Automatic exposure control to reduce the dose in subsecond multislice spiral CT: Phantom measurements and clinical results

Purpose: To investigate the potential of dose reduction in multislice spiral CT (MSCT) with automatic exposure control. Materials and Methods: The study was performed on a Sensation 4 multislice scanner. This prototype implementation analyzed the distribution of the attenuation along the z-axis in the lateral and sagittal directions of the digital radiogram. Depending on this distribution of the attenuation, the tube current (mA) is defined for every tube rotation. In addition, the tube current was modulated during each tube rotation. First, a three step oval water phantom was measured to evaluate the potential of this method with respect to dose reduction and image quality. In a patient study (n = 26), four different scan regions (shoulder, thorax, abdomen, pelvis) were examined and dose (mAs) and image quality evaluated in comparison to examinations with a standard protocol for these regions in adults and a weight-adjusted standard protocol in children. The image quality was classified in consensus as good, sufficient and poor image quality. Results: By adapting and modulating the tube current, we substantially reduced the variation of noise in one spiral scan and in one scan region of our patient collective. The dose (average mAs) was reduced by 31% to 66% in children (mean 44%) and between 35% and 64% in adults (mean 53%), depending on the scan region. The image quality was substantially improved in regions with high attenuation and did not suffer in low attenuation regions. Conclusion: The dose can be reduced substantially by an automatic exposure control including angular tube current modulation with the same or improved image quality.