The Physics of CT Dose

Richard Mather, PhD

Senior Manager, Clinical Science

Toshiba America Medical Systems, Inc.
 The Physics of CT Dose 1

Computed Tomography (CT) has been the fastest growing technology in medical imaging for more than
half a decade. Recent advances in Multi Detector CT (MDCT) have enhanced the number and range of CT
imaging applications available to physicians and their patients. These advancements have increased the
clinical utility of CT and over 62 million CT procedures are currently being performed annually in the United
States. With this increased use of CT has come a growing awareness of the potential risks from the radiation
dose associated with a CT scan1,2. In order to knowledgably balance clinical benefits gained from CT with
the potential risks of radiation exposure, it is critical to understand the factors that contribute to CT dose, as
well as how dose levels are estimated. Finally, it is essential to understand the ALARA principle (As Low As
Reasonably Achievable) of radiation use. ALARA requires the use of the lowest radiation dose that will yield
appropriate image quality for a particular patient to enable the correct clinical decision.

For more than 30 years, Computed

Tomography (CT) has allowed physicians to
explore the human body in ways that were
previously impossible. The technology has
progressed from single-slice axial scans
that required hours to perform to modern
multidetector helical exams that can image
the entire body in a few seconds (Figure 1).
CT is now the modality of choice for a wider
range of clinical applications than all other
imaging modalities combined. However, all
the benefits of CT must be balanced against
the risks associated with x-ray exposure.

While the biological effects of high

doses of radiation are well known and
documented3,4,5,6,7, the effects of low doses,
such as those received from CT exams,
are not as clear8,9. Most of what we believe
about low-dose ionizing radiation comes
Figure 1: 64-slice MDCT enables the rapid acquisition of thin-slice, volume datasets over large portions of the from information extrapolated from atomic
anatomy. 0.5 mm slices produce 350 micron isotropic resolution volumes, allowing images to be viewed in any
bomb survivors3,4, who received far greater
orientation with no loss of spatial resolution.
doses of radiation than a patient typically
2 The Physics of CT Dose
receives from a CT (Figure 2). From
these high dose effects, a conservative
model of radiation risk, known as the
linear no-threshold (LNT) model, was
developed 10,11,12,13 . The LNT model assumes
that the effects of high radiation doses can
be extrapolated to low doses. The model
also assumes that any dose, no matter how
small, has the potential to cause harm. At
low patient doses, the primary concern is
the possibility of developing cancer 10 to 20
years after the exposure14.
It is important to balance the potential
risk of a CT examination with the clinical
benefits: the dose used in a given exam
must be enough to deliver sufficient image
quality to answer the clinical question but as
low as possible to minimize the risk to the
patient. This approach is defined as the As
1.09
1.08
1.07
Relative Risk
1.06
1.05
1.04
1.03
1.02
1.01
1
Figure 2: The biological risks from ionizing radiation are clear above 50 mSv of whole
body dose based on the BEIR VII data. The risks below 50 mSv are not measured,
but are extrapolated using the assumption of the Linear No Threshold model. A
typical CT exam is on the order of 10 mSv.
Low As Reasonably Achievable (ALARA)
principle of radiation use3,4,15.
Under the ALARA principle, it is important
to consider radiation dose in conjunction
with a defined level of acceptable image
quality. Failing to consider the image
quality at a particular exposure level can be
potentially dangerous: too low a dose may
compromise the necessary image quality
and lead to either misdiagnosis or even
the need to repeat the entire scan. If a
rescan is required, the dose will be higher
due to the need for a higher mA technique,
and the dose from the original scan will
be wasted. Thus, adhering to the ALARA
principle does not simply mean reducing
the dose for all exams. The “appropriate”
dose will vary with the clinical context.
Relative Biological Risk
Measured Risk
Typical CT (10 mSv)
0 50 100 150
Effective Dose (mSv)
In order to determine the appropriate
dose for a given patient or exam, the
clinician needs to define the clinical
question. For example, to facilitate liver
transplant surgery planning, CT is often
used to determine the size of the patient’s
liver. For this clinical task, only a very
low dose may be all that is required since
only large, well-defined structures need
to be captured and high image noise
will not significantly affect the ability to
determine an accurate three-dimensional
liver volume. On the other hand, a higher
dose would be appropriate if the clinical
task were to visualize a small, low-contrast
lesion on a large patient’s liver because
it could be easily hidden by noise16. The
key is to adjust the radiation dose to the
diagnostic task at hand, using the lowest
possible dose that will yield the needed
200 250
 The Physics of CT Dose 3

information. For this reason, use of
ionizing radiation needs to be performed
within accepted appropriateness criteria
and under the guidance of an appropriately
trained physician and technologist.
A classic example of the ALARA principle
at work is in pediatric CT. Because of their
size and level of radiosensitivity, if children
were to be scanned with the same scan
techniques as adults they would actually
receive effective doses 6 to 7 times larger
than necessary to achieve the diagnostic
task17, 18. Software like Toshiba’s
SURE Exposure automatically chooses the
correct dose based on the patient’s size
and ensures that the ALARA principle is
upheld for all patients: pediatric and adult.
DOSE EFFICIENCY AND LOW CONTRAST
DETECTABILITY
Dose efficiency is the ability of a CT scanner
to achieve a particular level of image quality
at the lowest possible dose (Figure 3). The
best way to evaluate dose efficiency is to
look at the system’s ability to discriminate
objects with small differences in Hounsfield
Units (HU) from the background. Low-
contrast detectability (LCD) is closely
correlated with image noise as random
variation in an image will make small
objects that are similar in HU value to the
background hard to see (Figure 4). Since
noise depends on radiation dose and LCD
depends directly on image noise, LCD is
an excellent measure of a system’s overall
dose efficiency. The most dose efficient CT
system will be able to resolve the smallest
low-contrast object at the lowest dose19,20,21.
FACTORS AFFECTING PATIENT DOSE
AND IMAGE QUALITY
There are a number of scan parameters and
patient attributes that influence the dose and
image quality in a CT exam22,23,24,25. Some are
user controlled (e.g. kV, mAs, pitch). Other
factors are inherent to the scanner (e.g.,
detector efficiency, geometry). Still others
are patient dependent (e.g., patient size,
anatomy scanned). All these parameters
are interrelated. A solid understanding of
how each parameter relates to the others
and affects both dose and image quality is
essential to maintaining ALARA.
USER-CONTROLLED FACTORS
kV (kiloVolts) – Tube potential, or kV, is the
amount of voltage between an x-ray tube’s
anode and cathode. It determines the
energy of the x-rays being emitted. Higher

