Radiation dose reduction to the breast in thoracic CT: Comparison of bismuth shielding, organ‐based tube current modulation, and use of a globally decreased tube current

Wang, Jia; Duan, Xinhui; Christner, Jodie A.; Leng, Shuai; Yu, Lifeng

doi:10.1118/1.3651489

Cited by 92 publications

(96 citation statements)

References 22 publications

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“…In a study on a semi-anthropomorphic phantom, Vollmar et al 10 reported a 45% breast dose reduction with this technique,however, the spinal organ dose increased by 19%. Similar results were reported with the organ based tube current modulation technique, yielding 12% to 39% breast dose reduction, based on the size of thorax phantom 11 . Partial CT scanning technique was not available on our scanner.…”

Section: Discussionsupporting

confidence: 74%

“…Similarly, the estimated organ dose applied to the female breast decreased by 17.6% to 4.2 mGy in the IRIS group, without inducing streak artifacts reported when using bismuth breast shielding 10,11 and without compromising objective or subjective image quality. This desirable radiation reducing effect is amplified when given the significant proportion of young females undergoing pulmonary MDCTA; overall breast tissue radiosensitivity; as well as the fact that the breast is exposed to the primary beam in virtually all studies.…”

Section: Discussionmentioning

confidence: 88%

“…Although some authors advocate their use owing to their significant breast dose reducing effect 9,17,18 , other studies referred to increased noise level, decreased image quality, and the presence of streak and beam hardening artifacts induced by the shields 10,11 . Consequently, the American Association of Physicists in Medicine recently issued a statement on the use of bismuth shielding in CT scanning which makes note of several disadvantages to their use.…”

Section: Discussionmentioning

confidence: 99%

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Iterative reconstruction of pulmonary MDCT angiography: Effects on image quality, effective dose and estimated organ dose to the breast

Žižka¹,

Ryška²,

Štěpanovská³

et al. 2014

BIOMED PAP

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Aims.To compare the image characteristics, effective dose and estimated organ dose to the female breast in pulmonary MDCT angiography (MDCTA), reconstructed with either standard filtered back projection (FBP), or iterative reconstruction in image space (IRIS). Methods. Pulmonary MDCTA performed in 116 females (age 18 -77 years; body mass index 15 -48) was reconstructed with FBP (n=52) or IRIS (n=64). Scans were acquired on a 128-row MDCT system using automatic tube current modulation, 100 kV tube voltage, and a quality reference mAs value of 120 (FBP) and 80 (IRIS). Dose was calculated from CT dose index (CTDIvol) and dose length product (DLP) values utilising ImPACT software. Image noise was measured within the pulmonary artery. Qualitative visual assessment of the scans was performed (1=negligible noise, 5=noise obscuring diagnostic information). Results. The average CTDIvol yielded 4.33 mGy for FBP and 3.54 mGy for IRIS, respectively (18.2% decrease). The average effective scan dose was 2.73±0.57 mSv (FBP) and 2.29±0.68 mSv (IRIS), respectively (16.1% decrease). The estimated average organ dose to the breast decreased from 5.1±1.1 mGy (FBP) to 4.2±1.2 mGy (IRIS, 17.6% decrease). No nondiagnostic scans (score 5) were encountered in either group. Significant improvement in image noise levels (P<0.01) and subjective image quality (P<0.02) were noted in IRIS group. Conclusion. Pulmonary MDCTA utilizing a 100 kV technique, automatic tube current modulation, and iterative image reconstruction offers robust results in routine conditions among an unselected female population, with breast doses being comparable to two-view digital mammography. Moreover, iterative reconstruction offers improvements in both image noise and visual perception of the scans, thus suggesting a potential for further dose reduction.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Iterative reconstruction of pulmonary MDCT angiography: Effects on image quality, effective dose and estimated organ dose to the breast

Žižka¹,

Ryška²,

Štěpanovská³

et al. 2014

BIOMED PAP

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“…5,35,46 Several of these studies report significant increases in image noise. 5,35,41 Wang et al 39 showed image noise in both the heart and lung, with increasing noise closer to the shield, where as the study by Einstein et al 44 showed increased noise affecting coronary artery visualisation. Investigators have also reported the presence of undesirable streak and beam hardening artifacts.…”

Section: Image Qualitymentioning

confidence: 98%

The Current Use and Effectiveness of Bismuth Shielding in Computed Tomography: A Systematic Review

Lawrence¹,

Seeram²

2017

Radiol Open J

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CitationThe increased use of computed tomography (CT) has raised concerns regarding the radiation dose received by radiosensitive organs. It is important that practical and reliable dose reduction strategies are implemented to reduce patient radiation exposure. Aims: The purpose of this article is to evaluate the current clinical use and effectiveness of bismuth shielding as a dose reduction technique and assess its impact on image quality, in an attempt to develop a recommendation for dose reduction in CT. Methods: A systematic review of current literature was conducted using the PubMed and Scopus databases. A total of 50 relevant articles were thoroughly assessed and evaluated.Results: This review found that whilst bismuth shielding proves to provide significant dose reductions to radiosensitive organs, numerous concerns exist including wasted radiation, reduced image quality and unpredictable results when combined with AEC. Alternative methods such as tube current modulation and iterative reconstruction algorithms can provide equivalent dose savings at superior image quality, without the limitations of bismuth shields. Conclusion: Until these alternative methods become available in all departments, bismuth shielding remains a viable dose reduction strategy.

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“…the Siemens X-CARE. Wang et al (22) showed that organ-based tube current modulation can achieve the same dose reduction as bismuth shielding without introducing artefacts, affecting the CT number accuracy, and increasing image noise.…”

Section: Discussionmentioning

confidence: 99%

Overview, Practical Tips and Potential Pitfalls of Using Automatic Exposure Control in Ct: Siemens Care Dose 4d

Söderberg

2015

Radiat Prot Dosimetry

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Today, computed tomography (CT) systems routinely use automatic exposure control (AEC), which modulates the tube current. However, for optimal use, there are several aspects of an AEC system that need to be considered. The purpose of this study was to provide an overview of the Siemens CARE Dose 4D AEC system, discuss practical tips, and demonstrate potential pitfalls. Two adult anthropomorphic phantoms were examined using two different Siemens CT systems. When optimizing the CT radiation dose and image quality, the projection angle of the localizer, patient centring, protocol selection, scanning direction, and the use of protective devices require special attention.

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Radiation dose reduction to the breast in thoracic CT: Comparison of bismuth shielding, organ‐based tube current modulation, and use of a globally decreased tube current

Cited by 92 publications

References 22 publications

Iterative reconstruction of pulmonary MDCT angiography: Effects on image quality, effective dose and estimated organ dose to the breast

Iterative reconstruction of pulmonary MDCT angiography: Effects on image quality, effective dose and estimated organ dose to the breast

The Current Use and Effectiveness of Bismuth Shielding in Computed Tomography: A Systematic Review

Overview, Practical Tips and Potential Pitfalls of Using Automatic Exposure Control in Ct: Siemens Care Dose 4d

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