Dose Optimization and Reduction in CT of the Brain and Head and Neck Region

  • Tom Mulkens
  • Rodrigo Salgado
  • Patrick Bellinck
Part of the Medical Radiology book series (MEDRAD)


In this chapter an overview is given of different modalities for dose optimization and reduction in cranial CT and CT of the Head and Neck region. For adult cranial CT, the role of the justification process and the implementation of the use of imaging guidelines are discussed. Possibilities for dose reduction by use of diagnostic reference levels (RDLs) and the introduction of recent dose reduction techniques, like tube current modulation and iterative reconstruction, are overviewed. A separate part is dedicated to dose reduction in cranial CT of children. In the Head and Neck region, the main topics are use of low dose CT of the sinuses in adults and children and the recent introduction of cone beam CT as a low-dose alternative for conventional CT.


Iterative Reconstruction Tube Current Modulation Functional Endoscopic Sinus Surgery Acute Sinusitis CBCT Imaging 
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.


Brain CT:

  1. American College of Radiology, Appropriateness Criteria for imaging (2011).
  2. Boone JM, Geraghty EM, Seibert JA et al (2003) Dose reduction in pediatric CT: a rational approach. Radiology 228:352–360PubMedCrossRefGoogle Scholar
  3. Brisse H, Aubert B (2009) CT exposure from pediatric MDCT: results from the 2007–2008 SFIPP/IRSN survey. J Radiol 90:207–215PubMedCrossRefGoogle Scholar
  4. Britten AJ, Crotty M, Kiremidjian H et al (2004) The addition of computer simulated noise to investigate radiation dose and image quality in images with spatial correlation of statistical noise: an example application to X-ray CT of the brain. Br J Radiol 77:323–328PubMedCrossRefGoogle Scholar
  5. Brenner DJ, Elliston CD, Hall EJ et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. Am J Roentgenol 176:289–296Google Scholar
  6. Buls N, Bosmans H, Mommaert C et al (2009) Current status on pediatric CT doses: a multicentre study (Belgium). RSNA meeting, Chicago.
  7. Chan CY, Wong YC, Yu SK et al (1999) Radiation dose reduction in paediatric cranial CT. Pediatr Radiol 29:770–775PubMedCrossRefGoogle Scholar
  8. Clark J, Cranley K, Robinson J et al (2000) Application of draft European Commission reference levels to a regional CT dose survey. Br J Radiol 73:43–50Google Scholar
  9. Clarke JC, Cranley K, Kelly BE et al (2001) Provision of MRI can significantly reduce CT collective radiation dose. Br J Radiol 74:926–931PubMedGoogle Scholar
  10. Cohnen M, Fisher H, Hamacher J et al (2000) CT of the head by use of reduced current and kilovoltage: relationship between image quality and dose reduction. Am J Neuroradiol 21:1654–1660PubMedGoogle Scholar
  11. European Community (1998) Quality criteria for computed tomography. EC working document EUR 16262, Brussels, EU, 1998Google Scholar
  12. European Commission: Radiation protection 118. Referral guidelines for imaging. Office for Official Publications of the European Communities, Luxembourg, 2008.
  13. Fearon T, Vucich J (1987) Normalized pediatric organ-absorbed doses from CT examinations. Am J Roentgenol 148:171–174Google Scholar
  14. Fox AJ (2004) Use of the lowest necessary radiation dose (editorial). Am J Neuroradiol 25:519PubMedGoogle Scholar
  15. Galanski M, Nagel HD, Stamm G (2007) Paediatric CT exposure practice in the federal republic of Germany: results of a nationwide survey in 2005–2006. Medizinische Hochschule, HannoverGoogle Scholar
  16. Gündogdu S, Mahmutyazicioglu K, Ozdemir H et al (2005) Assessment of image quality of a standard and three dose-reducing protocols in adult cranial CT. Eur Radiol 5:1959–1968CrossRefGoogle Scholar
  17. Hart D, Wall BF (2004) UK population dose from medical X-ray examinations. Eur Radiol 50:285–291CrossRefGoogle Scholar
  18. Hall EJ, Brenner DJ (2008) Cancer risks from diagnostic radiology. Br J Radiol 81:362–378PubMedCrossRefGoogle Scholar
  19. Hidajat N, Wolf M, Nunnemann A et al (2001) Survey of conventional and spiral CT doses. Radiology 129:395–401Google Scholar
  20. Hiles PA, Brennen SE, Scott SA et al (2001) A survey of patient dose and image quality for computed tomography in Wales. J Radiol Prot 21:345–354PubMedCrossRefGoogle Scholar
  21. Huda W, Atherton JV, Ware DA et al (1997) An approach for the estimation of effective radiation dose at CT in pediatric patients. Radiology 203:417–422PubMedGoogle Scholar