Low Contrast Resolution

Dose Comparision

30
25
Dose (mGy)

20
a
15
b
10
c Figure 4: Low Contrast Detectability (LCD) increases as the noise decreases.
5
0 Toshiba
5 4 3 2
Object Size (mm)
Figure 3: Low contrast resolution of different CT manufacturers from Product Data
Sheets (as of September 2007). Toshiba can achieve 2 mm low contrast resolution
with about the same or with less dose than other manufacturers need to resolve 3, 4,
and 5 mm low contrast objects. Similarly, the dose Toshiba needs to resolve those 3,
4, and 5 mm low contast objects is 40-60% less than the other manufacturers.
4 The Physics of CT Dose
energy x-rays have a greater probability than
lower energy x-ray of passing through the
body and creating signal at the detector.
With all else being equal, higher kV means
less noise. However, when these high-
energy x-rays are absorbed by the body,
they deposit more energy than lower
energy x-rays and, therefore, contribute
more to patient dose. For the same scan
parameters, changing the kV from 120 to
135 increases the dose by about 33%.
The image noise is reduced since the dose
is higher and more photons are reaching
the detectors, but the tissue contrast is
compromised as well. The main reason for
using higher kVs, such as 135 kV, is to get
better penetration for very large patients or
dense anatomy such as bone.
Width of Helical Path (From Collimation)
Center of Helical Path
Pitch=1
Direction of
Continuous
Patient Transport
Z, mm
t, sec
O O
Figure 5: Illustration of the effect of pitch on patient dose. For the same mA and rotation time, higher beam pitch values (>1) spread the X-rays out and reduce dose while lower
beam pitch values (<1) concentrate the X-rays, increasing the dose.
mAs (milliAmpere-seconds) – The tube
current, or mA, determines the number of x-
rays the tube produces. Combined with the
gantry rotation time, this represents the total
x-ray output of the tube per rotation, or mAs
(pronounced “mass”). Changing the mAs is
the most common method of adjusting dose
and noise level. For example, cutting the
mAs in half will reduce the patient dose by
a factor of 2, but also halve the number of x-
rays reaching the detector. Since fewer x-rays
are being detected, the image noise will be
increased and the LCD will be diminished . 26
CT Pitch and Helical Pitch – Beam pitch
is defined as the distance the table travels
in a rotation divided by the total active
detector width in the Z direction. Helical
pitch is the same except it is divided by the
individual channel thickness rather than
Width of Helical Path (From Collimation)
Center of Helical Path
Pitch=2
Extended Helical
Direction of
Continuous
Patient Transport
Z, mm
t, sec
the nominal total collimation. By either
definition, the higher the pitch, the faster
the table moves through the x-ray beam
and, consequently, the lower the dose to
the patient. It is important to note that
multislice scanners are different from single-
slice scanners with respect to pitch. Due to
the amount of redundant data with 64-slice
scanners, good reconstruction algorithms
can prevent the slice sensitivity profile from
broadening with pitches between 1 and 2.
However, as the pitch increases, there is
less projection data for a given slice and the
noise will increase with higher pitch values.
Therefore, while increasing the pitch lowers
the patient dose, it may also increase noise,
meaning one must increase the mA as the
pitch increases to maintain image quality.
Higher pitch value may also result in more
helical artifact. Therefore, the main clinical
Width of Helical Path (From Collimation)
Center of Helical Path
Pitch=0.5
Overlapping Helical
Direction of
Continuous
Patient Transport
Z, mm
t, sec
O
 The Physics of CT Dose 5

reason to scan with a high pitch value is to
reduce the total scan time.
mAseff (Effective mAs) – The mAseff is
simply the mAs divided by the pitch. It is a
common, if imprecise, practice to use mAs
as a surrogate for dose (DLP, as discussed
later, is a better value to use). However, since
pitch affects the patient dose, mAs by itself
does not completely represent the number
of x-rays entering the patient (Figure 5). By
dividing the standard mAs by the beam pitch,
a value that is proportional to the patient dose
on a given scanner is derived. While using
mAseff as a dose surrogate works adequately
well for comparing relative patient doses on a
single scanner, it does not work for comparing
doses from two different scanners. Many
aspects of the scanner’s design play a role in
the total dose delivered and the same mAseff
on two different scanners does not equate
to the same patient dose. The best way
to compare dose between scanners is
to examine the low-contrast detectability
(Figure 6).
Collimation – With multislice scanning, there
are many combinations of slice width and
number of slices that may be used to acquire
the scan volume. With all collimations on
multislice systems, the actual x-ray beam is
slightly wider than the nominal beam width
(i.e., number of detector rows multiplied by
detector element width). This is to ensure
that the detectors on the edge of the array
receive uniform x-ray coverage, resulting in
a small amount of unused radiation called
penumbra. Typically, the total amount
of penumbra is the same regardless of
the nominal beam width. Therefore, with
larger beams, the extra radiation from the
penumbra is a smaller percentage of the
overall useful beam width. Therefore, for the
best image quality and dose efficiency, the
thinnest slices covering the entire detector is
ideal (Figure 7).
Acquired and Reconstructed Slice Width –
The acquired slice width is governed by
the multislice detector configuration and
determines the minimum image width that
can be reconstructed. For example, images
acquired at a detector configuration of 16
x 1 mm can be reconstructed at 1 mm
or greater while images acquired at 16 x
0.5 mm can be reconstructed as thinly as
0.5 mm slices. Since one of the factors
contributing to image noise is the number
of photons used to create the image, thicker
reconstructed images have less noise with all

Figure 6: Effect of noise on low-contrast detectability. Whether due to lower dose on
the same scanner or lower dose efficiency between scanners, the system noise has
significant effects on the scanner’s ability to differentiate low-contrast objects.
Figure 7: Aquilion detectors from 4- to 64-slice. All Aquilion scanners have a
consistent detector design manufactured to image with as thin as 0.5 mm slices
and cover up to 32 mm per gantry rotation. The 4-, 8-, and 16-slice systems have
0.5 mm central detector elements with 1mm elements on the outside edges. The
32- and 64-slice detector is completely comprised of 0.5 mm elements. This design
allows flexability of scanning and uniformity of image quality across all the systems.
6 The Physics of CT Dose

