Title:
A comparison of methods to estimate organ doses in CT when utilizing approximations to the tube current modulation function.

Abstract:
Most methods to estimate patient dose from computed tomography (CT) exams have been developed based on fixed tube current scans. However, in current clinical practice, many CT exams are performed using tube current modulation (TCM). Detailed information about the TCM function is difficult to obtain and therefore not easily integrated into patient dose estimate methods. The purpose of this study was to investigate the accuracy of organ dose estimates obtained using methods that approximate the TCM function using more readily available data compared to estimates obtained using the detailed description of the TCM function.
Twenty adult female models generated from actual patient thoracic CT exams and 20 pediatric female models generated from whole body PET∕CT exams were obtained with IRB (Institutional Review Board) approval. Detailed TCM function for each patient was obtained from projection data. Monte Carlo based models of each scanner and patient model were developed that incorporated the detailed TCM function for each patient model. Lungs and glandular breast tissue were identified in each patient model so that organ doses could be estimated from simulations. Three sets of simulations were performed: one using the original detailed TCM function (x, y, and z modulations), one using an approximation to the TCM function (only the z-axis or longitudinal modulation extracted from the image data), and the third was a fixed tube current simulation using a single tube current value which was equal to the average tube current over the entire exam. Differences from the reference (detailed TCM) method were calculated based on organ dose estimates. Pearson's correlation coefficients were calculated between methods after testing for normality. Equivalence test was performed to compare the equivalence limit between each method (longitudinal approximated TCM and fixed tube current method) and the detailed TCM method. Minimum equivalence limit was reported for each organ.
Doses estimated using the longitudinal approximated TCM resulted in small differences from doses obtained using the detailed TCM function. The calculated root-mean-square errors (RMSE) for adult female chest simulations were 9% and 3% for breasts and lungs, respectively; for pediatric female chest and whole body simulations RMSE were 9% and 7% for breasts and 3% and 1% for lungs, respectively. Pearson's correlation coefficients were consistently high for the longitudinal approximated TCM method, ranging from 0.947 to 0.999, compared to the fixed tube current value ranging from 0.8099 to 0.9916. In addition, an equivalence test illustrated that across all models the longitudinal approximated TCM is equivalent to the detailed TCM function within up to 3% for lungs and breasts.
While the best estimate of organ dose requires the detailed description of the TCM function for each patient, extracting these values can be difficult. The presented results show that an approximation using available data extracted from the DICOM header provides organ dose estimates with RMSE of less than 10%. On the other hand, the use of the overall average tube current as a single tube current value was shown to result in poor and inconsistent estimates of organ doses.