title: Uncertainties in effective dose estimates of adult CT head scans: the effect of head size.
abstract: OBJECTIVE
  This study is an extension of a previous study where the uncertainties in effective dose estimates from adult CT head scans were calculated using four CT effective dose estimation methods, three of which were computer programs (CT-EXPO, CTDOSIMETRY, and IMPACTDOSE) and one that involved the dose length product (DLP). However, that study did not include the uncertainty contribution due to variations in head sizes.
  
  
  METHODS
  The uncertainties due to head size variations were estimated by first using the computer program data to calculate doses to small and large heads. These doses were then compared with doses calculated for the phantom heads used by the computer programs. An uncertainty was then assigned based on the difference between the small and large head doses and the doses of the phantom heads.
  
  
  RESULTS
  The uncertainties due to head size variations alone were found to be between 4% and 26% depending on the method used and the patient gender. When these uncertainties were included with the results of the previous study, the overall uncertainties in effective dose estimates (stated at the 95% confidence interval) were 20%-31% (CT-EXPO), 15%-30% (CTDOSIMETRY), 20%-36% (IMPACTDOSE), and 31%-40% (DLP).
  
  
  CONCLUSIONS
  For the computer programs, the lower overall uncertainties were still achieved when measured values of CT dose index were used rather than tabulated values. For DLP dose estimates, head size variations made the largest (for males) and second largest (for females) contributions to effective dose uncertainty. An improvement in the uncertainty of the DLP method dose estimates will be achieved if head size variation can be taken into account.
authors.affiliation: Department of Medical Physics, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia. kent.gregory@health.sa.gov.au
authors.forename: Kent J
authors.initials: KJ
authors.lastname: Gregory
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bibbo
authors.forename: John E
authors.initials: JE
authors.lastname: Pattison
mesh_terms: D000328:Adult; D005260:Female; D006257:Head / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D009929:Organ Size; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D012727:Sex Characteristics; D012984:Software; D014057:Tomography, X-Ray Computed; D035501:Uncertainty