other factors being equal. However, thicker
slices have less z-axis resolution. Figure 8
shows the effect of imaging with different slice
thicknesses. Even with overlapping slices, the
thicker images do not allow the image clarity
available with the 0.5 mm acquired slices. All
of Toshiba’s multislice scanners, from 4 to 64
slice, offer 0.5 mm slices, the thinnest in the
industry. The Aquilion’s Quantum detector
consists entirely of 0.5 mm channels. On
the Aquilion 64, most exams are acquired in
the 64 x 0.5 mm configuration for the best
image quality and the lowest total penumbra
contribution. To reduce the image noise, it is
always possible to reconstruct thicker slices
from the thin, 0.5 mm acquired dataset.
Therefore, scanning with the thinnest possible
slices avoids partial volume artifacts (when a
single voxel contains more than one tissue),
allows excellent multiplanar reformats (MPR)
and 3D renderings (Figures 8 and 9), and
retains the most flexibility in reconstruction
without resorting to a higher radiation dose.
In light of the dose effects of collimation, the
optimal image quality and dose efficiency are
achieved with the thinnest slices covering the
entire detector.
Reconstruction Kernel – As part of the
reconstruction process, the acquired data is
filtered by the reconstruction kernel. Since
the reconstruction kernel plays a large role in
determining spatial resolution, it has a great
effect on the amount of noise in the image
and consequently, on the dose needed
for a given level of image noise. There is
a large variety of reconstruction kernels to
chose from. Sharper kernels lead to better
in-plane spatial resolution (at the cost of
greater noise), while smooth kernels reduce
the image noise at the expense of some
in-plane resolution. The choice of kernel is
made based on the clinical need: most body
kernels are relatively soft to reduce the image
noise and enhance contrast resolution,
while lung kernels tend to be sharp to better
identify the tiny airways.
SCANNER-INHERENT FACTORS
Detector efficiency – No single hardware
aspect of a scanner has more influence on
dose than the efficiency of the detection
system. The detector’s ability to catch the x-
ray, convert it to light, transmit that light, and
convert it to an electrical signal with minimal
loss defines the overall efficiency of the
detector. More efficient detectors result in
lower patient dose for a given level of image
quality. In order to create the highly efficient
i llumination detector material, Toshiba’s

A B C

Figure 8: Effect of axial slice width on image reformats. When thick axial images are acquired or reconstructed, the
multiplanar reformat image quality that can be derived from them deteriorates. A) shows an MPR made from 5 mm
images with no overlap. B) shows an MPR made from 5 mm images with 4 mm of overlap. C) shows 0.5 mm images
with no overlap. Note the slight increase in clarity for (B) and the significant increase in clarity for (C). Thinner axial
slices result in better reformatted images.

Figure 9: Effect of axial slice thickness on polyp detection. The same dataset was reconstructed using 4, 3, 2, and 1
mm axial slices. With the 4 mm and 3 mm datasets, the polyp is not distinguishable from a diverticular fold. At 2 mm,
it becomes visible, but poorly defined. At 1 mm, the definition is greatly enhanced.
 The Physics of CT Dose 7

scientists invented a new method of sintering
the Gadolinium Oxysulfide (GOS) ceramic27.
With this new method, only Praesodynium
is added to the base ceramic which keeps
the light output high and allows the material
to be accurately machined to 0.5 mm
slices with clean, sharp edges. Toshiba’s
Quantum Detector system, based on the
i llumination material, is the only system
that has maintained 0.5 mm slices from the
4-slice scanner all the way up to the 64.
i llumination’s low afterglow and fast decay
times allow fast scanning and rotation times
without image artifacts while its high light
output contributes to the system’s industry
leading low contrast detectability.
Filtration – X-ray tubes, as the name implies,
produce the x-rays that are detected to
create the CT image. These x-rays, upon
leaving the tube, have a spectrum of
energies that range from very low energy
up to a maximum energy equal to the kV
(Figure 10). As discussed earlier, lower
energy x-ray photons do not penetrate
through the body as well as higher energy
ones. In fact, the lowest energy photons
will not pass through the body at all. Since
image formation relies upon photons getting
through the body and being picked up by the
detectors, these lowest energy photons only
contribute to patient dose. Therefore, all CT
scanners add a certain amount of filtration
outside the x-ray tube to block the low energy
x-rays. There is, however, a tradeoff involved
when choosing the amount of filtration: in
the process of removing low energy x-rays,
some desirable, medium and high energy x-
rays will be removed as well, thus decreasing
the overall output of the tube. This means
that higher mA values are needed to realize
a given image noise level. Furthermore, it
is the medium energy x-rays that provide
the best soft tissue contrast. Thus, heavier
filtering will compromise the system’s LCD.
Therefore, a CT system needs enough
filtration to block the lowest energy photons
but not so much as to lose the ability to
optimally distinguish low-contrast anatomy.
Geometry – It is a common misconception
that a CT scanner’s geometry (i.e., focus to
isocenter and focus to detector distances)
and focal spot dimensions play a significant
role in patient dose. In reality, the focal spot
dimensions only affect the overall dose by a
few percent. It is the ratio of the scanner’s
focus to isocenter and focus to detector
distances combined with the physical size of
the detector that determines the geometry’s

Initial Spectrum in a Vaccuum

Number of X-rays

Initial Spectrum in Air

Characteristic X-Ray Peak

Filtered Spectrum
Max kV

X-ray Energy
Figure 10: Typical bremsstrahlung spectrum with and without filtration. The initial
spectrum (orange), in a vacuum, steadily decreases up to the kV setting. in air, the
lowest energy x-rays are filtered out, but a large number of low energy x-rays remain
(blue). Many of the lowest energy x-rays will not penetrate a patient and only contribute
to dose. All CT scanners employ a certain amount of additional filtration to “harden”
the beam and remove the low energy x-rays (green).
8 The Physics of CT Dose

role. From the diagram in Figure 11, it is
clear that as long as the detection system
size increases in proportion to the distance
from the focal spot, there is no difference
in mAs technique (i.e., dose) needed to
achieve the same image quality between
the two geometries. There is actually a skin
dose advantage to a longer geometry since
the patient is further away from the x-ray
tube during scanning. Furthermore, longer
geometries are more resistant to scatter since
there is a higher probability that a scattered
photon will miss the detector entirely.
PATIENT FACTORS
Patient Size – The size of the patient plays a
large role in the total dose absorbed for the
same technique. Figure 12 shows the effect of
patient thickness on the absorbed dose.
With smaller patient sizes, such as in a pediatric
case, the dose can be two to three times higher
than on an adult when using the same imaging
technique. However, with smaller patient sizes,
less kV and mAs are needed to achieve the
same image quality. Therefore, it is essential
to tailor the kV and mAs to the patient size to
minimize the dose28,29,30.
Body Part Scanned – Different organs
in the body have different sensitivities to
radiation. For example, the stomach is
more sensitive to radiation than the liver,
which is more sensitive to radiation than
bone. This means that for the same
absorbed dose, there is more risk if the
abdomen is scanned versus anatomy that is
mostly bone, such as the lower leg. This is
largely due to the rate of cellular replication
in these organs5.
Age – The risk of developing cancer from
a CT exam decreases with age. The latent
period, or time between radiation exposure
and the clinical onset of cancer, is on the
order of 10 years or more. Furthermore,
younger patients organs are more
radiosensitive in general, due to the rapid
rate of cell division and growth. Therefore, it
is critical in young patients to keep the dose
as low as possible while maintaining the
necessary image quality.
DOSE MEASUREMENTS
In order to adequately compare doses
between different CT systems, it is
necessary to understand how dose is
measured and reported. While it would be
ideal to measure the actual radiation dose
to each patient undergoing a CT scan, such
measurements are not possible. Rather,

