European Radiology

, Volume 22, Issue 9, pp 1937–1945 | Cite as

Automated tube potential selection for standard chest and abdominal CT in follow-up patients with testicular cancer: comparison with fixed tube potential

  • Ralph Gnannt
  • Anna Winklehner
  • Daniel Eberli
  • Alexander Knuth
  • Thomas Frauenfelder
  • Hatem Alkadhi
Computed Tomography



To evaluate prospectively, in patients with testicular cancer, the radiation dose-saving potential and image quality of contrast-enhanced chest and abdominal CT with automated tube potential selection.


Forty consecutive patients with testicular cancer underwent contrast-enhanced arterio-venous chest and portal-venous abdominal CT with automated tube potential selection (protocol B; tube potential 80–140 kVp), which is based on the attenuation of the CT topogram. All had a first CT at 120 kVp (protocol A) using the same 64-section CT machine and similar settings. Image quality was assessed; dose information (CTDIvol) was noted.


Image noise and attenuation in the liver and spleen were significantly higher for protocol B (P < 0.05 each), whereas attenuation in the deltoid and erector spinae muscles was similar. In protocol B, tube potential was reduced to 100 kVp in 18 chest and 33 abdominal examinations, and to 80 kVp in 5 abdominal CT examinations; it increased to 140 kVp in one patient. Image quality of examinations using both CT protocols was rated as diagnostic. CTDIvol was significantly lower for protocol B compared to protocol A (reduction by 12%, P < 0.01).


In patients with testicular cancer, radiation dose of chest and abdominal CT can be reduced with automated tube potential selection, while image quality is preserved.


Computed tomography Radiation dose Tube potential Testicular cancer Image quality 


