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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

RADIATION PROTECTION IN
DIAGNOSTIC AND
INTERVENTIONAL RADIOLOGY
Part 18: Optimization of protection in CT scanner
Practical exercise - Quality Control

IAEA
International Atomic Energy Agency

Contents
Quality control tests
CT accuracy, uniformity, linearity. and noise,
Low and high contrast resolution
Z-axis sensitivity
Alignment, table top travel accuracy
Gantry tilt measurement
Dosimetry

IAEA

18: Optimization of protection in CT scanner

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 1: Quality Control

IAEA
International Atomic Energy Agency

Physical parameters of CT image


Image quality
May be expressed in terms of physical parameters such
as uniformity, linearity, noise, spatial resolution, low
contrast resolution
Image quality depends on the technical characteristics of
the CT scanner, the exposure factors used and image
viewing conditions.
Quality may be assessed by quantitative measurement
using test phantoms, and by the appearance of artifacts.
Measurements should be conducted regularly
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18: Optimization of protection in CT scanner

Scanner performance: technical


parameters (I)
Test Phantoms:
Test phantoms of a standardized human shape
or test objects of a particular shape, size and
structure, are used for the purposes of
calibration and evaluation of the performances
of CT scanners
Phantoms should allow for evaluation of CT
number; uniformity; noise; spatial resolution;
slice thickness; dose; positioning of table top

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18: Optimization of protection in CT scanner

Scanner performance: technical


parameters (II)
CT Number Accuracy

CT number depends on tube voltage, filtration, object thickness


CT number of water is by definition equal to 0
Measured CT number should be < 4 HU in the central ROI

CT Number Linearity
The linear relationship between the calculated CT number and the linear
attenuation coefficient of each element of the object
Deviations from linearity should be < 5 HU

CT Number Uniformity
The CT number of each pixel in the image of an homogeneous object
should be the same over the image area
The difference in the CT number between a peripheral and a central
region of an homogeneous test object should be < 8 HU
Differences are largely due to beam hardening

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18: Optimization of protection in CT scanner

Scanner performance: technical


parameters (III)
Noise
The local statistical fluctuation (standard deviation) of CT
numbers in a homogeneous Region Of Interest (ROI)
Noise strongly affects the low contrast resolution
Noise is dependent on the radiation dose

Noise

1
dose

Image noise should be measured over an area of about 10% of


the cross-sectional area of the test object.
Goal obtain an image with an acceptable level of noise while
keeping the patient dose as low as reasonably achievable

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18: Optimization of protection in CT scanner

Scanner performance: technical


parameters (IV)
Spatial Resolution
The high contrast resolution determines the minimum
size of details visualized in the plane of the slice with a
contrast >10%.
It is affected by:
the reconstruction algorithm
the detector width
the effective slice thickness
the object to detector distance
the x-ray tube focal spot size
the matrix size.

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18: Optimization of protection in CT scanner

Scanner performance: technical


parameters (V)
Spatial Resolution
The low contrast resolution determines the size
of detail that can be visibly reproduced when
there is only a small difference in density relative
to the surrounding area
Low contrast resolution is limited by noise.
The perception threshold in relation to contrast and
detail size can be determined by creating contrastdetail curve.

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18: Optimization of protection in CT scanner

Scanner performance: technical


parameters (VI)
Slice Thickness
The slice thickness is determined in

the center of the field of view as the


distance between the two points on
the sensitivity profile along the axis
of rotation at which response has
fallen to 50%.
The use of post-patient collimation
to reduce the width of the image
slice leads to very significant
increases in the patient dose

Positioning of couch
The accuracy of positioning of the
patient couch is evaluated by
moving the loaded couch a defined
distance and moving it back to the
start position

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Minimum requirements: CT scanner (I)


Image noise
The Standard Deviation of CT numbers in the central 500
mm2 ROI for a water or tissue equivalent phantom should
not deviate more than 20% from the baseline.
CT number values
The deviation in the CT number values for water or tissue
equivalent material and materials of different densities
should < 20 HU or 5%.
CT number uniformity
The SD of the CT number over a 500 mm 2 region of
interest for water or tissue equivalent material at the center
and at the periphery of phantom should vary by less than
1.5% of the baseline
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Minimum requirements: CT scanner


(II)
Computed tomography dose index (CTDI)
The CTDI for a single slice for each available beam shaping filter and
for each available slice thickness should not deviate more than 20%
from the baseline.
Irradiated slice thickness
The FWHM of the dose profile should not differ more than 20% from
baseline.
High contrast resolution (spatial resolution)
The FWHM of the point spread function of a pin, or the edge response
function of an edge should not differ more than 20% from baseline.
Low contrast resolution
Polystyrene pins of 0.35 cm diameter inserted in a uniform body water
phantom should be visible in the image.