Focal Spot Phantom Diameter (mm)

3.50
Short Geometry 3.00
Long Geometry 2.50
Relative CTDI

2.00
1.50
1.00
0.50
Aperture
0.00
50 100 150 200 250 300 350
Detection System Size Figure 12: Relationship of body size to dose for a given x-ray technique. Smaller
patients have less mass attenuating the x-rays and therefore receive more dose for
the same technique. For this reason, pediatric protocols should use much less mAs
Figure 11: Schematic of the dose implications of different focus to detector than adult protocols.
geometries. X-rays spread out as they get further from the focal spot. However, if
the detector size increases with the longer distance, the same number of x-rays are
captured with either geometry.

proxies for dose, or “dose indices” have
been established. These measurements
are straightforward and repeatable in
nature. However, it is important to note
that, with current technology, these values
are only proxies for dose, as they are based
on simplifying assumptions and phantom
measurements. The common uses and
misuses of these measurements are
discussed below.
CTDI – For CT, a dose proxy known as
Computed Tomography Dose Index (CTDI) , 31
is estimated for the head and body using two
standard plastic phantoms. One phantom
is 16 cm in diameter to approximate the size
of a head, and the other phantom is 32 cm
in diameter to approximate the size of a torso
or abdomen. The main purpose of these
phantoms is to simulate the attenuation and
0.5 mm high-resolution lung CT.
Effective dose of 5.6 mSv.
scatter from a patient in the scanner. The
phantoms each have several holes designed
to hold a 10 cm ion chamber for direct dose
measurements: one in the center of the
phantom and four near the edge at the 3,
6, 9, and 12 o’clock positions. By making
measurements in each of these holes with
a given protocol, it is possible to derive a
number, or “index”, that is representative
of the dose absorbed in the phantom. It
is important to note that since a patient is
neither perfectly cylindrical nor made of
plastic, the CTDI value does not represent
the actual dose to the patient. Rather, CTDI is
a useful tool in comparing the relative doses
between two protocols on a given scanner.
Furthermore, CTDI is typically measured
using a 10 cm ion chamber which has been
shown to miss the edges of the scatter tails,
especially for wider beam widths.
3D volume rendered high-resolution lung CT.
Effective dose of 5.6 mSv.
The Physics of CT Dose 9
There are several versions of CTDI that are
discussed in the medical physics community,
but the two most common and most useful
are CTDIw and CTDIvol. CTDIw is the
weighted average of the measured doses in
the 5 phantom hole positions given by:
CTDIw represents the axial absorbed dose
to the phantom for a given protocol and is
only applicable to non-helical protocols.
For helical protocols, similar to the way that
mAseff is used to account for the overlapping
acquisition, CTDIvol takes pitch into account:
It is important to understand that while CTDI
can be useful when comparing protocols on
10 The Physics of CT Dose
a given scanner, it is misleading to use it to
compare the dose delivered by two different
scanners. A common misuse of CTDI is to
equate the normalized version, nCTDI, with
scanner dose. nCTDI is the CTDI value
for a given mAs value, typically 100 mAs.
However, the measured CTDI for a given mAs
value depends on the system’s filtration: more
filtration means fewer x-rays coming out of the
tube. For a given mAs value, a heavily filtered
system will have a lower nCTDI value than a
system with less filtration. However, it will also
have significantly lower image quality as well
for that same mAs value. This will be evident
in the LCD measurement and the image
noise. In order to achieve the same signal-to-
noise ratio, the heavily filtered system will have
to increase its mAs value to match the image
quality of the system with less filtration. This
also means that scanners with high filtration
Cardiac CTA.
Effective dose of 8.6 mSv.
will require larger generators to achieve the
same level of image quality.
This dependence on beam filtration
illustrates the main reason that CTDI is not a
good metric for dose comparisons between
scanners. The main drawback to CTDI is
that there is no image quality component
to it and the only way to compare doses
between different scanner systems is by first
equalizing image quality. Since low-contrast
detectability combines aspects of both image
quality and dose into a single scanner metric,
it is a far better choice when comparing the
dose efficiency of two different scanners.
As stated above, nCTDI (per 100 mAs) is
frequently misused to compare the doses
delivered from different scanners. Since
nCTDI values are only for a given mAs
Abdominal aorta with runoff using SUREExposure.
Effective abdominal dose of 4.7 mSv.
setting, they cannot be used to compare
actual patient doses. Different scanners use
different mAs values for the same clinical
task and image quality, due to differences
in filtration. Therefore, unless the image
quality is equalized between the systems, any
dose comparison between those systems is
meaningless. Scanner comparison reports,
such as those from ImPACT and ECRI, as
well as the manufacturer’s own product data
sheets, by convention report the scanner’s
nCDTI. While these values contain good
information about the tube output and beam
filtration, it is important to remember they
are not indications of the scanner’s dose
efficiency.
As an example, if scanner A has a CTDI per
100 mAs in the body of 10 mGy and scanner
B has a CTDI per 100 mAs of 8 mGy, we
 The Physics of CT Dose 11

