. (C) 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

In this study we compared various defect pixel correction methods for reducing artifact appearance within projection images used for computed tomography (CT) reconstructions.Defect pixel correction algorithms were examined with respect to their artifact behaviour within planar projection images as well as in volumetric CT reconstructions. We investigated four algorithms: nearest neighbour, linear and adaptive linear interpolation, and a frequency-selective spectral-domain approach.To characterise the quality of each algorithm in planar image data, we inserted line defects of varying widths and orientations into images. The structure preservation of each algorithm was analysed by corrupting and correcting the image of a slit phantom pattern and by evaluating its line spread function (LSF). The noise preservation was assessed by interpolating corrupted flat images and estimating the noise power spectrum (NPS) of the interpolated region.For the volumetric investigations, we examined the structure and noise preservation within a structured aluminium foam, a mid-contrast cone-beam phantom and a homogeneous Polyurethane (PUR) cylinder.The frequency-selective algorithm showed the best structure and noise preservation for planar data of the correction methods tested. For volumetric data it still showed the best noise preservation, whereas the structure preservation was outperformed by the linear interpolation.The frequency-selective spectral-domain approach in the correction of line defects is recommended for planar image data, but its abilities within high-contrast volumes are restricted. In that case, the application of a simple linear interpolation might be the better choice to correct line defects within projection images used for CT.

The purpose of this study was to validate the use of a single shaped filter (SF) for computed tomography (CT) using variable source-to-filter distance (SFD) for the examination of different object diameters.A SF was designed by performing simulations with the purpose of achieving noise homogeneity in the reconstructed volume and dose reduction for arbitrary phantom diameters. This was accomplished by using a filter design method thats target is to achieve a homogeneous detector noise, but also uses a correction factor for the filtered back projection process. According to simulation results, a single SF designed for one of the largest phantom diameters meets the requirements for all diameters when SFD can be adjusted. To validate these results, a SF made of aluminium alloy was manufactured. Measurements were performed on a CT scanner with polymethyl methacrylate (PMMA) phantoms of diameters from 40-100 mm. The filter was positioned at SFDs ranging from 97-168 mm depending on the phantom diameter. Image quality was evaluated for the reconstructed volume by assessing CT value accuracy, noise homogeneity, contrast-to-noise ratio weighted by dose (CNRD) and spatial resolution. Furthermore, scatter distribution was determined with the use of a beam-stop phantom. Dose was measured for a PMMA phantom with a diameter of 100 mm using a calibrated ionization chamber.The application of a single SF at variable SFD led to improved noise uniformity and dose reduction: noise homogeneity was improved from 15% down to about 0%, and dose was reduced by about 37%. Furthermore, scatter dropped by about 32%, which led to reduced cupping artifacts and improved CT value accuracy. Spatial resolution and CNRD was not affected by the SF.By means of a single SF with variable SFD designed for CT, significant dose reduction can be achieved and image quality can be improved by reducing noise inhomogeneity as well as scatter-induced artifacts.

