Abstract
Background: Computed Tomography (CT) scan of brain is the most widely used CT examination. Latest CT scanners have the potential to deliver very low radiation dose by utilizing tube potential and tube current modulation techniques. We aim to determine the application of CARE kV (tube potential modulation) and CARE Dose4D (tube current modulation) in CT scan of brain. Both CARE kV and CARE Dose4D are well-established innovative technology of Siemens Medical Solutions.
 Methodology: A prospective hospital-based study was conducted during four months at Tribhuvan University Teaching Hospital (TUTH). The data were collected on a Siemens Somatom Definition Edge 128 slices CT scanner. Non-random purposive sampling technique was employed. Ethical approval and consent to participate were taken for every participant. Non-contrast (NC) CT images were acquired without using CARE kV and CARE Dose4D, whereas during contrast-enhanced (CE) investigation, both were turned on keeping other scanning parameters constant for each individual.
 Results: A total of 72 patients, 42 males and 28 females - mean age 41y (range 16-87y) participated in this study. The Body Mass Index (BMI) was 22.0, range 20.1-25.0. The mean value of Computed Tomography Dose Index (CTDI), Dose Length Product (DLP) and Effective Dose (ED) before and after switching on both CARE kV and CARE Dose4D were 58.19±0.35 and 39.67±3.59 milli-Gray (mGy), 946.67 and 652.58 mGy-cm, and 1.98 and 1.36 milli-Sievert (mSv) respectively.
 Conclusion: CARE kV and CARE Dose4D can reduce radiation dose in CT scan of brain without loss of image quality.
Highlights
Latest surveys have revealed that 60-70% of the patient doses in diagnostic radiology are received from Computed Tomography (CT) examinations.[1]
A prospective hospital-based study was conducted from April to August 2015 in Department of Radiology and Imaging, Tribhuvan University Teaching Hospital (TUTH)
Froemming et al.[13] performed CT urography with kV selection and tube current modulation in excretory phase and they concluded that the combination of automated kV selection, tube current modulation and iterative method of image reconstruction results in radiation dose reduction without ruining image quality
Summary
Latest surveys have revealed that 60-70% of the patient doses in diagnostic radiology are received from Computed Tomography (CT) examinations.[1]. CARE Dose4D is a recent refinement of TCM determined in all in x, y and z-directions.[8] It modulates tube current on the basis of regional body anatomy for adjustment of x-ray quantum noise to maintain constant image noise with improved dose efficiency.[6] The principles of both these techniques are explained in more detail elsewhere.[8,9] in this study, we aim to evaluate the reduction of dose in CT scan of brain with care dose 4D and Care kV. We aim to determine the application of CARE kV (tube potential modulation) and CARE Dose4D (tube current modulation) in CT scan of brain Both CARE kV and CARE Dose4D are well-established innovative technology of Siemens Medical Solutions
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