Dose Reduction and Optimization in Computed Tomography of the Chest

  • Pierre Alain Gevenois
  • Denis Tack
Part of the Medical Radiology book series (MEDRAD)


Even if the clinical benefit of multi-detector computed tomography (MDCT) of the chest is expected to be much higher than the potential risks from radiation, reduction and optimization of the radiation dose are highly recommended in accordance with the ALARA principle. As the chest is composed by organs and structures that are characterized by high differences in attenuation values with spontaneously high contrasts, it is well established that MDCT dose can be dramatically reduced. It has been indeed documented that in numerous clinical circumstances, radiation dose cannot be higher than 10 to 20% of the standard doses recommended by the scanner vendors (i.e. CTDIvol from 0.6 to 3 mGy, DLP from 30 to 120 mGy cm, E from 0.6 to 2.5 mSv as compared to 8–14 mSv). This is of particular concern in patients with long life expectancy and can be achieved by automatic exposure control in adjunction to either reduced tube current time product, reduced tube potential, or both. Newly developed dose reduction strategies, in particular iterative reconstructions will enable to obtain CT scans of high quality with a dose close of that delivered for plain film examinations.


Chronic Obstructive Pulmonary Disease Compute Tomography Examination Bronchiolitis Obliterans Syndrome Pulmonary Emphysema Compute Tomography Pulmonary Angiography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Bae KT, Slone RM, Gierada DS, Yusen RD, Cooper JD (1997) Patients with emphysema: quantitative CT analysis before and after lung volume reduction surgery. Radiology 203:705–714PubMedGoogle Scholar
  2. Bankier AA, Van Muylem A, Scillia P, De Maertelaer V, Estenne M, Gevenois PA (2003) Air trapping in heart–lung transplant recipients: variability of anatomic distribution and extent at sequential expiratory thin-section CT. Radiology 229:737–742PubMedCrossRefGoogle Scholar
  3. Bankier AA, Schaefer-Prokop C, De Maertelaer V, Tack D, Jaksch P, Klepetko W, Gevenois PA (2007) Air trapping on thin-section CT examinations: comparison of standard-dose and simulated low-dose techniques. Radiology 242:898–906PubMedCrossRefGoogle Scholar
  4. Bendaoud S, Remy-Jardin M, Wallaert B et al (2011) Sequential versus volumetric computed tomography in the follow-up of chronic bronchopulmonary diseases: comparison of diagnostic information and radiation dose in 63 adults. J Thorac Imaging 26:190–195PubMedCrossRefGoogle Scholar
  5. Dinkel HP, Sonnenschein M, Hoppe H, Vock P (2003) Low-dose multislice CT of the thorax in follow-up of malignant lymphoma and extrapulmonary primary tumors. Eur Radiol 13:1241–1249PubMedGoogle Scholar
  6. Dirksen A, Dijkman JH, Madsen F et al (1999) A randomized clinical trial of α1-antitrypsin augmented therapy. Am J Respir Crit Care Med 160:1468–1472PubMedGoogle Scholar
  7. Eur (1999) European guidelines on quality criteria for computed tomography—EUR 16262 EN access on line at
  8. Gierada DS, Yusen RD, Pilgram TK et al (2001) Repeatability of quantitative CT indexes of emphysema in patients evaluated for lung volume reduction surgery. Radiology 220:448–454PubMedGoogle Scholar
  9. Golding SJ, Shrimpton PC (2002) Radiation dose in CT: are we meeting the challenge? (commentary). Br J Radiol 75:1–4PubMedGoogle Scholar
  10. Henschke CI, McCauley DI, Yankelevitz DF et al (1999) Early lung cancer action project: overall design and findings from baseline screening. Lancet 354:99–105PubMedCrossRefGoogle Scholar
  11. Itoh H, Ikeda M, Arahata S et al (2000) Lung cancer screening: minimum tube current required for helical CT. Radiology 215:175–183PubMedGoogle Scholar
  12. Lee KS, Primack SL, Staples CA, Mayo JR, Aldrich JE, Müller NL (1994) Chronic infiltrative lung disease: comparison of diagnostic accuracies of radiography and low- and conventional-dose thin-section CT. Radiology 191:669–673PubMedGoogle Scholar
  13. Madani A, De Maertelaer V, Zanen J, Gevenois PA (2007) Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification—comparison with macroscopic and microscopic morphometry. Radiology 243:250–257PubMedCrossRefGoogle Scholar
  14. Massaro GD, Massaro D (1997) Retinoic acid treatment abrogates elastase-induced pulmonary emphysema in rats. Nat Med 3:675–677 (Erratum in: Nat Med 3(7):805, July 1997)Google Scholar
  15. Mayo JR, Webb WR, Gould R et al (1987) High-resolution CT of the lungs: an optimal approach. Radiology 163:507–510PubMedGoogle Scholar
  16. Mayo JR, Whittall KP, Leung AN et al (1997) Simulated dose reduction in conventional chest CT: validation study. Radiology 202:453–457PubMedGoogle Scholar