  22. International Commission on Radiological Protection (1991) Recommendations of the International Commission on Radiological Protection. ICRP report 60. Annals of the ICRP, 21 (1–3), 1991Google Scholar
  23. Kalra MK, Maher MM, Toth TL et al (2004a) Techniques and applications of automatic tube current modulation. Radiology 233:649–657PubMedCrossRefGoogle Scholar
  24. Kilic K, Erbas G, Guryldirim M et al (2011) Lowering the dose in head CT using adaptive statistical iterative reconstruction. Am J Neuroradiol, Epub, 11 August 2011,  10.3174/ajnr.A2585
  25. Leipsic J, LaBounty TM, Heilbron B et al (2010) Adaptive statistical iterative reconstruction: assessment of image noise and image quality in coronary CT angiography. Am J Roentgenol 195:649–654CrossRefGoogle Scholar
  26. McCrohan JL, Patterson IF, Gagne RM et al (1987) Average radiation doses in standard head examination for 250 CT systems. Radiology 163:263–268PubMedGoogle Scholar
  27. Mullins ME, Lev MH, Bove P et al (2004) Comparison of image quality between conventional and low-dose nonenhanced head CT. Am J Neuroradiol 25:533–538PubMedGoogle Scholar
  28. Oikarinen H, Meriläinen S, Pääkö E et al (2009) Unjustified CT examinations in young patients. Eur Radiol 19:1161–1165PubMedCrossRefGoogle Scholar
  29. Pantos I, Thalassinou S, Argentos S et al (2011) Adult patient radiation doses from non-cardiac CT examinations: a review of published results. Br J Radiol 84:293–303PubMedCrossRefGoogle Scholar
  30. Rehani MM, Berry M (2000) Radiation doses in computed tomography. Br Med J 320:593–594CrossRefGoogle Scholar
  31. Rogers LF (2001) Taking care of children: check out the parameters used for helical CT (editorial). Am J Roentgenol 176:287Google Scholar
  32. Royal College of Radiologists, UK, Referral guidelines (2011).
  33. Shah R, Gupta AK, Rehani MM et al (2005) Effect of reduction in tube current on reader confidence in paediatric computed tomography. Clin Radiol 60:224–231PubMedCrossRefGoogle Scholar
  34. Shrimpton PC, Jones DG, Hillier MC et al (1991) Survey of CT practice in the UK, NRPB-R249 report. National Radiological Protection Board (NRPB), Chilton, UKGoogle Scholar
  35. Shrimpton PC, Hillier MC, Lewis MA et al (2005) Dose from CT examination in the UK-2003 review. NRPB-W67 Report. National Radiological Protection Board, ChiltonGoogle Scholar
  36. Silkoset RD, Lysdahl KB, Olerud HM (2010) Variations in doses from CT examinations, presented at: European Congress of Radiology, ViennaGoogle Scholar
  37. Silva AC, Lawder HJ, Hara A et al (2010) Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. Am J Roentgenol 194:191–199CrossRefGoogle Scholar
  38. Smith AB, Dillon WP, Lau BC et al (2008) Radiation dose reduction strategy for CT protocols: successful implementation in neuroradiology section. Radiology 247:499–506PubMedCrossRefGoogle Scholar
  39. Stamm G (2007) Collective radiation dose from MDCT: critical review of survey studies. In: Radiation dose from adult and pediatric multidetector computed tomography, 1st edn. Springer, Berlin-Heidelberg, pp 81–97Google Scholar
  40. Tsapaki V, Aldrich JE, Sharma R et al (2006) Dose reduction in CT while maintaining diagnostic confidence: Diagnostic reference levels at routine head, chest and abdominal CT–IAEA-coordinated research project. Radiology 240:828–834PubMedCrossRefGoogle Scholar
  41. Van Unnik J, Broerse JJ, Geleijns J et al (1997) Survey of CT techniques and absorbed dose in various Dutch hospitals. Br J Radiol 70:367–371PubMedGoogle Scholar
  42. Veit R, Guggenberger R, Nosske D et al (2010) Diagnostische referenzwerte für röntgenuntersuchungen. Radiologe 50:907–912PubMedCrossRefGoogle Scholar
  43. Verdun FR, Gutierrez D, Vader JO et al (2008) CT radiation dose in children: a survey to establish age-based diagnostic reference levels in Switzerland. Eur Radiol 18:1980–1986PubMedCrossRefGoogle Scholar
  44. Wong ETH, Yu SK, Lai M et al (2001) MAPD–an objective way to select mAs for paediatric brain CT. Br J Radiol 74:932–937PubMedGoogle Scholar
  45. Yeoman LJ, Howarth L, Britten A et al (1992) Gantry angulation in brain CT: dosage implications, effect on posterior fossa artifacts, and current international practice. Radiology 184:113–116PubMedGoogle Scholar
  46. Zacharia TT, Kanekar SG, Nguyen DT et al (2011) Optimization of patient dose and image quality with z-axis dose modulation for computed tomography (CT) in head trauma and stroke. Emerg Radiol 18:103–107PubMedCrossRefGoogle Scholar
  47. Zwirewich CV, Mayo JR, Müller NL (1991) Low-dose high resolution CT of lung parenchyma. Radiology 180:413–417PubMedGoogle Scholar

