Rpdir-P18 QC For CT Web

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology
RADIATION PROTECTION IN
DIAGNOSTIC AND
INTERVENTIONAL RADIOLOGY
Part 18: Optimization of protection in CT scanner
Practical exercise - Quality Control
IAEA
International Atomic Energy Agency
Contents
Quality control tests
CT accuracy, uniformity, linearity. and noise,
Low and high contrast resolution
Z-axis sensitivity
Alignment, table top travel accuracy
Gantry tilt measurement
Dosimetry
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18: Optimization of protection in CT scanner
Part 18: Optimization of protection in CT

scanner
Topic 1: Quality Control
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Physical parameters of CT image

Image quality
May be expressed in terms of physical parameters such
as uniformity, linearity, noise, spatial resolution, low
contrast resolution
Image quality depends on the technical characteristics of
the CT scanner, the exposure factors used and image
viewing conditions.
Quality may be assessed by quantitative measurement
using test phantoms, and by the appearance of artifacts.
Measurements should be conducted regularly
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Scanner performance: technical

parameters (I)
Test Phantoms:
Test phantoms of a standardized human shape
or test objects of a particular shape, size and
structure, are used for the purposes of
calibration and evaluation of the performances
of CT scanners
Phantoms should allow for evaluation of CT
number; uniformity; noise; spatial resolution;
slice thickness; dose; positioning of table top
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parameters (II)
CT Number Accuracy
CT number depends on tube voltage, filtration, object thickness

CT number of water is by definition equal to 0
Measured CT number should be < 4 HU in the central ROI
CT Number Linearity
The linear relationship between the calculated CT number and the linear
attenuation coefficient of each element of the object
Deviations from linearity should be < 5 HU
CT Number Uniformity
The CT number of each pixel in the image of an homogeneous object
should be the same over the image area
The difference in the CT number between a peripheral and a central
region of an homogeneous test object should be < 8 HU
Differences are largely due to beam hardening
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parameters (III)
Noise
The local statistical fluctuation (standard deviation) of CT
numbers in a homogeneous Region Of Interest (ROI)
Noise strongly affects the low contrast resolution
Noise is dependent on the radiation dose
Noise
1
dose
Image noise should be measured over an area of about 10% of

the cross-sectional area of the test object.
Goal obtain an image with an acceptable level of noise while
keeping the patient dose as low as reasonably achievable
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parameters (IV)
Spatial Resolution
The high contrast resolution determines the minimum
size of details visualized in the plane of the slice with a
contrast >10%.
It is affected by:
the reconstruction algorithm
the detector width
the effective slice thickness
the object to detector distance
the x-ray tube focal spot size
the matrix size.
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parameters (V)
Spatial Resolution
The low contrast resolution determines the size
of detail that can be visibly reproduced when
there is only a small difference in density relative
to the surrounding area
Low contrast resolution is limited by noise.
The perception threshold in relation to contrast and
detail size can be determined by creating contrastdetail curve.
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parameters (VI)
Slice Thickness
The slice thickness is determined in
the center of the field of view as the

distance between the two points on
the sensitivity profile along the axis
of rotation at which response has
fallen to 50%.
The use of post-patient collimation
to reduce the width of the image
slice leads to very significant
increases in the patient dose
Positioning of couch
The accuracy of positioning of the
patient couch is evaluated by
moving the loaded couch a defined
distance and moving it back to the
start position
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Minimum requirements: CT scanner (I)

Image noise
The Standard Deviation of CT numbers in the central 500
mm2 ROI for a water or tissue equivalent phantom should
not deviate more than 20% from the baseline.
CT number values
The deviation in the CT number values for water or tissue
equivalent material and materials of different densities
should < 20 HU or 5%.
CT number uniformity
The SD of the CT number over a 500 mm 2 region of
interest for water or tissue equivalent material at the center
and at the periphery of phantom should vary by less than
1.5% of the baseline
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Minimum requirements: CT scanner

(II)
Computed tomography dose index (CTDI)
The CTDI for a single slice for each available beam shaping filter and
for each available slice thickness should not deviate more than 20%
from the baseline.
Irradiated slice thickness
The FWHM of the dose profile should not differ more than 20% from
baseline.
High contrast resolution (spatial resolution)
The FWHM of the point spread function of a pin, or the edge response
function of an edge should not differ more than 20% from baseline.
Low contrast resolution
Polystyrene pins of 0.35 cm diameter inserted in a uniform body water
phantom should be visible in the image.
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scanner
Topic 2: Noise
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Imaging performance (Noise)