  17. Naidich DP, Marshall CH, Gribbin C, Arams RS, McCauley DI (1990) Low-dose CT of the lungs: preliminary observations. Radiology 175:729–731PubMedGoogle Scholar
  18. National Lung Screening Trial Team (2011) The national lung screening trial: overview and study design. Radiology 258:243–253CrossRefGoogle Scholar
  19. Newell JD, Hogg JC, Snider GL (2004) Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema. Eur Respir J 23:769–775PubMedCrossRefGoogle Scholar
  20. O’Connor OJ, Vandeleur M, McGarrigle AM, Moore N, McWilliams SR, McSweeney SE, O’Neill M, Ni Chroinin M, Maher MM (2010) Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients. Radiology 257:820–829PubMedCrossRefGoogle Scholar
  21. Pontana F, Pagniez J, Flohr T et al (2011a) Chest computed tomography using iterative reconstruction versus filtered back projection (part 1): evaluation of image noise reduction in 32 patients. Eur Radiol 21:627–635PubMedCrossRefGoogle Scholar
  22. Pontana F, Duhamel A, Pagniez J et al (2011b) Chest computed tomography using iterative reconstruction versus filtered back projection (part 2): image quality of low-dose CT examinations in 80 patients. Eur Radiol 21:636–643PubMedCrossRefGoogle Scholar
  23. Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J (2002) Impact of COPD in North America and Europe in 2000: subjects’ perspective of confronting COPD international survey. Eur Respir J 20:799–805PubMedCrossRefGoogle Scholar
  24. Rogers L (2001a) Radiation exposure in CT: why so high? Am J Roentgenol 177:277Google Scholar
  25. Rogers LF (2001b) Serious business: radiation safety and radiation protection. Am J Roentgenol 177:1Google Scholar
  26. Schindera ST, Graca P, Patak MA, Abderhalden S, von Allmen G, Vock P, Szucs-Farkas Z (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
  27. Schueller-Weidekamm C, Schaefer-Prokop CM, Weber M et al (2006) CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. Radiology 241:899–907PubMedCrossRefGoogle Scholar
  28. Shrimpton PC, Hillier MC, Lewis MA et al (2003) Data from computed tomography (CT) examinations in the UK—2003 review. NRPB-W67, National Radiological Protection Board, ChiltonGoogle Scholar
  29. Sigal-Cinqualbre AB, Hennequin R, Abada HT, Chen X, Paul JF (2004) Low-kilovoltage multidetector row chest CT in adults: feasability and effect on image quality and iodine dose. Radiology 231:169–174PubMedCrossRefGoogle Scholar
  30. Singh S, Kalra MK, Gilman MD et al (2011) Adaptive statistical iterative reconstruction technique for radiation dose reduction in chest CT: a pilot study. Radiology 259:565–573Google Scholar
  31. Snider GL, Kleinerman JL, Thurlbeck WM et al (1985) The definition of emphysema: report of a National Heart, Lung, and Blood Institute, Division of Lung Disease workshop. Am Rev Respir Dis 132:182–185Google Scholar
  32. Studler U, Gluecker T, Bongartz G, Roth J, Steinbrich W (2005) Image quality from high-resolution CT of the lung: comparison of axial scans and of sections reconstructed from volumetric data acquired using MDCT. Am J Roentgenol 185:602–607Google Scholar
  33. Swensen SJ, Jett JR, Sloan JA et al (2002) Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med 165:508–513PubMedGoogle Scholar
  34. Szucs-Farkas Z, Schaller C, Bensler S, Patak MA, Vock P, Schindera ST (2009) Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 and 120 kVp protocols in a matched cohort. Invest Radiol 44:793–799PubMedCrossRefGoogle Scholar
  35. Tack D, De Maertelaer V, Petit W, Scillia P, Muller P, Suess C, Gevenois PA (2005) Comparisons of standard-dose and simulated low-dose multi-detector-row CT pulmonary angiography. Radiology 236:318–325PubMedCrossRefGoogle Scholar
  36. Unscear (2000) Sources and effects of ionizing radiation. United Nations scientific committee on the effects of atomic radiation report to the General Assembly. United Nations, New YorkGoogle Scholar
  37. Waaijer A, Prokop M, Velthuis BK, Bakker CJ, de Kort GA, van Leeuwen MS (2007) Circle of Willis at CT angiography: dose reduction and image quality–reducing tube voltage and increasing tube current settings. Radiology 242:829–832CrossRefGoogle Scholar
  38. Wittenberg R, Peters JF, Sonnemans JJ et al (2011) Impact of image quality on the performance of computer-aided detection of pulmonary embolism. Am J Roentgenol 196:95–101CrossRefGoogle Scholar
  39. Zwirewich CV, Mayo JR, Müller NL (1991) Low-dose high-resolution CT of lung parenchyma. Radiology 180:413–417PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2011

Authors and Affiliations

  1. 1.Department of Radiology, Clinic of Chest Imaging, Hôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
  2. 2.Department of RadiologyRHMS Clinique Louis CatyBaudourBelgium

Personalised recommendations