CT-automatic exposure control devices: What are their performances?

Purpose: To avoid unnecessary exposure to the patients, constructors have developed tube current modulation algorithms. The purpose of this work is to assess the performance of computed tomography (CT) tube current modulation concerning patient dose and image noise in MSCT scanners. Material and methods: A conical PMMA phantom with elliptical cross-section, to vary the thickness of the irradiated object in a monotonous way, and an anthropomorphic chest phantom were scanned under similar conditions on a general electrics (GE) LightSpeed VCT (64 slices) scanner. Noise measurements were made by calculating the standard deviation of the CT-number on a homogeneous ROI in both phantoms. The dose was estimated with the parameters read in the DICOM header of each studied image. Results: The study has shown that most of the time, constant noise levels (noise index) can be obtained by a variation of the mA. Nevertheless, this adaptation can be not fast enough when the variation of the attenuation changes is rapid. Thus, an adaptation length up to 5 cm was obtained. A 18% dose reduction can be achieved (mean of 9.9%) by switching from z-axis modulation algorithm to xyz-axis modulation option. However, exposure in the chest area can be higher with current modulation than without, when trying to keep an image noise level constant in thoraco-abdominal investigations. Conclusion: Current modulation algorithms can produce inadequate quality images due to problems with tube current stabilization when a sudden attenuation variation takes place as at the start of a scanning sequence. As expected, rotational (xyz-axis) modulation performs better than only z-axis modulation algorithm. The use of automatic exposure control (AEC) can lead to an increase of the dose if the maximum allowed current is not properly set in thoraco-abdominal acquisitions