Head and Neck CT

  1. American Academy of Pediatrics (no authors listed) (2001) Subcommittee on management of sinusitis and Committee on quality improvement: clinical practice guideline: management of sinusitis. Pediatrics 108:798–808Google Scholar
  2. Bulla S, Blanke P, Hassepass F et al (2011) Reducing the radiation dose for low-dose CT of the paranasal sinuses using iterative reconstruction: feasibility and image quality. Eur J Radiol, EPub June 8, 2011, doi  10.1016/e.ejrad.2011.05.002
  3. Czechowski J, Janeczek J, Kelly G et al (2001) Radiation dose to the lens in sequential and spiral CT of facial bones and sinuses. Eur Radiol 11:711–713PubMedCrossRefGoogle Scholar
  4. Duvoisin B, Landry M, Chapuis et al (1991) Low-dose CT and inflammatory disease of the paranasal sinuses. Neuroradiology 33:403–406Google Scholar
  5. Eggesbö HB (2006) Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol 16:872–888PubMedCrossRefGoogle Scholar
  6. George P, Huges J (1990) Respiratory system. In: Summitt (ed) Comprehensive pediatrics, MosbyGoogle Scholar
  7. Glasier CM, Mallory GB, Steele RW (1989) Significance of opacification of the maxillary and ethmoid sinuses in infants. J Pediatr 114:45–50PubMedCrossRefGoogle Scholar
  8. Gordts F, Clement PA, Destryker A et al (1997) Prevalence of sinusitis signs on MRI in a non-ENT pediatric population. Rhinology 35:154–157PubMedGoogle Scholar
  9. Greess H, Lutze J, Nomayr A et al (2004) Dose reduction in subsecond multislice spiral CT examination of children by online tube current modulation. Eur Raadiol 14:995–999CrossRefGoogle Scholar
  10. Hagtvedt T, Aalokken TM, Notthellen J et al (2003) A new low-dose CT examination compared with standard-dose CT in the diagnosis of acute sinusitis. Eur Radiol 13:976–980PubMedGoogle Scholar
  11. Hein E, Rogalla P, Klingebiel R et al (2002) Low-dose CT of the paranasal sinuses with eye lens protection: effect on image quality and radiation dose. Eur Radiol 12:1693–1696PubMedCrossRefGoogle Scholar
  12. Hodez C, Griffaton-Taillandier C, Bensimon I (2011) Cone-beam imaging: applications in ENT. Eur Ann Otorhinolaryngol Head Neck Dis 128:65–78PubMedCrossRefGoogle Scholar
  13. Kalra MK, Maher MM, Toth TL et al (2004b) Techniques and applications of automatic tube current modulation. Radiology 233:649–657PubMedCrossRefGoogle Scholar
  14. Kearny SE, Jones P, Meakin K et al (1997) CT scanning of the paranasal sinuses–the effect of reducing mAs. Br J Radiol 70:1071–1074Google Scholar
  15. Kronemer KA, McAlister WH (1997) Sinusitis and its imaging in the pediatric population. Pediatr Radiol 27:837–846PubMedCrossRefGoogle Scholar
  16. Loubele M, Jacobs R, Maes F et al (2005) Radiation dose vs. image quality for low-dose CT protocols of the head for maxillofacial surgery and oral implant imaging. Radiat Prot Dosimetry 117:211–216PubMedCrossRefGoogle Scholar
  17. Loubele M, Bogaerts R, Van Dijck E et al (2009) Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. Eur J Radiol 71:461–468PubMedCrossRefGoogle Scholar
  18. Marmolya G, Wiesen EJ, Yagan R et al (1991) Paranasal sinuses: low-dose CT. Radiology 181:689–691PubMedGoogle Scholar
  19. McAlister WH, Lusk R, Muntz HR (1989) Comparison of plain radiographs and coronal CT scan in infants and children. Am J Roentgenol 153:1259–1264Google Scholar
  20. McAlister WH, Parker BR, Kushner DC et al (2000) Sinusitis in the pediatric population. American College of Radiology. ACR Appropriateness Criteria, 1999. Radiology 215:811–818PubMedGoogle Scholar
  21. McCollough CH, Bruesewitz RT, Kofler JM (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26:503–512PubMedCrossRefGoogle Scholar
