Risk-minimizing tube current modulation for computed tomography

Aim/Problem: Every computed tomography (CT) examination is accompanied by radiation exposure. The aim is to reduce this as much as possible without compromising image quality by using a tube current modulation technique.Standard procedure: CT tube current modulation (TCM), which has been in use for about two decades, adjusts the tube current to the patient's attenuation (in the angular and z-directions) in a way that minimizes the mAs product (tube current-time product) of the scan without compromising image quality. This mAsTCM, present in all CT devices, is associated with a significant dose reduction in those anatomical areas that have high attenuation differences between anterior-posterior (a.p.) and lateral, particularly the shoulder and pelvis. Radiation risk of individual organs or of the patient is not considered in mAsTCM.Methodological innovation: Recently, a TCM method was proposed that directly minimizes the patient's radiation risk by predicting organ dose levels and taking them into account when choosing tube current. It is shown that this so-called riskTCM is significantly superior to mAsTCM in all body regions. To be able to use riskTCM in clinical routine, only a software adaptation of the CT system would be necessary.Conclusions: With riskTCM, significant dose reductions can be achieved compared to the standard procedure, typically around 10%-30%. This is especially true in those body regions where the standard procedure shows only moderate advantages over a scan without any tube current modulation at all. It is now up to the CT vendors to take action and implement riskTCM.