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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 2: Noise

IAEA
International Atomic Energy Agency

Imaging performance (Noise)


Noise is assessed using cylindrical

phantoms, which are either filled with water


or made of a tissue equivalent material

Once an axial image of the phantom has

been acquired, noise is measures as the


standard deviation in CT number in a region
of interest (ROI) placed in the center of the
image
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Imaging performance (Noise)


Region of
interest
(ROI)

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Imaging performance (Noise)


Noise values are given in manufacturers

specifications are quoted for a specific phantom


(e.g., manufacturers QA phantom) and for specified
scan techniques
These conditions must be matched exactly for the
purposes of the acceptance test
Manufacturers quote noise at a particular surface
dose
If this is the case, dose for axial scans can be
measured by taping an ion chamber to the surface
of the phantom
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Imaging performance (Noise)


Baseline noise values should be obtained

for several scan protocols that will be used


clinically, using the routine QC noise
phantom

To ensure that noise figures are both

accurate and representative, it is essential to


find the mean value from several scans (10
scans.)
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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 3: CT uniformity and linearity

IAEA
International Atomic Energy Agency

CT number uniformity
CT number uniformity can be assessed at the

same time as measuring noise, by placing four


additional ROI (N, E, S and W) at positions near
the edge of the image of a uniform phantom
The mean CT number is then noted for these four
regions, as well as the center
The deviation from the central value should be
calculated
The CT number uniformity should be measured for
large fields of view
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CT number uniformity

Axial image of
a homogenous
phantom

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CT number uniformity
CT number linearity is assessed using a

phantom containing inserts of a number of


different materials (materials should cover a
wide range of CT numbers)
One example of a suitable phantom to use
at acceptance is the Catphan (The Phantom
Laboratory, Salem, NY), which contains four
inserts with CT numbers ranging from
approximately -1000HU to +1000HU
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CT number uniformity

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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 4: Low and high contrast resolution

IAEA
International Atomic Energy Agency

Low contrast resolution


Low contrast resolution (or low contrast

detectability) is often quoted in specification


documentation as the smallest visible object at a
given contrast for a given dose
Since this measurement relates directly to imaging
performance, it is an important value to verify at
acceptance testing
At least 20 images of the low contrast insert (LCR)
should be acquired and then viewed by at least 3
observers under optimal viewing conditions to
obtain an average
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Low contrast resolution

Typical
image of the
Catphan LCR
insert

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Spatial resolution (high contrast)


There exist two broad categories of measuring
techniques :
analysis of the point spread function, usually by

calculation of the modulation transfer function (MTF)


either objective analysis or visual assessment of images
of a resolution bar phantom.

The resolution is quoted as the spatial frequency (in line


pairs/cm) at which the modulation falls to 50%, 10% or
2% MTF.
These figures are often given for more than one
reconstruction algorithm, e.g., for standard and highresolution scans.
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Spatial resolution (high contrast)


The number of line

pairs per cm just


visible in the image is
approximately
equivalent to the 2%
value of the MTF
This result can then be
compared with the 2%
MTF, as quoted in the
manufacturers
specifications
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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 5: Z-axis sensitivity

IAEA
International Atomic Energy Agency

Z-Sensitivity (Imaged slice width)


Axial measurements
Phantoms used for axial measurements may contain
thin metal plates, wires or arrays of air holes, inclined at
an angle to the image plane
Manufacturers should be able to supply an appropriate
phantom or, alternatively, the Catphan contains an insert
suitable for this test
Note: to obtain meaningful measurements, the thickness
of the plates, wires or holes cannot be greater than the
nominal slice width concerned. This may create
problems for the sub-millimetre slice widths offered on
multi-slice scanners.
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Z-Sensitivity (Imaged slice width)


