title: Comparison of patient specific dose metrics between chest radiography, tomosynthesis, and CT for adult patients of wide ranging body habitus.
abstract: OBJECTIVE
  Given the radiation concerns inherent to the x-ray modalities, accurately estimating the radiation doses that patients receive during different imaging modalities is crucial. This study estimated organ doses, effective doses, and risk indices for the three clinical chest x-ray imaging techniques (chest radiography, tomosynthesis, and CT) using 59 anatomically variable voxelized phantoms and Monte Carlo simulation methods.
  
  
  METHODS
  A total of 59 computational anthropomorphic male and female extended cardiac-torso (XCAT) adult phantoms were used in this study. Organ doses and effective doses were estimated for a clinical radiography system with the capability of conducting chest radiography and tomosynthesis (Definium 8000, VolumeRAD, GE Healthcare) and a clinical CT system (LightSpeed VCT, GE Healthcare). A Monte Carlo dose simulation program (PENELOPE, version 2006, Universitat de Barcelona, Spain) was used to mimic these two clinical systems. The Duke University (Durham, NC) technique charts were used to determine the clinical techniques for the radiographic modalities. An exponential relationship between CTDIvol and patient diameter was used to determine the absolute dose values for CT. The simulations of the two clinical systems compute organ and tissue doses, which were then used to calculate effective dose and risk index. The calculation of the two dose metrics used the tissue weighting factors from ICRP Publication 103 and BEIR VII report.
  
  
  RESULTS
  The average effective dose of the chest posteroanterior examination was found to be 0.04 mSv, which was 1.3% that of the chest CT examination. The average effective dose of the chest tomosynthesis examination was found to be about ten times that of the chest posteroanterior examination and about 12% that of the chest CT examination. With increasing patient average chest diameter, both the effective dose and risk index for CT increased considerably in an exponential fashion, while these two dose metrics only increased slightly for radiographic modalities and for chest tomosynthesis. Effective and organ doses normalized to mAs all illustrated an exponential decrease with increasing patient size. As a surface organ, breast doses had less correlation with body size than that of lungs or liver.
  
  
  CONCLUSIONS
  Patient body size has a much greater impact on radiation dose of chest CT examinations than chest radiography and tomosynthesis. The size of a patient should be considered when choosing the best thoracic imaging modality.
authors: Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705.
authors: Yakun
authors: Y
authors: Zhang
authors: Medical Physics Graduate Program, Department of Physics, Cleveland State University, Cleveland, Ohio 44115.
authors: Xiang
authors: X
authors: Li
authors: Medical Physics Graduate Program, Carl E. Ravin Advanced Imaging Laboratories, and Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705.
authors: W Paul
authors: WP
authors: Segars
authors: Medical Physics Graduate Program, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Departments of Physics, Biomedical Engineering, and Electrical and Computer Engineering, Duke University Medical Center, Durham, North Carolina 27705.
authors: Ehsan
authors: E
authors: Samei
mesh_terms: D000328:Adult; D049628:Body Size; D005260:Female; D006801:Humans; D008297:Male; D009010:Monte Carlo Method; D019047:Phantoms, Imaging; D057285:Precision Medicine / Q000379:methods*; D011829:Radiation Dosage; D013902:Radiography, Thoracic / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*