# CT dose

## Units of dose

We can think of the different dose measurements as a stepwise progression, each time adding an additional variable into the equation.

### 1. CT Dose Index (CTDI)

First, we measure the dose to the detectors from a single gantry rotation to give us the CTDI.

#### CT dose index

DefinitionDose to the phantom from single gantry rotation
UnitsmGy
Affected byCollimator Focus-isocentre distance

### 2. Weighted CTDI (CTDIw)

The dose is not equal across the scan plane. It is higher in the periphery than in the centre. We need to adjust for this by making the average periphery dose make up 2/3 of the dose to give us the weighted CTDI.

There are separate calculations for imaging the head, body and paediatric patients. In adults we use a head phantom (16 cm) and a body phantom (32 cm) with dosimeters placed at the periphery and centre in order to calculate the weighted average of doses.

#### Weighted CTDI

DefinitionAdjusted for spatial variation of dose
EquationCTDIw = 1/3 CTDIcentre + 2/3 CTDIperiphery
UnitsmGy

### 3. Volume CTDI (CTDIvol)

We don’t scan single slices. The concentration of the dose along a patient is determined by the pitch. The higher the pitch, the larger the gaps between slices and the lower the dose. Taking into account the pitch gives us the volume CTDI.

#### Volume CTDI

Definition

Accounts for effect of pitch. Higher pitch = lower dose as less overlapping

However, many manufacturers autocompensate for changes in pitch by adjusting mA to keep the noise and dose constant.

EquationCTDIvol = CTDIw / pitch
UnitsmGy

### 4. Dose length product (DLP)

Now we know the CTDlvol, we multiply this by the distance along the patient we have scanned to give us the dose length product. It is proportional to the radiation risk to the patient.

#### Dose length product

DefinitionTotal dose to phantom / patient along the distance scanned
EquationDLP = CTDIvol x distance scanned
UnitsmGy*cm

### 5. Effective dose (E)

We now have the total dose along the patient. But radiation does not affect all organs equally. Each organ has a sensitivity to radiation that needs to be taken into account. We display this as the effective dose.

#### Effective dose

DefinitionPhysical effect of total dose on patient determined by the sensitivity of imaged area to radiation
Equation

In the latest ICRP103 guideline the equation used to calculate effective dose is:

E = ΣT (WT) x ΣR (WRDT,R) or

E = Σ WTHT

Key:

• HT or WTDT,R is the equivalent dose in a tissure or organ (T)
• WT is the tissue weighting factor
UnitsMillisieverts (mSv) or J.kg-1 – note that the units have changed as this is the effective dose to patients.

## Factors affecting dose

• Tube current
• Doubling mA = doubling of CTDI, DLP and E
• Rotation time
• Doubling rotation time = doubling of CTDI, DLP and E
• Pitch
• Doubling pitch = halving of CTDI, DLP and E
• kVp
• Dose is approximately ∝ kVp2 i.e. doubling the kVp will increase the dose by a factor of 4 (approximately).

### Σ  Summary 