Axial measurements
Phantoms manufacturers may quote the tolerance
for each nominal slice width setting in their
specification documentation
Z-sensitivity measurements in axial mode can be
used to check that imaged slice widths are within
the tolerances given
This can also be used in conjunction with irradiated
slice width measurements to assess the accuracy of
post patient collimation and to calculate the
geometric efficiency for the scanner
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Z-Sensitivity (Imaged slice width)

Plan view of a test object used to measure imaged


slice widths for axial scans
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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 6: Alignment

IAEA
International Atomic Energy Agency

Alignment of indicating lights with


scan, coronal and sagittal planes
Several methods can
be used to perform
these tests
The techniques
described here are
straightforward to
implement and require
minimal test
equipment.
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Agreement between internal and


external scan plane lights
Use an envelope-wrapped film (therapy verificaiton
film) for the measurement. However, a piece of
paper or card can also be used
The film is placed flat on the table and illuminated
by the external scan plane light
The position of the light is marked on the film
envelope and the table is moved automatically to
the scan plane
If the distance between the internal and external
lights is correct, the internal light should now
coincide with the mark on the film envelope.
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Co-incidence of internal scan plane


lights and scan plane
Pin pricks are made in a piece of therapy
verification film (or similar) along the line of the
internal scan plane light
The film is wrapped around a phantom and
scanned with a narrow axial and developed
Coincidence between the pin pricks and the x-ray
beam exposure indicates alignment between the
alignment lights and the scan plane

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Co-incidence of internal scan plane


lights and scan plane
For multi-slice scanners, pin pricks (and, thus, the
internal alignment light) are usually found to
coincide with the center of the four slices

To plan a scan so that the x-ray beam is centered


over the internal scan plane lights at zero, it will be
necessary to center the first and last slices
symmetrically around zero (e.g. four slices from
7.5 mm to +7.5 mm on a 4 x 5 mm scan)
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Co-incidence of internal scan plane


lights and scan plane

Pin pricks made in


film at position of
scan plane light

Z
X-ray beam
exposure

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Coronal and Sagital plane lights


A long, thin object, with a high CT number relative to

air, such as the lead in a pencil or a straightened


paper clip, can be used as a marker to perform this
test
The marker is supported above the patient table and
aligned, using the indicating lights, so that it is
positioned at the isocentre, parallel to the z-axis and
perpendicular to the scan plane
If indicating lights are accurately aligned to the coronal
and sagital planes, the marker should appear as a dot
at exactly x = 0, y = 0 on the axial image.

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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 7: Table travel accuracy

IAEA
International Atomic Energy Agency

Table travel accuracy


A ruler or tape measure placed alongside the table,
can be used to check that the amount of table
movement indicated on the gantry agrees with the
actual distance moved.
A load of approximately 70- 80 kg should be
placed on the table in order to simulate the weight
of a patient.
The test should be performed twice: by driving the
table top both away from and towards the gantry.
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Table travel accuracy

Assessment of distance indicator accuracy


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Axial scan incrementation accuracy


Verification of incrementation accuracy between
successive axial slices can be achieved by placing
therapy verification film on the couch (in the
isocentre plane) and exposing it to an axial scan
sequence

Narrow slices separated by a couch increment


greater than 1 slice width can be used, and the
distance between the lines on the film measured
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Table travel accuracy for helical scans


In helical scanning, it is not sufficient to use a simple

mechanical test because the distance imaged depends on


couch speed and scanner software
One method of assessing distance accuracy is to use an
acrylic test object containing two small radio-opaque
markers, separated by a fixed distance (e.g., 20 cm)
The test object is scanned in Scan Projection Radiography
(SPR) mode and a helical scan is planned to start at the
first marker and to end at a distance x from the first marker
If couch travel is accurate during the helical scan, the
markers should be clearly seen on the first and final images
of the series.
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Couch travel accuracy for helical


scans

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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 8: Gantry tilt measurement

IAEA
International Atomic Energy Agency

Gantry Tilt
The accuracy of displayed gantry tilt can be
assessed by supporting therapy verification
film at the gantry end of the patient table
The film must be held vertically (e.g., by
taping to an acrylic block), so that it is
parallel to the sagital plane and intersects
scan and coronal planes at right angles

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Gantry Tilt
Three axial exposures are made using the same
film:
one for the maximum superior gantry tilt,
one for the maximum inferior gantry tilt
one at 0 gantry tilt

