Effect of CT Localizer Radiographs on Radiation Dose Associated With Automatic Tube Current Modulation: A Multivendor Study

Objectives To assess the influence of the CT localizer radiograph on the automatic tube current modulation system of 7 CT scanners produced by 4 different CT manufacturers. Methods The influence of the localizer orientation, table height, tube current and tube potential values on the radiation dose of the related CT scan were evaluated. Images were acquired by using an anthropomorphic phantom positioned in the CT gantry isocenter as well as from -6 cm to +6 cm vertically to the isocenter. Results Vertical movement of the CT table height affected the radiation dose in all scanners using anterior-posterior or a posterior-anterior localizer orientation albeit differently, depending on the manufacturer; only in 1/7 scanner no influence was observed. The latero-lateral localizer orientation proved to be more effective in limiting the influence of the vertical miscentering in all scanners. Changing localizer's tube voltage influenced the scan radiation dose in scanners produced by two manufacturers, while no significant effect was observed in scanners produced by the other two manufacturers. No significant dose variation was observed in 6/7 scanners when changing the localizer's tube current. Conclusion Localizer radiograph shows a significant influence on the radiation exposure but with different outcomes depending on the manufacturer of the CT scanner. Radiologists and radiographers should have a thorough understanding of these differences to assure patients the best examination in terms of radiation dose and image quality.