Noise is assessed using cylindrical
phantoms, which are either filled with water

or made of a tissue equivalent material
Once an axial image of the phantom has
been acquired, noise is measures as the

standard deviation in CT number in a region
of interest (ROI) placed in the center of the
image
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Region of
interest
(ROI)
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Noise values are given in manufacturers
specifications are quoted for a specific phantom

(e.g., manufacturers QA phantom) and for specified
scan techniques
These conditions must be matched exactly for the
purposes of the acceptance test
Manufacturers quote noise at a particular surface
dose
If this is the case, dose for axial scans can be
measured by taping an ion chamber to the surface
of the phantom
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Baseline noise values should be obtained
for several scan protocols that will be used

clinically, using the routine QC noise
phantom
To ensure that noise figures are both
accurate and representative, it is essential to

find the mean value from several scans (10
scans.)
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scanner
Topic 3: CT uniformity and linearity
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CT number uniformity can be assessed at the
same time as measuring noise, by placing four

additional ROI (N, E, S and W) at positions near
the edge of the image of a uniform phantom
The mean CT number is then noted for these four
regions, as well as the center
The deviation from the central value should be
calculated
The CT number uniformity should be measured for
large fields of view
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Axial image of
a homogenous
phantom
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CT number linearity is assessed using a
phantom containing inserts of a number of

different materials (materials should cover a
wide range of CT numbers)
One example of a suitable phantom to use
at acceptance is the Catphan (The Phantom
Laboratory, Salem, NY), which contains four
inserts with CT numbers ranging from
approximately -1000HU to +1000HU
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scanner
Topic 4: Low and high contrast resolution
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Low contrast resolution (or low contrast
detectability) is often quoted in specification

documentation as the smallest visible object at a
given contrast for a given dose
Since this measurement relates directly to imaging
performance, it is an important value to verify at
acceptance testing
At least 20 images of the low contrast insert (LCR)
should be acquired and then viewed by at least 3
observers under optimal viewing conditions to
obtain an average
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Typical
image of the
Catphan LCR
insert
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Spatial resolution (high contrast)

There exist two broad categories of measuring
techniques :
analysis of the point spread function, usually by
calculation of the modulation transfer function (MTF)

either objective analysis or visual assessment of images
of a resolution bar phantom.
The resolution is quoted as the spatial frequency (in line

pairs/cm) at which the modulation falls to 50%, 10% or
2% MTF.
These figures are often given for more than one
reconstruction algorithm, e.g., for standard and highresolution scans.
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Spatial resolution (high contrast)

The number of line
pairs per cm just

visible in the image is
approximately
equivalent to the 2%
value of the MTF
This result can then be
compared with the 2%
MTF, as quoted in the
manufacturers
specifications
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scanner
Topic 5: Z-axis sensitivity
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Z-Sensitivity (Imaged slice width)

Axial measurements
Phantoms used for axial measurements may contain
thin metal plates, wires or arrays of air holes, inclined at
an angle to the image plane
Manufacturers should be able to supply an appropriate
phantom or, alternatively, the Catphan contains an insert
suitable for this test
Note: to obtain meaningful measurements, the thickness
of the plates, wires or holes cannot be greater than the
nominal slice width concerned. This may create
problems for the sub-millimetre slice widths offered on
multi-slice scanners.
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Axial measurements
Phantoms manufacturers may quote the tolerance
for each nominal slice width setting in their
specification documentation
Z-sensitivity measurements in axial mode can be
used to check that imaged slice widths are within
the tolerances given
This can also be used in conjunction with irradiated
slice width measurements to assess the accuracy of
post patient collimation and to calculate the
geometric efficiency for the scanner
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Plan view of a test object used to measure imaged

slice widths for axial scans
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scanner
Topic 6: Alignment
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Alignment of indicating lights with

scan, coronal and sagittal planes
Several methods can
be used to perform
these tests
The techniques
described here are
straightforward to
implement and require
minimal test
equipment.
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Agreement between internal and

external scan plane lights
Use an envelope-wrapped film (therapy verificaiton
film) for the measurement. However, a piece of
paper or card can also be used
The film is placed flat on the table and illuminated
by the external scan plane light
The position of the light is marked on the film
envelope and the table is moved automatically to
the scan plane
If the distance between the internal and external
lights is correct, the internal light should now
coincide with the mark on the film envelope.
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Co-incidence of internal scan plane

lights and scan plane
Pin pricks are made in a piece of therapy
verification film (or similar) along the line of the
internal scan plane light
The film is wrapped around a phantom and
scanned with a narrow axial and developed
Coincidence between the pin pricks and the x-ray
beam exposure indicates alignment between the
alignment lights and the scan plane
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For multi-slice scanners, pin pricks (and, thus, the
internal alignment light) are usually found to
coincide with the center of the four slices
To plan a scan so that the x-ray beam is centered

over the internal scan plane lights at zero, it will be
necessary to center the first and last slices
symmetrically around zero (e.g. four slices from
7.5 mm to +7.5 mm on a 4 x 5 mm scan)
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Pin pricks made in

film at position of
scan plane light
Z
X-ray beam
exposure
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37
Coronal and Sagital plane lights

