Optimizing a perfusion CT protocol for head and neck cancer

Abstract

Abstract Perfusion computed tomography (CTP) images tumor angiogenesis and can assess tumor aggressiveness. However, the CTP examinations are dose intensive. This study aimed to optimize a routinely used CTP protocol for the head and neck region in oncology in order to reduce the effective dose to the patient and simultaneously achieve the same image quality. The Alderson phantom was scanned on a GE Revolution CT scanner. A scan with our standard protocol for head and neck cancer patients was used (100kV, 80mAs, 5mm slice thickness and backprojection algorithm) and in seven predefined regions (ROI) the signal to noise ratio (SNR) was measured. For the dose optimized protocol, the tube voltage was lowered and the mAs adaptation protocol was used. To improve image quality different percentage of an adaptive statistical iterative reconstruction (ASiR) was applied. For a better resolution we set the slice thickness to 2.5 mm. The mAs adaption range and the percentage of the ASiR reconstruction were varied until we found a combination with the same median SNR in the seven defined ROIs as for our old protocol. For the old and the optimized protocol dose measurements were performed using 25 LiF-TLDs. Organ doses were calculated and the effective dose was determined based on the weighting factors of ICRP103. The optimized scanning protocol used a voltage of 80kV, a mAs range between 15 and 80, a noise level of 10%, and 50% ASiR reconstruction. The median SNR ratio was slightly better (14% better SNR) with the new protocol. An effective dose of 8 mSv was measured with the original protocol and 4 mSv with the optimized scanning protocol. For organs in the scanning field the dose was reduced by a factor of 2 and outside the field by a factor of 2.2. Advanced reconstruction algorithms allow a significant dose reduction and an improvement of image resolution, while maintaining the image quality.