  1. 1.
    Shah MN, Devesa SS, Zhu K, McGlynn KA (2007) Trends in testicular germ cell tumours by ethnic group in the United States. Int J Androl 30:206–213, discussion 213–204PubMedCrossRefGoogle Scholar
  2. 2.
    Huddart RA, Birtle AJ (2005) Recent advances in the treatment of testicular cancer. Expert Rev Anticancer Ther 5:123–138PubMedCrossRefGoogle Scholar
  3. 3.
    Albers P, Albrecht W, Algaba F et al (2005) Guidelines on testicular cancer. Eur Urol 48:885–894PubMedCrossRefGoogle Scholar
  4. 4.
    Schmoll HJ, Jordan K, Huddart R et al (2010) Testicular seminoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21:v140–v146PubMedCrossRefGoogle Scholar
  5. 5.
    Amis ES Jr, Butler PF (2010) ACR white paper on radiation dose in medicine: three years later. J Am Coll Radiol 7:865–870PubMedCrossRefGoogle Scholar
  6. 6.
    Sodickson A, Baeyens PF, Andriole KP et al (2009) Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 251:175–184PubMedCrossRefGoogle Scholar
  7. 7.
    Brenner DJ, Doll R, Goodhead DT et al (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 100:13761–13766PubMedCrossRefGoogle Scholar
  8. 8.
    Kalra MK, Maher MM, Toth TL et al (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233:649–657PubMedCrossRefGoogle Scholar
  9. 9.
    Huda W, Scalzetti EM, Levin G (2000) Technique factors and image quality as functions of patient weight at abdominal CT. Radiology 217:430–435PubMedGoogle Scholar
  10. 10.
    Winklehner A, Goetti R, Baumueller S et al (2011) Automated attenuation-based tube potential selection for thoracoabdominal computed tomography angiography: improved dose effectiveness. Invest Radiol 46:767–773PubMedCrossRefGoogle Scholar
  11. 11.
    Radiology DSo (1998) European guidelines on quality criteria for computed tomography.
  12. 12.
    May MS, Wust W, Brand M et al (2011) Dose reduction in abdominal computed tomography: intraindividual comparison of image quality of full-dose standard and half-dose iterative reconstructions with dual-source computed tomography. Invest Radiol 46:465–470PubMedCrossRefGoogle Scholar
  13. 13.
    AAPM Task Group 23 of the Diagnostic Imaging Council CT Committee (2008) The measurement, reporting, and management of radiation dose in CT. The American Association of Physicists in Medicine, College Park, MDGoogle Scholar
  14. 14.
    Shrimpton PC, Hillier MC, Lewis MA, Dunn M (2006) National survey of doses from CT in the UK: 2003. Br J Radiol 79:968–980PubMedCrossRefGoogle Scholar
  15. 15.
    Pontana F, Pagniez J, Flohr T et al (2011) Chest computed tomography using iterative reconstruction vs filtered back projection (Part 1): evaluation of image noise reduction in 32 patients. Eur Radiol 21:627–635PubMedCrossRefGoogle Scholar
  16. 16.
    Winklehner A, Karlo C, Puippe G et al (2011) Raw data-based iterative reconstruction in body CTA: evaluation of radiation dose saving potential. Eur Radiol 21:2521–2526PubMedCrossRefGoogle Scholar
  17. 17.
    Mitsumori LM, Shuman WP, Busey JM, Kolokythas O, Koprowicz KM (2012) Adaptive statistical iterative reconstruction versus filtered back projection in the same patient: 64 channel liver CT image quality and patient radiation dose. Eur Radiol 22:138–143PubMedCrossRefGoogle Scholar
  18. 18.
    Gnannt R, Winklehner A, Goetti R, Schmidt B, Kollias S, Alkadhi H (2012) Low kilovoltage CT of the neck with 70  kVp: comparison with a standard protocol. AJNR Am J Neuroradiol. doi: 10.3174/ajnr.A2910
  19. 19.
    Nakayama Y, Awai K, Funama Y et al (2006) Lower tube voltage reduces contrast material and radiation doses on 16-MDCT aortography. AJR Am J Roentgenol 187:W490–W497PubMedCrossRefGoogle Scholar
  20. 20.
    Yu L, Li H, Fletcher JG, McCollough CH (2010) Automatic selection of tube potential for radiation dose reduction in CT: a general strategy. Med Phys 37:234–243PubMedCrossRefGoogle Scholar
  21. 21.
    Alkadhi H, Schindera ST (2011) State of the art low-dose CT angiography of the body. Eur J Radiol 80:36–40PubMedCrossRefGoogle Scholar
  22. 22.
    Leschka S, Stolzmann P, Schmid FT et al (2008) Low kilovoltage cardiac dual-source CT: attenuation, noise, and radiation dose. Eur Radiol 18:1809–1817PubMedCrossRefGoogle Scholar
  23. 23.
    Wintersperger B, Jakobs T, Herzog P et al (2005) Aorto-iliac multidetector-row CT angiography with low kV settings: improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol 15:334–341PubMedCrossRefGoogle Scholar
  24. 24.
    Schindera ST, Graca P, Patak MA et al (2009) Thoracoabdominal-aortoiliac multidetector-row CT angiography at 80 and 100  kVp: assessment of image quality and radiation dose. Invest Radiol 44:650–655PubMedCrossRefGoogle Scholar
  25. 25.
    Marin D, Nelson RC, Barnhart H et al (2010) Detection of pancreatic tumors, image quality, and radiation dose during the pancreatic parenchymal phase: effect of a low-tube-voltage, high-tube-current CT technique—preliminary results. Radiology 256:450–459PubMedCrossRefGoogle Scholar
  26. 26.
    Marin D, Nelson RC, Samei E et al (2009) Hypervascular liver tumors: low tube voltage, high tube current multidetector CT during late hepatic arterial phase for detection—initial clinical experience. Radiology 251:771–779PubMedCrossRefGoogle Scholar
  27. 27.
    Hansen J, Jurik AG (2009) Diagnostic value of multislice computed tomography and magnetic resonance imaging in the diagnosis of retroperitoneal spread of testicular cancer: a literature review. Acta Radiol 50:1064–1070PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Ralph Gnannt
    • 1
  • Anna Winklehner
    • 1
  • Daniel Eberli
    • 2
  • Alexander Knuth
    • 3
  • Thomas Frauenfelder
    • 1
  • Hatem Alkadhi
    • 1
  1. 1.Institute of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Clinic for UrologyUniversity Hospital ZurichZurichSwitzerland
  3. 3.Clinic for OncologyUniversity Hospital ZurichZurichSwitzerland

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