The three scan planes should then be visible on


the developed film
The angles + and - between scan planes at
maximum tilt relative to that at 0 tilt should equal
tilt angles displayed on the gantry.
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Assessment of accuracy of gantry tilt

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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT


scanner
Topic 9: Dosimetry

IAEA
International Atomic Energy Agency

Dosimetry - CTDI in air


The Computed Tomography Dose Index

(CTDI) in air can be measured using a 10


cm pencil ionization chamber, located in the
scan plane at the isocentre
The ion chamber can be supported using a
laboratory test stand and clamp

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Dosimetry - CTDI in air

Ionization
chamber

Table
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Dosimetry - CTDI in air


It is important to measure the CTDI in air
under the following conditions When
commissioning a CT scanner:
For all beam shaping filters
For all nominal slice widths
For all clinical kV settings
For a range of scan times
For a range of mA settings
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Dosimetry - CTDI in air

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Dosimetry - CTDI in air

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Dosimetry - CTDI in air (helical)

Axial slice positions

Helical scan (pitch 1)


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Dosimetry - CTDI in Acrylic Phantoms


The body phantom is placed on the patient table
and the head phantom is supported in the head
rest
Phantoms are aligned and centred at the scan
isocentre
The ion chamber is inserted into either the central
or one of the peripheral holes of the phantom (all
other holes being filled with acrylic rods)

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Dosimetry - CTDI in Acrylic Phantoms


Dose measurements at the center are used to
calculate the central CTDI
Peripheral CTDI is measured in at least four
positions around the phantom, so as to achieve a
true average
Note: If gantry rotation is initiated from different
angular positions for successive scans it may be
necessary to take a number of measurements at
each position in order to get a representative mean
dose
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Dosimetry - CTDI in Perspex


Phantoms
Insert to plug holes

Head phantom

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Body phantom (or annulus


to fit over head phantom)

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Dosimetry - CTDI in Perspex


Phantoms
Central and peripheral CTDIs are used to
calculate weighted CTDI, CTDIw:
1
n CTDI w =
C

1
2
CTDI100,c + CTDI100,p
3
3

CTDIws can be compared against diagnostic


reference levels for standard scan
examinations
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Example of CTDI Values for some CT


units
MODEL

KV

FAD

Siemens
HIQ

133

700

10

0.195

(mGy/mAs)
weighted
Head
Body
0.161 (0.83) 0.093 (0.48)

Siemens
Plus S

120

700

10

0.128

0.110 (0.86)

Siemens
Plus S

137

700

0.161

GE Pace

120

525

10

0.344

0.200 (0.58)

0.094 (0.27)

Philips
LX

120

606

10

0.200

0.160 (0.80)

0.081 (0.41)

Air

nCDTI

0.062 (0.48)
0.082 (0.51)

FAD(mm): Focus to Axis distance


S (mm): Slice thickness

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Dose Profiles (Irradiated slice width)


Measurement of irradiated slice widths, for all

nominal slice width settings, provides a direct test


of pre-patient beam collimation and allows
geometric efficiencies to be calculated for the
scanner
Geometric efficiency (GE) is defined as:
GE =
width slice irradiated x 100 %
width slice imaged
It is recommended that GE value is displayed on
the console if it is less than 70%
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Dose Profiles (Irradiated slice width)


First method : expose therapy verification film, supported in
air at the isocentre, at each of the slice width settings
Once developed, optical density profiles may be plotted
using a digitizer or the width measured using a ruler
To provide an accurate dose profile, a calibration curve can
be applied to convert optical density profiles into dose
profiles, from which irradiated slice widths (FWHM of dose
profiles) may be derived
Alternative technique: measure dose profiles using TLDs.

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Dose Profiles (Irradiated slice width)

Measurement of
irradiated slice
widths for a range
of nominal slice
width settings

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Quality control program


Example of a quality control program for a CT unit:
Physical parameter

Level of
expertise

Frequency Priority

Remedial level

Image noise

A
B

D/W
1 y*

H
H

CT number values

D/W

1 Y*

CT number uniformity

1y

> 1.5%

CTDI

1y

Baseline 20%

Irradiated slice thickness

1y

> 20% or 1 mm

Image slice thickness

1y

> 20% or 1 mm

High contrast resolution

1y

Baseline 20%

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Baseline 20%
*more scans/parameters
Water: 10 HU
Other materials 20 HU
*more scans/parameters

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