A long, thin object, with a high CT number relative to
air, such as the lead in a pencil or a straightened

paper clip, can be used as a marker to perform this
test
The marker is supported above the patient table and
aligned, using the indicating lights, so that it is
positioned at the isocentre, parallel to the z-axis and
perpendicular to the scan plane
If indicating lights are accurately aligned to the coronal
and sagital planes, the marker should appear as a dot
at exactly x = 0, y = 0 on the axial image.
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scanner
Topic 7: Table travel accuracy
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Table travel accuracy

A ruler or tape measure placed alongside the table,
can be used to check that the amount of table
movement indicated on the gantry agrees with the
actual distance moved.
A load of approximately 70- 80 kg should be
placed on the table in order to simulate the weight
of a patient.
The test should be performed twice: by driving the
table top both away from and towards the gantry.
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Table travel accuracy
Assessment of distance indicator accuracy

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Axial scan incrementation accuracy

Verification of incrementation accuracy between
successive axial slices can be achieved by placing
therapy verification film on the couch (in the
isocentre plane) and exposing it to an axial scan
sequence
Narrow slices separated by a couch increment

greater than 1 slice width can be used, and the
distance between the lines on the film measured
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Table travel accuracy for helical scans

In helical scanning, it is not sufficient to use a simple
mechanical test because the distance imaged depends on

couch speed and scanner software
One method of assessing distance accuracy is to use an
acrylic test object containing two small radio-opaque
markers, separated by a fixed distance (e.g., 20 cm)
The test object is scanned in Scan Projection Radiography
(SPR) mode and a helical scan is planned to start at the
first marker and to end at a distance x from the first marker
If couch travel is accurate during the helical scan, the
markers should be clearly seen on the first and final images
of the series.
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Couch travel accuracy for helical

scans
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scanner
Topic 8: Gantry tilt measurement
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Gantry Tilt
The accuracy of displayed gantry tilt can be
assessed by supporting therapy verification
film at the gantry end of the patient table
The film must be held vertically (e.g., by
taping to an acrylic block), so that it is
parallel to the sagital plane and intersects
scan and coronal planes at right angles
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Gantry Tilt
Three axial exposures are made using the same
film:
one for the maximum superior gantry tilt,
one for the maximum inferior gantry tilt
one at 0 gantry tilt
The three scan planes should then be visible on

the developed film
The angles + and - between scan planes at
maximum tilt relative to that at 0 tilt should equal
tilt angles displayed on the gantry.
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Assessment of accuracy of gantry tilt
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scanner
Topic 9: Dosimetry
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Dosimetry - CTDI in air

The Computed Tomography Dose Index
(CTDI) in air can be measured using a 10

cm pencil ionization chamber, located in the
scan plane at the isocentre
The ion chamber can be supported using a
laboratory test stand and clamp
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50
Ionization
chamber
Table
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51

It is important to measure the CTDI in air
under the following conditions When
commissioning a CT scanner:
For all beam shaping filters
For all nominal slice widths
For all clinical kV settings
For a range of scan times
For a range of mA settings
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Dosimetry - CTDI in air (helical)
Axial slice positions
Helical scan (pitch 1)

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Dosimetry - CTDI in Acrylic Phantoms

The body phantom is placed on the patient table
and the head phantom is supported in the head
rest
Phantoms are aligned and centred at the scan
isocentre
The ion chamber is inserted into either the central
or one of the peripheral holes of the phantom (all
other holes being filled with acrylic rods)
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Dosimetry - CTDI in Acrylic Phantoms

Dose measurements at the center are used to
calculate the central CTDI
Peripheral CTDI is measured in at least four
positions around the phantom, so as to achieve a
true average
Note: If gantry rotation is initiated from different
angular positions for successive scans it may be
necessary to take a number of measurements at
each position in order to get a representative mean
dose
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Dosimetry - CTDI in Perspex