cannot yet say whether scanner A or B will
deliver less dose. If we determine the image
quality is equivalent when scanner A uses
150 mAs and scanner B uses 250 mAs,
then we could make a comparison. For this
protocol, scanner A would deliver 10*150 =
15 mGy and scanner B would deliver 8*250
= 20 mGy. In this case, even though scanner
A has a larger CTDI per 100 mAs value, the
dose to the patient needed to maintain the
same level of image quality is 30% more for
scanner B. Since it is not usually possible to
scan the same patient on each scanner and
equalize the image quality, scanning standard
phantoms with standard measurements, such
as LCD, is the only reliable way to compare
dose between two different scanner systems.
Effective Dose and DLP – From a
patient’s point of view, their only concern
is the potential health risk from the
exam. Unfortunately, there is not enough
information in the CTDI value to get an
estimate of patient risk. With CTDI there
is no indication of how much anatomy was
scanned. For the same kV, mAs, and pitch,
the CTDI value is the same whether 10 cm
of the abdomen was imaged or the entire
chest, abdomen, and pelvis. Intuitively, with
a longer scan, more of the body is exposed
to radiation and the risk should be higher.
However, CTDI does not reflect this. In order
to describe the total energy imparted to
the patient, a value called the Dose Length
Product (DLP) is used. The DLP is found
by multiplying the CTDIvol for a protocol by
the total length of anatomy scanned. The
advantage of the DLP is that it incorporates
the actual mAs used (unlike CTDI per 100
mAs) and the total scan length (unlike
CTDIvol). As such, the DLP carries much
more information about the actual dose used
than the CTDI values alone (Figure 13).
In order to estimate patient risk, it is
necessary to incorporate information about
the anatomy scanned. As previously stated,
some organs are more sensitive to radiation
than others. The radiosensitivity of each
organ is represented by a weighting factor
(w) based on the atomic bomb survivor
data3,4,5. By adding the amount of each
organ scanned, weighted by its sensitivity,
the patient’s Effective dose (E) can be
derived. One of the main benefits of E is
that it can be compared on a risk basis with
other radiation exposures. For example, in
the U.S., the average person receives about
3 millisieverts (mSv) of naturally occurring
radiation per year (mostly from radon in

X-rays

2x

CTDIW1, DLP1, E1
x
CTDIW2, DLP2, E2

Difference between these two cases:

CTDIW1 = CTDIW2 DLP1 = 2 DLP2 E1 > E2

E1=2 E2 if the same anatomical area is covered

Figure 13: Relationship between CTDI, DLP, and effective dose. For a given x-ray
technique, the CTDIw value is independent of the distance covered. Therefore, the
CTDIw values in cases one and two above are identical even though the patient in
case one is absorbing twice as many x-rays. The DLP accounts for the distance as
well as the x-ray technique and reflects increased dose with the greater coverage. The
increased DLP directly affects the effective dose which will be double in this case if
the same general anatomy is covered by both scans.
12 The Physics of CT Dose
the soil and cosmic rays). In comparison,
a typical CT scan of the chest is about 5-7
mSv. Therefore, the dose from the CT is
approximately equal to two years of natural
exposure. This method of describing dose
in terms of equivalent natural background
time is known as Background Equivalent
Radiation Time or BERT32. This is a useful
way of describing radiation since it places the
dose into an understandable perspective for
the patient.
Based on the the linear no-threshold model
discussed earlier, there is no “safe” level
of radiation and any exposure carries a
small but finite risk. According to the latest
Biological Effects of Ionizing radiation (BEIR)
data, the risk of developing a fatal cancer
10-20 years following an exposure of 10 mSv
is about 0.05% or 1 in 20004. To put this in
8 year-old pediatric lung CT.
Effective dose of 1.9 mSv.
perspective, a person assumes the same risk
of death from driving 10,000 miles in a car or
from smoking a pack of cigarettes per day for
6 months14.
It is important to realize that in nearly all cases,
the benefit of medical imaging far outweighs
the small risk16, 33, 34, 35, 36. However, it is critical
that CT and other imaging modalities be used
based on accepted appropriateness criteria
and with the principles of ALARA always in
the forefront.
TOSHIBA DOSE REDUCTION
In order to adhere to the ALARA principle
and always put patient safety first, Toshiba
Medical Systems has designed its CT
scanners to give the best image quality
at the lowest possible dose. From the
dual-supported anode x-ray tube, to the
ultra-efficient Quantum detector system
and noise-free data acquisition system
(DAS), to the dose-saving SUREExposure3D
mA modulation software, to advanced,
adaptive reconstruction and noise reduction
algorithms, the Aquilion system is designed
to deliver the best image quality at the lowest
possible dose.
Quantum Detectors – In designing a dose
efficient CT scanner, the first step is to build
an acquisition system of detectors and
electronics that perform well under low signal
conditions. At the core of the Quantum
Detector is Toshiba’s patented illumination
detector material. Through a proprietary
manufacturing process, praesodynium
doped gadolinium oxy-sulfide (GOS)
crystals are sintered into a highly efficient
CT detector. The illumination material is
 The Physics of CT Dose 13

over 99% absorption efficient and optically
transparent with a light output of 2.3 times
that of cadmium tungstate (CdWO4). It is
characterized by fast decay times and low
afterglow properties that allow artifact-free
scanning down to 0.35 seconds per rotation
and below. Combined with precise and
highly shielded electronics to ensure the
quietest, truest signal possible, the Quantum
Detectors ensure maximum signal in low-
dose acquisitions.
MegaCool Tube – Since vibrations in the
™ and removed from the system. In this
anode can cause instabilities in the x-ray
beam requiring wider collimation with more
penumbra, Toshiba designed its MegaCool
x-ray tube with bearing supports on both
ends of the anode axis. This added anode
stability effectively reduces the variations
in the beam, allowing high-quality imaging
to be performed at fast rotation speeds,
up to 0.35 sec/rotation, while minimizing
extra patient dose from penumbra.
Furthermore, the MegaCool tube has
an innovative feature to collect off-focal
electrons and prevent them from producing
x-rays. If these electrons are not captured,
they can lead to artifacts and image quality
degradation as well as unnecessary patient
dose. By fitting a positively charged grid
near the electrically grounded anode, any
secondary, off-focal electrons are captured
way, the MegaCool tube provides optimum
image quality with a minimum of radiation
dose to the patient (Figure 14).
SUREExposure3D – Since the human body
is not perfectly round and uniform in size
and density, different mAs settings are
required to achieve the same image quality
in different parts of the body. For example,
during a typical lung scan, the first part of the
acquisition must penetrate the bony shoulder
area, while the middle part is largely low-
attenuating air, and the end has to penetrate
the liver and diaphragm. In this example, a
larger mAs is needed through the shoulders,
a smaller amount through the lungs, and
an amount somewhere in between for the
abdomen. Furthermore, patients are not
all the same size. A sumo wrestler would
clearly require more mAs to achieve a given
image quality level than would a ballerina.
In addition, because patients are shaped in
an elliptical fashion, more mAs is typically
needed when x-rays are passing laterally
through the body than when they are passing
anterior-posterior.