  22. Miracle AC, Mukerji SK (2008a) Conebeam CT of the head and neck, part 2: clinical applications. Am J Neuroradiol 30:1088–1095CrossRefGoogle Scholar
  23. Miracle AC, Mukerji SK (2008b) Conebeam CT of the head and neck, part 2: clinical applications. Am J Neuroradiol 30:1285–1292CrossRefGoogle Scholar
  24. Mulkens TH, Broers C, Fieuws S et al (2005a) Comparison of effective doses for low-dose MDCT and radiographic examination of sinuses in children. Am J Roentgenol 184:1611–1618Google Scholar
  25. Mulkens TH, Bellinck P, Baeyaert M et al (2005b) Use of an automatic exposure control mechanism for dose optimization in multidetector-row CT examinations: clinical evaluation. Radiology 237:213–223PubMedCrossRefGoogle Scholar
  26. Nauer CB, Eichenberger A, Dupach B et al (2011) CT radiation dose for computer-assisted endoscopic sinus surgery: dose survey and determination of dose-reduction limits. Am J Neuroradiol 30:617–622CrossRefGoogle Scholar
  27. Pauwels R, Beinsberger J, Collaert B et al (2011) Effective dose range of cone beam computed tomography scanners. Eur J Radiol doi: 10.1016/ejrad.2010.11.028
  28. Rao VM, El-Noueam KI (1998) Sinonasal imaging. Anatomy and pathology. Radiol Clin North Am 36:921–939PubMedCrossRefGoogle Scholar
  29. Robb RA (1982) The dynamic spatial reconstructor: an X-ray video-fluoroscopic CT scanner for dynamic volume imaging of moving organs. IEEE Trans Med Imaging 1:22–33PubMedCrossRefGoogle Scholar
  30. Ruivo J, Mermuys K, Bacher K et al (2009) Cone beam computed tomography, a low-dose imaging technique in the postoperative assessment of cochlear implantation. Otol Neurotol 30:299–303PubMedCrossRefGoogle Scholar
  31. Rustemeyer P, Streubuhr U, Suttmoeller J (2004) Low-dose dental computed tomography: significant dose reduction without loss of image quality. Acta Radiol 45:847–853PubMedCrossRefGoogle Scholar
  32. Schell B, Bauer RW, Lehnert T et al (2011) Low-dose computed tomography of the paranasal sinus and facial skull using a high-pitch dual-source system–fist clinical results. Eur Radiol 21:107–112PubMedCrossRefGoogle Scholar
  33. Shrimpton PC, Jones DG, Hillier MC et al (1991) Survey of CT practice in the UK, NRPB-R249 report. National Radiological Protection Board (NRPB), Chilton, UKGoogle Scholar
  34. Sohaib SA, Peppercorn PD, Horrocks JA et al (2001) The effect of decreasing mAs on image quality and patient dose in sinus CT. Br J Radiol 74:157–161PubMedGoogle Scholar
  35. Suojanen JN, Regan F (1995) Spiral CT scanning of the paranasal sinuses. Am J Neuroradiol 16:787–789PubMedGoogle Scholar
  36. Tack D, Widelec J, De Maertelaer V et al (2003) Comparison between low-dose and standard-dose multidetector CT in patients with suspected chronic sinusitis. Am J Roentgenol 181:939–944Google Scholar
  37. Vandenberghe B, Jacobs R, Bosmans H (2010) Modern dental imaging: a review of the current technology and clinical applications in dental practice. Eur Radiol 20:2637–2655PubMedCrossRefGoogle Scholar
  38. Zinreich SJ, Benson ML, Oliveiro PJ (1996) Sinusonasal cavities: CT normal anatomy, imaging of the osteomeatal complex, and functional endoscopic sinus surgery. In: Harnsberger HR (ed) Head and neck imaging, 3rd edn. St.Louis, MosbyGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Tom Mulkens
    • 1
  • Rodrigo Salgado
    • 2
  • Patrick Bellinck
    • 1
  1. 1.Department of RadiologyHeilig Hart ZiekenhuisLierBelgium
  2. 2.Department of RadiologyUniversitair Ziekenhuis AntwerpenEdegemBelgium

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