Phantoms
Insert to plug holes
Head phantom
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Body phantom (or annulus

to fit over head phantom)
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Dosimetry - CTDI in Perspex

Phantoms
Central and peripheral CTDIs are used to
calculate weighted CTDI, CTDIw:
1
n CTDI w =
C
1
2
CTDI100,c + CTDI100,p
3
3
CTDIws can be compared against diagnostic

reference levels for standard scan
examinations
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Example of CTDI Values for some CT

units
MODEL
KV
FAD
Siemens
HIQ
133
700
10
0.195
(mGy/mAs)
weighted
Head
Body
0.161 (0.83) 0.093 (0.48)
Siemens
Plus S
120
700
10
0.128
0.110 (0.86)
Siemens
Plus S
137
700
0.161
GE Pace
120
525
10
0.344
0.200 (0.58)
0.094 (0.27)
Philips
LX
120
606
10
0.200
0.160 (0.80)
0.081 (0.41)
Air
nCDTI
0.062 (0.48)
0.082 (0.51)
FAD(mm): Focus to Axis distance

S (mm): Slice thickness
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Dose Profiles (Irradiated slice width)

Measurement of irradiated slice widths, for all
nominal slice width settings, provides a direct test

of pre-patient beam collimation and allows
geometric efficiencies to be calculated for the
scanner
Geometric efficiency (GE) is defined as:
GE =
width slice irradiated x 100 %
width slice imaged
It is recommended that GE value is displayed on
the console if it is less than 70%
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First method : expose therapy verification film, supported in
air at the isocentre, at each of the slice width settings
Once developed, optical density profiles may be plotted
using a digitizer or the width measured using a ruler
To provide an accurate dose profile, a calibration curve can
be applied to convert optical density profiles into dose
profiles, from which irradiated slice widths (FWHM of dose
profiles) may be derived
Alternative technique: measure dose profiles using TLDs.
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Measurement of
irradiated slice
widths for a range
of nominal slice
width settings
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Quality control program

Example of a quality control program for a CT unit:
Physical parameter
Level of
expertise
Frequency Priority
Remedial level
Image noise
A
B
D/W
1 y*
H
H
CT number values
D/W
1 Y*
1y
> 1.5%
CTDI
1y
Baseline 20%
Irradiated slice thickness
1y
> 20% or 1 mm
Image slice thickness
1y
> 20% or 1 mm
High contrast resolution
1y
Baseline 20%
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Baseline 20%
*more scans/parameters
Water: 10 HU
Other materials 20 HU
*more scans/parameters
64

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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

18: Optimization of protection in CT scanner

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT

Physical parameters of CT image

18: Optimization of protection in CT scanner

Scanner performance: technical

18: Optimization of protection in CT scanner

Scanner performance: technical

CT number depends on tube voltage, filtration, object thickness

18: Optimization of protection in CT scanner

Scanner performance: technical

Image noise should be measured over an area of about 10% of

18: Optimization of protection in CT scanner

Scanner performance: technical

18: Optimization of protection in CT scanner

Scanner performance: technical

18: Optimization of protection in CT scanner

Scanner performance: technical

the center of the field of view as the

18: Optimization of protection in CT scanner

Minimum requirements: CT scanner (I)

18: Optimization of protection in CT scanner

Minimum requirements: CT scanner

18: Optimization of protection in CT scanner

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT

Imaging performance (Noise)

phantoms, which are either filled with water

Once an axial image of the phantom has

been acquired, noise is measures as the

18: Optimization of protection in CT scanner

Imaging performance (Noise)

18: Optimization of protection in CT scanner

Imaging performance (Noise)

specifications are quoted for a specific phantom

18: Optimization of protection in CT scanner

Imaging performance (Noise)

for several scan protocols that will be used

To ensure that noise figures are both

accurate and representative, it is essential to

18: Optimization of protection in CT scanner

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT

same time as measuring noise, by placing four

18: Optimization of protection in CT scanner

18: Optimization of protection in CT scanner

phantom containing inserts of a number of

18: Optimization of protection in CT scanner

18: Optimization of protection in CT scanner

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 18: Optimization of protection in CT

Low contrast resolution

detectability) is often quoted in specification

18: Optimization of protection in CT scanner

Low contrast resolution

18: Optimization of protection in CT scanner

Spatial resolution (high contrast)

calculation of the modulation transfer function (MTF)

The resolution is quoted as the spatial frequency (in line

18: Optimization of protection in CT scanner

Spatial resolution (high contrast)

pairs per cm just