title: Organ-based computed tomographic (CT) radiation dose reduction to the lenses: impact on image quality for CT of the head.
abstract: OBJECTIVE
  Recently, a new specific organ dose adaption and reduction protocol, or SODAR tool (X-CARE, Siemens Healthcare), which reduces dose to the anterior aspect of the body of patients, was installed on our computed tomographic scanner. The purpose of this pilot project was to evaluate image quality and dose distribution in the acquired data with the new protocol.
  
  
  METHODS
  Sixteen consecutive patients were scanned with the new SODAR head protocol. The findings were compared with 16 matched patients who were imaged with the standard computed tomographic head trauma protocol. Image quality was assessed qualitatively using a scale of 1 to 4 (1, excellent; 2, good; 3, fair; 4, nondiagnostic). Additionally, 1-cm regions of interest were placed in the white matter of the cerebral hemispheres, the cerebellar hemispheres, and the brain stem at the level of the pons for a quantitative analysis. The standard deviation of each measurement was recorded as an indicator for image noise. Dose measurement trials were performed using optically stimulated luminescence dosimeters on head phantoms and then on patients.
  
  
  RESULTS
  Subjective image quality ranged between 1 and 3; no scan areas were considered nondiagnostic. Overall image quality of the posterior fossa averaged at 1.656 was slightly reduced compared to the cerebral hemispheres (mean, 1.141). The mean standard protocol brain stem image quality was 1.604, with only minimal deterioration to 1.708 in the SODAR group.No significant difference in image noise could be found between the SODAR group with a mean noise of 4.515 and standard images with a mean of 4.721 (P > 0.05).The dose to the anterior aspect of the patient was lowered to 3.2 mGy compared to 4.5 mGy on the lateral aspect of the scan (P > 0.05). To compensate for the photon loss in the posterior aspect, the dose has to be slightly increased to a mean of 6 mGy, but overall, a significant dose reduction with stable image quality could be achieved by reducing the dose length product from 1489 to 1347 mGy·cm using SODAR (P < 0.0001).
  
  
  CONCLUSIONS
  Using the SODAR protocol resulted not only in an impressive 46% to 59% frontal dose reduction but also in the overall dose reduction. This dose reduction was obtained without sacrificing image quality, providing diagnostic images of the brain while protecting radiosensitive structures like the eye lenses in trauma brain imaging. Future applications will be reducing dose to other radiosensitive structures such as the thyroid gland and breast tissue from potentially harmful low-energy radiation without compromising image quality.
authors.affiliation: Diagnostic Radiology, Vancouver General Hospital, Vancouver, BC, Canada. anja.reimann@vch.ca
authors.forename: Anja Judith
authors.initials: AJ
authors.lastname: Reimann
authors.forename: Chris
authors.initials: C
authors.lastname: Davison
authors.forename: Thor
authors.initials: T
authors.lastname: Bjarnason
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Thakur
authors.forename: Thakur
authors.initials: T
authors.lastname: Yogesh
authors.forename: Karl
authors.initials: K
authors.lastname: Kryzmyk
authors.forename: John
authors.initials: J
authors.lastname: Mayo
authors.forename: Savvas
authors.initials: S
authors.lastname: Nicolaou
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D004867:Equipment Design; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007908:Lens, Crystalline / Q000000981:diagnostic imaging*; D019047:Phantoms, Imaging; D010865:Pilot Projects; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D015898:Tomography Scanners, X-Ray Computed; D014057:Tomography, X-Ray Computed / Q000379:methods*