Cathode

Aperture

Anode

Figure 14: MegaCool x-ray tube. With its anode electrically grounded and supported at both
ends, the MegaCool tube allows long scanning with no cooling delays and has a stable focal Coronal MPR abdominal CT.
spot. This stable focal spot, along with the unique aperture that collects off-focal electrons Effective dose of 5.6 mSv.
makes the MegaCool tube an integral part of the Aquilion’s low-dose engineering.
14 The Physics of CT Dose

Toshiba’s SUREExposure3D software
automatically adjusts the mAs rapidly during
the scan to adapt to and compensate for all
of these changes in attenuation level. Using
data from the AP and lateral scanograms, the
software determines exactly how much mAs
is necessary to maintain a user-defined level
of image quality (Figure 15). Exposure3D
SURE
does this in all three dimensions (x, y, and z).
Therefore, as the scan moves from the
shoulders to the lung, the mAs goes down,
and as the tube rotates around the patient,
less mAs is used anterior-posterior than
laterally. For the same image quality level,
compared to non-modulated scanning,
Exposure3D can reduce the dose by up
SURE
to 40%.
The unique nature of coronary imaging gives
another opportunity for dose savings. With
low and steady heart rates, the optimum
phase for reconstruction is typically between
65 and 80% R-R. Since the data in the rest
of the cardiac cycle is used only for examining
the bulk ventricular function, a much lower
mAs value is necessary. Exposure3D
SURE
with ECG dose modulation allows the mA to
be significantly reduced during the systolic
phases of the cardiac cycle, enabling a
reduction in patient dose of as much as 50%.
Boost3D – Even with an optimized detector
system and mAs modulation, highly
attenuating anatomy such as the shoulders
and pelvis can severely reduce the number
of photons reaching the detectors. This
localized reduction in photon count can
lead to degradation in image quality in the
form of excess noise and streak artifacts.
Conventionally, these highly attenuating
areas are imaged using increased mAs
and kVp to overcome the low photon
count. However, since increasing the
imaging technique results in higher patient
dose, Toshiba engineers developed an
adaptive, three-dimensional algorithm
that preferentially corrects the raw data
in areas with low photon count. This
algorithm, known as Boost3D, seeks out
portions of the raw-projection data where
there is a disproportionate loss in x-ray
signal and applies the three-dimensional
filter locally to reduce the image noise and
streak artifacts. In areas of normal signal,
no correction is applied and the native
image quality is preserved. Such local, or
adaptive, techniques produce the optimum
results because the filter is applied only
where it is needed. Since this algorithm
removes streak artifacts caused by photon

SURE
Exposure
160 75 mAs
140
60 mAs
120
100
mA

80
60 25 mAs
40
60 90 120 150 180 210 240 270 300 330

Figure 15: SUREExposure tailors the dose to the individual patient. More
dose is needed to penetrate dense areas like the upper abdomen and
bony pelvis while lower mAs is adequate in less-dense areas like the lung.
Overall dose can be lowered by as much as 40% while preserving uniform
image quality.
 The Physics of CT Dose 15

starvation, it can either be applied to
enhance images using conventional mAs
settings, or to allow low-dose imaging with
acceptable image quality by reducing
the scan technique and, thereby, the
patient dose. Figure 16A demonstrates
images through the shoulder in a cardiac
bypass patient using a relatively low scan
technique. The images exhibit typical
structured noise and streak artifacts
resulting from the low photon count.
However, when Boost3D is applied, Figure
16B shows the resulting image quality: the
image noise is greatly reduced and the
streak artifacts disappear. By reducing the
noise and mitigating the effects of low-dose
scanning, adaptive techniques such as
Boost3D are key developments in Toshiba’s
commitment to patient focused imaging.
Quantum Denoising Software
Beyond optimized scanning techniques
and streak removal, it is possible to
minimize the overall noise left in the
reconstructed image. Toshiba’s Quantum
Denoising Software (QDS) is an adaptive
noise reduction filter that works on
reconstructed image data by preferentially
smoothing areas of uniform density
while preserving the edge information
of the image. The algorithm uses locally
sampled edge information within the
image to blend together variable strength
smoothing and sharpening filters37. In
areas of uniform density with few edges,
the algorithm smoothes the image and
reduces the noise; in areas with edges,
such as near tissue boundaries and
other complex structures, the algorithm
enhances the image. QDS works in
both two and three dimensions and can
drastically reduce image noise, allowing
a corresponding savings in patient dose.
Figure 17 illustrates the substantial dose
savings possible using QDS. Figure 17A
shows the relative noise in the liver of a
patient using a standard scan technique.
17B demonstrates the increase in image
noise as the mAs is dropped by 47%.
Finally, 17C highlights the ability of the
QDS to reduce the noise in the liver to
below that of the original, higher-dose
image. QDS works in conjunction with the
SURE Exposure3D software to adjust the mAs
based on the expected noise reduction
from the adaptive filter. In this way, patient
dose reduction is totally integrated in the
Aquilion console software.

