How do the Parameters affect Image

Quality and Dose for Abdominal CT?

Image Review
Mannudeep K. Kalra, MD, DNB
Massachusetts General Hospital
Harvard Medical School

Financial Disclosure
This presentation was made possible with
support from RSNA R & E Foundations
Education Scholar Grant 2010-2012
GE Healthcare:
Faculty for Master Course on Radiation

Learning Points
Understand effects of scan parameters on
abdominal CT images
Apply knowledge of image and lesion appearance
to make indication specific CT protocols.

Lungs: Lack of Effect at Lower Dose

270 mAs 20 mGy

35 mAs : 2.7 mGy

135 mAs 10 mGy

18 mA s : 1.3 mGy

70 mAs : 5 mGy

Lungs = High Contrast = CT Colonography

Low Dose

CT Colonography: High Contrast = Lower Dose

30-40 mAs: 100-120 kV

Flat polyp (8 mm)
2-4 mGy

What else is high contrast in Abdomen?

High contrast = Kidney stones
Calcium Vs Soft tissues

Lower Dose

Kidney stone CT: Seen at Lower Dose

FBP300mAs 140kV30mGy

350mAs 120kV24mGy

200mAs 120kV13mGy

65 kg
BMI 26
100mAs 120kV7mGy

50mAs 120kV3.4mGy

URINARY STONE CT
Tube Potential
Tube current
(prefer AEC)
Image thickness (mm)
CTDI vol

Fixed mA

120 KV commonly (100 kV< 60 kg)

About 30-50% lower than routine abdomen
2.5- 5mm
2-6 mGy (size based)

Use AEC (NI 20)

(A) CT images of 60-year-old

man acquired with fixed
current and (B) AEC at NI
20 show a tiny calculus
(arrow) in left renal
pelvis. AEC (A) enabled
50% dose reduction
compared to fixed
current technique.

Calcium : Seen at Lower Dose

Radiodense stones (GB) can also be seen at low dose

FBP300mAs 140kV30mGy

350mAs 120kV24mGy

100mAs 120kV7mGy

200mAs 120kV13mGy

50mAs 120kV3.4mGy

Bones- chest or abdomen:

Well Seen at Lower Dose
200 mAs 12 mGy FBP

150 mAs 9 mGy FBP

100 mAs 6 mGy FBP

50 mAs 3 mGy FBP

What else is high contrast in Abdomen?

Contrast enhancing
Structures (vessels= CTA)
Lesions (hypervascular lesions)

Lower KV= lower Dose

140 kV
29 mGy

Abdominal @ Different KV

Mean HU 120.5
SD: 12.8

80 kV
8 mGy

120 kV
24 mGy

Mean HU 138.1
SD: 13.8

100 kV
16 mGy

Mean HU 209.9
SD: 42.9

Mean HU 161.7
SD: 30.6

CTA of Aorta
High Contrast CTA
allows use of
lower KV
(non-obese)

Schindera,Sebastianetal.

100 kV (60 cc)

160 mAs
7 mGy

80 kV (60 cc)
260 mAs
5 mGy

2009LippincottWilliams&Wilkins,Inc.PublishedbyLippincottWilliams&Wilkins,Inc.

80 kV (45 cc)
260 mAs
5 mGy

InvestigativeRadiology.
44(10):650655,October2009.

Multiphase Liver CT: Lower KV + IR algorithm

Contrast
enhancing
lesions: HCC
& metastasis

IR helps
140 kV
300 mAs
5 mm
FBP
17 mSv

80 KV
540 mAs
5 mm
FBP
5 mSv

80 kV
540 mAs
5mm
Hybrid IR
5 mSv

Multiphase Liver:
Lower KV + IR
Contrast
enhancing
lesions: HCC
& metastasis

IR helps
120 kV
200-530 mAs
5 mm
FBP
20 mGy

80 KV
360 630 mAs
5 mm
FBP
11 mGy

80 kV
360 630 mAs
5mm
Hybrid IR
11 mGy

Multiphase Exam: Dose Reduction: Liver

Arterial phase:
Lower kV (100)

Liver only coverage

AEC

PV phase:
Usual or Lower kV
Longer coverage
AEC

CT Enterography (CTE): Lower Dose

Rel. higher contrast
Oral contrast Vs
bowel wall
FBP 200 mAs 7 mGy

FBP 100 mAs 3.5 mGy

IRIS 10 mAs 3.5 mGy

= Lower Dose
50% of routine CT

Routine abdomen CT
Higher dose than kidney stones and CTC

Lower contrast between soft tissue lesions

and soft tissue organs

Routine Abdomen: Patient factors and Dose

o Size: Obese vs average or slim
o Use AEC always for mA optimization
o Lower kV in smaller patients with contrast CT helps cut dose
o Arms by the side of the patient
o Keep out or Keep above the abdomen with pad not besides
o Patient motion (voluntary or involuntary)
o Pitch > 1; Rotation time < 0.8 second

Routine Abdomen: Use AEC

Obese

339 mAs
23 mGy

Average/slim
65 kg

115 kg
200 mAs
14 mGy

50 mAs
3.4 mGy

200 mAs
14 mGy

50 mAs
100
mAs
3.4 mGy
6.7 mGy

633 mA

90 mA

24 mGy

360 mA

3.4 mGy

45 mA

180 mA

14 mGy

1.7 mGy

7 mGy

135 mAs
10 mGy

270 mAs
CTDI vol: 20 mGy

18 mAs
1.3 mGy

Varying mAs
120 kV
5 mm,
Pitch: 0.9:1
FBP: B30

67 mAs
5.0 mGy

36 mAs
2.7 mGy

CT For Hematuria: Decreasing Scan Phases

Wider x-ray beam
Pitch
Tube Potential (kV)

Tube current

1.25 >> 0.625

~ or > 1:1
100-120

Use AEC

Unenhanced CT

46-year-old
woman with
hematuria.
Optimal
enhancement
of kidneys
and adequate
opacification
and distension
of ureters
seen.

50 mL IV contrast bolus
250 mL saline drip infusion
Wait 15 minutes (Prone)
100 mL IV contrast bolus @ 3 mL/sec.

Scan at 100-sec. delay

Maher MM, Kalra MK, et al. BJR 2004

Non-contrast
limit coverage: kidneys to SP
Lower dose ( - 50%)
AEC

Multiphase Exam: Hematuria

Post Contrast:
Wider coverage
AEC

CT Appendicitis: Lower Dose

Standard Dose:
110 -200 mAs AEC
120 kV
122 mGy.cm
Lower Dose
30-40 mAs AEC
544 mGy.cm
CE CT: 3ml/sec

Benign Disease: Young Patients

Ex: Appendicitis
Limited coverage: L3 to SP
AEC for size adapted dose

Lower noise: Higher dose

Rule out Abdo CT

Low contrast lesions

Use AEC to optimize

Lesion Detection high confidence
CT colonography
CT angiography
Kidney stones
Hypervascular lesions

Higher noise = Lower dose

Use AEC &/ low kV