PURPOSE:Thousands of cone-beam computed tomography (CBCT) scanners for vascular, maxillofacial, neurological, and body imaging are in clinical use today, but there is no consensus on uniform acceptance and constancy testing for image quality (IQ) and dose yet. The authors developed a quality assurance (QA) framework for fully automated and time-efficient performance evaluation of these systems. In addition, the dependence of objective Fourier-based IQ metrics on direction and position in 3D volumes was investigated for CBCT.METHODS:The authors designed a dedicated QA phantom 10 cm in length consisting of five compartments, each with a diameter of 10 cm, and an optional extension ring 16 cm in diameter. A homogeneous section of water-equivalent material allows measuring CT value accuracy, image noise and uniformity, and multidimensional global and local noise power spectra (NPS). For the quantitative determination of 3D high-contrast spatial resolution, the modulation transfer function (MTF) of centrally and peripherally positioned aluminum spheres was computed from edge profiles. Additional in-plane and axial resolution patterns were used to assess resolution qualitatively. The characterization of low-contrast detectability as well as CT value linearity and artifact behavior was tested by utilizing sections with soft-tissue-equivalent and metallic inserts. For an automated QA procedure, a phantom detection algorithm was implemented. All tests used in the dedicated QA program were initially verified in simulation studies and experimentally confirmed on a clinical dental CBCT system.RESULTS:The automated IQ evaluation of volume data sets of the dental CBCT system was achieved with the proposed phantom requiring only one scan for the determination of all desired parameters. Typically, less than 5 min were needed for phantom set-up, scanning, and data analysis. Quantitative evaluation of system performance over time by comparison to previous examinations was also verified. The maximum percentage interscan variation of repeated measurements was less than 4% and 1.7% on average for all investigated quality criteria. The NPS-based image noise differed by less than 5% from the conventional standard deviation approach and spatially selective 10% MTF values were well comparable to subjective results obtained with 3D resolution pattern. Determining only transverse spatial resolution and global noise behavior in the central field of measurement turned out to be insufficient.CONCLUSIONS:The proposed framework transfers QA routines employed in conventional CT in an advanced version to CBCT for fully automated and time-efficient evaluation of technical equipment. With the modular phantom design, a routine as well as an expert version for assessing IQ is provided. The QA program can be used for arbitrary CT units to evaluate 3D imaging characteristics automatically.

The estimation of patient dose using Monte Carlo (MC) simulations based on the available patient CT images is limited to the length of the scan. Software tools for dose estimation based on standard computational phantoms overcome this problem; however, they are limited with respect to taking individual patient anatomy into account. The purpose of this study was to generate whole-body patient models in order to take scattered radiation and over-scanning effects into account. Thorax examinations were performed on three physical anthropomorphic phantoms at tube voltages of 80 kV and 120 kV; absorbed dose was measured using thermoluminescence dosimeters (TLD). Whole-body voxel models were built as a combination of the acquired CT images appended by data taken from widely used anthropomorphic voxel phantoms.MC simulations were performed both for the CT image volumes alone and for the whole-body models. Measured and calculated dose distributions were compared for each TLD chip position; additionally, organ doses were determined. MC simulations based only on CT data underestimated dose by 8% -15% on average depending on patient size with highest underestimation values of 37% for the adult phantom at the caudal border of the image volume. The use of whole-body models substantially reduced these errors; measured and simulated results consistently agreed to better than 10%.This study demonstrates that combined whole-body models can provide three-dimensional dose distributions with improved accuracy. Using the presented concept should be of high interest for research studies which demand high accuracy, e. g. for dose optimization efforts. (C) 2014 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

PURPOSE With recently introduced technical innovations for CT systems, the dose of CT scan acquisitions has been substantially reduced; even effective dose values below 1 mSv have been reported. Due to this development, dose of the localizer radiograph may contribute substantially to dose of the whole CT examination. Since there are only limited data in the literature regarding patient dose for the different types of localizer radiographs, patient dose values were estimated in our study by measurements and Monte Carlo simulations and compared to dose values of typical CT examinations. METHODS First, dose distributions were measured in anthropomorphic phantoms for three different body regions (head, thorax, abdomen-pelvic) and three positions of the x-ray tube (AP, PA, and lateral views); measured values were compared to simulated data using Monte Carlo techniques for validation purposes. Second, organ and effective dose values for the various investigated localizer radiograph scenarios were calculated and compared with published dose values for standard CT and low-dose CT examinations. RESULTS For the anthropomorphic phantom, deviations of the dose values between measured and calculated results were in the range of 15%. Organ and effective dose values showed a strong dependence on the tube position. The largest differences were observed for chest localizer radiographs in the female phantom for the dose to the breast (AP: 1.01 mGy vs PA: 0.24 mGy). Overall effective dose values were in the range of 0.04-0.42 mSv per localizer radiograph acquisition. CONCLUSIONS In view of the technical dose-reducing innovations in CT, localizer radiographs may substantially contribute to the total dose of the whole CT examination, particularly in the case of dedicated low-dose scans used, e.g., for young patients or screening purposes. Optimization of dose in localizer radiographs should be pursued further in the same way as it was done in CT.