Effect of dose metrics and radiation risk models when optimizing CT x-ray tube voltage

We investigated the effect of different CT dose metrics, as well as the implications of various radiation risk models, on the optimization of x-ray tube voltage (kV) in CT. Soft tissue attenuation characteristics and noise levels, obtained from CT scans of a Rando phantom, were used to compute contrast-to-noise ratios (CNR) at x-ray tube voltages between 80 and 140 kV. Four CT dose metrics were evaluated: (a) CTDI_air, (b) weighted CTDI_w, (c) organ dose (D_organ), and (d) effective dose (E). All doses were obtained using the ImPACT CT Dosimetry software package. Soft tissue CNR was adjusted by the modification of the mAs by assuming that CNR² was proportional to mAs. Optimization criteria were: (a) maintaining a constant CNR at each kV and identifying the value that minimizes patient dose; and (b) maintaining a constant dose at each kV and identifying the value that maximizes CNR. We also investigated the implication for optimization strategies assuming that radiation risk is proportional to Eⁿ, with n varying between 0 and 2. Optimizing with respect to phantom measurements (i.e., CTDI_air and CTDI_w) could generate results that differed quantitatively and qualitatively from those obtained using patient doses (i.e., D_organ and E). For head CT scans, 140 kV offered the lowest patient doses as well as the highest CNR, whereas in abdominal scans 80 kV was optimal. Use of an optimal kV for CT imaging over current practice of using 120 kV might reduce patient doses by 10–15%, or improve CNR by 5–10%. Assuming that the risk was proportional to Eⁿ made no difference to the optimal kV for positive values of n up to 2. We conclude that (a) CT optimization with respect to kV should generally be performed with respect to the patient effective dose, (b) neither CTDI_air nor the body CTDI_w are appropriate for use in CT optimization, (c) the range of current radiation risk models should not affect the optimal kV value in CT imaging.