A B A B C

Figure 16: Effect of Boost3D on streaks from low photon count. A) shows typical
streaks through the shoulder region. B) shows the same dataset reconstructed with
Figure 17: Effect of Quantum Denoising Software on liver scan. A) shows a scan at
Boost3D.
standard x-ray exposure and noise level. B) shows a scan at 45% lower mAs. The
noise value is increased. C) shows the lower mAs scan with QDS. The noise is the
same as the standard exposure, but with significantly less dose.
16 The Physics of CT Dose
EMERGING TECHNOLOGIES
The next frontier of CT dose reduction
comes from emerging technologies such as
wide area coverage detectors. With the ability
to cover an entire organ, such as the heart
or the brain, in a single rotation, Toshiba’s
256 slice CT scanner (works in progress)
can drastically reduce patient dose. Without
the need for overlapping slices, wide area
detector scanners can reduce the dose by up
to 80% as compared to today’s state-of-the-
art multislice systems38. Furthermore, since
the entire heart can be acquired in a single
rotation, coronary artery imaging with doses in
the range of a calcium score is possible.
CONCLUSIONS
Comparing the patient dose between
different scanners is impossible without
also equalizing image quality. Low Contrast
Detectability is an excellent measure of the
system’s overall dose efficiency since both
dose and image quality are represented.
Many factors affect the dose, and Toshiba’s
SURE Technologies, including SUREExposure3D,
automatically adjust parameters to maintain
image quality and reduce dose. To maintain
adherence to the ALARA principal, every
aspect of Toshiba’s Aquilion CT scanner is
built to minimize patient dose.
GLOSSARY OF TERMS
Absorbed dose: The energy absorbed by
the exposed tissue or material per unit mass.
The unit is the Gray (Gy) which equals 1
Joule (energy) per kilogram.
Absorption: One possible interaction of
radiation with matter. In absorption, the
particle (x-ray, electron, etc) is completely
stopped and deposits all of its energy in the
tissue or material.
ALARA: As Low As Reasonably Achievable.
Principle of radiation protection that
requires the use of the minimum amount
of radiation to achieve the clinical task.
Not necessarily the “lowest” dose, but the
lowest appropriate dose.
Attenuation: The reduction in radiation from
passing through a tissue or material. This
takes place through absorption or scatter of
the x-ray photons.
Beam hardening: The preferential removal
of low- and medium-energy x-rays from
the spectrum by absorption in a material.
The material acts as an x-ray filter. If these
changes in the x-ray spectrum are not
accounted for in the reconstruction, beam
hardening artifact can occur which appears
as streaks and shadows in the CT image,
especially near very dense objects.
Beam Pitch: Pitch value based on the entire
x-ray beam width. Often just referred to as
“pitch”. Identical to IEC definition of pitch. It
is defined as the table feed divided by the
nominal slice thickness times the number
of slices. Along with the rotation time,
Beam Pitch determines the speed at which
the volume is scanned. It is different from
Helical Pitch in that it divides out the total
number of slices. Typical values are between
0.5 and 1.5. Beam Pitch values below 1
indicate an overlapping exposure.
Body phantom: The standard 32 cm
diameter cylindrical phantom used to
measure CTDI. It is intended to represent
the attenuation and scatter properties of a
typical abdomen. The phantom is made of
Perspex (PMMA), is approximately 15 cm
deep, and typically has 5 holes (one hole
at the center and four holes 1 cm below
the surface at the 12, 3, 6, and 9 o’clock
positions) to hold the 10 cm ion chamber.
Bowtie Filter: A beam shaping filter that is
thicker at the edges than in the center. It
is used to reduce the beam intensity at the
edges of the field of view where the patients
are not as thick. This both reduces the
patient dose and makes for a more uniform
photon flux at the detectors.
Cadmium Tungstate (CdWO4): High-density
crystal material used in gamma- and x-ray
detection. Most of the original solid state CT
detectors were CdWO4 and its light output
value is the standard against which other
materials are compared. Most manufacturers
have moved away from CdWO4 due to the
toxic nature of cadmium.
Cone Angle: Angle at which the x-ray beam
diverges from the tube in the z-direction.
MSCT scanners with 16 slices and greater
have cone angle that is large enough that it
must be accounted for in reconstruction to
avoid image artifacts. The most successful
cone beam reconstruction algorithms in use
in scanners up to 64 slices are based on the
FDK (Feldkamp Davis Kress) algorithm.
CTDI: Computed Tomography Dose Index.
The standard method of measuring an index
for dose in a CT system. While this number
is an index and does not represent an actual
patient dose, it is benchmark. It is measured
using two Perspex (PMMA) phantoms: a 32
cm diameter “body” phantom and a 16 cm
diameter “head” phantom. CTDI is a useful

metric to compare the doses from different
protocols on the same scanner. However,
since it is so dependent on filtration, it is
unreliable to use to compare the doses from
different scanners. CTDI is not proportional to
patient dose since its value is the same whether
10 cm or 100 cm of the body is exposed.
CTDI100: The CTDI value measured using
a 100 mm ion chamber. CTDI¬100 is the
integrated absorbed dose value along the
entire 100 mm chamber. As scanners
increase z-axis coverage, the 100 mm
chamber becomes increasingly inadequate
to evaluate the dose.
CTDIFDA: The CTDI value measured by
integrating 14 slice widths. This value is
difficult to measure since the integration
length is variable.
CTDIvol: The weighted CTDI (CTDIw)
divided by the helical pitch. By correcting
for the pitch, this value represents the
overlapping dose profiles for pitches < 1
or the space between the dose profiles for
pitches >1.
CTDIw: Weighted CTDI. The weighted
average of the CTDI100 values calculated
by adding 2/3 of the average measured
peripheral value to 1/3 of the measured
center value.
Dose Profile: The actual collimated width
of the exposure beam. For MSCT, the
dose profile is usually slightly larger than
the nominal collimation to ensure uniform
radiation density in all the detector rows.
DLP: Dose Length Product. The DLP
represents the total amount of energy
imparted to the body. It is the product
of the CTDIvol and the scan length. DLP
is useful when comparing the dose
from different scanners since it contains
information on the scan protocol used. DLP
is proportional to patient dose. It is defined
in units of mGy-cm.
Effective dose (E): A value for dose that
represents patient risk in terms of an
equivalent whole body exposure. It allows
for dose comparisons with other sources
of ionizing radiation including different
medical imaging modalities and natural
background radiation. The risks estimates
are largely based on studies of the
atomic bomb survivors. Effective dose is
expressed in units of milliSieverts (mSv).
Fan angle: Angle at which the x-ray beam
diverges from the tube in the xy-direction.
This fan angle allows the tube and detectors
to rotate around the scanner’s isocenter and
image circular fields of view (FOVs) up to 50
cm and more.
Field of View (FOV): The diameter of the
reconstructed image. The FOV determines
how much of the anatomy is visible in the
image. It is possible to reconstruct images
up to the acquired FOV.
Filtration: Thickness of aluminum or copper
(typically) used to remove low energy x-rays
from the beam. These low energy x-rays
only add to patient dose and do not take
part in the creation of images. The amount
of filtration also affects the total tube output.
GOS: Gadolinium Oxysulfide (Gd2O2S).
Dense scintillator material used to make
fast CT detectors with high light output.
preferably doped with Praesodynium (Pr)
to improve the light output.
Gray (Gy): Unit of absorbed dose. The
Gy is the SI unit equivalent of the rad (1
Gy = 100 rad). Absorbed dose is defined
in terms of energy absorbed in a unit of
The Physics of CT Dose 17
mass. The Gy is equal to 1 Joule of energy
absorbed in 1 kg of tissue.
Head phantom: The standard 16 cm
diameter cylindrical phantom used to
measure CTDI. It is intended to represent
the attenuation of a typical head. The
phantom is made of Perspex (PMMA), is
approximately 15 cm deep, and typically
has 5 holes (one hole at the center and four
holes 1 cm below the surface at the 12, 3,
6, and 9 o’clock positions) to hold the 10 cm
ion chamber.
Helical Pitch: Pitch value based on the
width of the individual slice in a multislice
scanner. It is defined as the table feed
divided by the nominal slice. Along with
the rotation time, Helical Pitch determines
the speed at which the volume is scanned.
It differs from the Beam Pitch in that it is
not divided by the total number of slices.
Typical values of helical pitch for a 64 slice
system are in the range of 41 to 96. Typical
values of helical pitch for a 16 slice system
are in the range of 11 to 24.
Hounsfield Unit: Named after Sir Godfrey
Hounsfield who defined it. The HU
represents the attenuation properties of the
tissue. It is also referred to as a CT number.
It is equal to the (µx – µw / µw) x 1000 such
that air is -1000 and water is 0.
Ionization Chamber: A radiation measuring
device used to estimate dose in a CT system.
It detects the x-rays by counting the number
of charged particles (ions) created by the
exposure. It is sometimes called an ion
chamber, for short. Typically, a 100 mm ion
chamber is used to measure CTDI.
Kerma: The sum of the energy of all the
charged particles (ions) created by the
exposure. For low energies, kerma is
roughly equal to absorbed dose. For high
18 The Physics of CT Dose
energies, the kerma can be much higher
than the absorbed dose.
K-factor: Conversion factor for estimating
effective dose from DLP39. There are
different values for the head, neck, chest,
abdomen, and pelvis. This is a convenient
way to get a rough estimate of the effective
dose for a patient using values readily
available on the scanner.
kV: The energy between the x-ray tube’s
anode and cathode. This determines
the maximum energy of the x-ray beam
produced by the tube and also influences the
average energy of the spectrum. Higher kV
values lead to higher energy x-rays which will
penetrate thick objects more easily. However,
higher energy also means higher dose.
Low Contrast Detectability (LCD): The
system’s ability to depict small objects with
densities very near that of their surrounding
tissue. Measurements of LCD include
the detectable object size, the percentage
difference from the background, and the
dose needed to achieve the object size
and contrast. Since the LCD is an image
quality metric that is sensitive to dose, it is
an excellent measurement of a CT system’s
overall dose efficiency.
mA: Tube current. The mA is the the amount
of current placed through the x-ray tube’s
cathode. The current is proportional to the
number of electrons created at the cathode
and accelerated towards the anode by the
high voltage (kV). More mA leads to more
electrons which leads to more x-rays leaving
the tube. The dose delivered by the system
varies linearly with mA.
mAs: The mAs (pronounced “mass”) is the
product of the tube current and the rotation
time. This gives the total number of x-rays
produced over a given time. Dose varies
linearly with mAs. The mAs contains more
information than the mA alone (300 mA at 1
sec rotation is double the dose of 300 mA at
0.5 sec rotation).
mAseff: Effective mAs. The mAseff
incorporates the overlapping nature of helical
scanning by dividing the mAs by the beam
pitch. By including the extra dose from the
overlapping beams, mAseff contains more
information than the mAs alone (100 mAs
at a pitch of 0.5 has double the dose of 100
mAs at pitch 1).
MPR: Multiplanar Reformat. Method of
taking a volume of thin slice data and
resampling it in a different orientation than
the data was acquired. With the isotropic
resolution of MSCT scanners, MPRs are
routinely created with no difference in
spatial resolution than the original axial
dataset. Since the anatomy of interest is
not usually best visualized in the axial plane,
the MRP is an invaluable tool for analyzing a
MSCT dataset.
MSAD: Multiple Scan Average Dose. The
average dose in the central slice with multiple
adjacent slices being exposed. It is equal
to the CTDI when the slice spacing is 1 and
enough scans are acquired.
MTF: Modulation Transfer Function.
Describes the scanner’s ability to represent
different spatial frequencies. In other
words, how faithfully a scanner can resolve
the details of the object scanned. It is
measured by taking the Fourier transform
of the point spread function of the scanner
and can be used to describe the scanner’s
spatial resolution.
Noise: Random variation in the pixel values
of the reconstructed image. Noise contains
no useful information and degrades image
quality. High noise values can obscure
anatomy and hinder low contrast detectability.
On a given scanner, noise increases with
decreasing dose.
Noise power spectrum (NPS): A more
complete description of the image noise than
simple standard deviation alone. NPS reveals
correlations in the noise by representing noise
in terms of its spatial frequency distribution.
Organ dose: Absorbed dose to a given organ.
This value is particularly useful in formulating
a true effective patient dose.
Partial volume artifact: Image artifact
occurring when the pixel size or slice
thickness is not small enough to individually
represent multiple densities. Usually appears
as streaking, blurring, or loss of
edge definition.
Pitch: See Beam Pitch and Helical Pitch.
Quantum Detectors: Toshiba’s highly efficient
detection system consisting of the patented,
GOS-based illumination™ detector material
and the quiet, efficient Data Acquisition
System (DAS). Toshiba’s Quantum detectors
provide 0.5 mm slices and 2 mm low-contrast
resolution resulting in excellent image quality.
Rad: Unit of absorbed dose (stands for
Radiation Absorbed Dose) equal to one erg
absorbed in one gram of tissue. The rad has
been replaced by the SI unit Gray (Gy). One
Gy equals 100 rad.
Rem: Unit of effective dose (stands for
Radiation Equivalent Man). The rem has
been replaced by the SI unit Sievert (Sv).
One Sv equals 100 rem.
Scatter: X-rays that are not completely
absorbed or completely transmitted will
deposit a portion of their energy and continue
on in a different direction. This scattered

radiation contributes to noise within the
image when they are picked up at the
detector.
Sievert (Sv): Unit of effective dose. The
Sievert replaces the rem where 1 Sv is
equal to 100 rem. The average natural
background radiation in the United States is
about 3 millisSeverts (mSv).
Slice sensitivity profile: The full width at half
maximum (FWHM) size of the reconstructed
slice in the z-direction. Factors such as
the detector width, helical pitch, and z-
interpolation algorithm can affect the slice
sensitivity profile.
SUREExposure3D: Toshiba’s automatic
exposure control and mA modulation
software. SUREExposure3D controls
and modulates the mA in the XY and
Z directions to achieve and maintain a
uniform, user-selected noise level within the
images. SUREExposure3D uses attenuation
information gathered from the AP and lateral
scanograms to determine the appropriate
mA. SUREExposure3D can lower the dose by
as much as 40% while maintaining image
quality. Since SUREExposure3D is based on
the actual patient attenuation, it is especially
useful for ensuring that the appropriate dose
levels are used in pediatric cases.
Table Feed: The amount of table travel (in
mm) per rotation, for helical scanning, or
between scans for axial scanning. Along
with the detector collimation, table feed
determines the pitch.
Voxel: The discrete image volume is made
of individual 3D elements. Each element is
called a voxel (short for volume element) and
represents a single HU value.
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