Comparison of Methods to

Estimate Water-Equivalent
Diameter for Calculation of
Patient Dose
NECHPS Summer Meeting
6 June 2018
Overview
• Introduction
• Motivation
• Dose metrics
• Methods
• Attenuation-based
• Geometry-based
• Data set
• Results and Analysis
• Potential issues
• Impact of inaccuracy in measurement
Motivation

• High CT contribution to public dose

• Method for estimating patient dose
• Risk analysis
• Treatment planning
• Efficiency

Public Health England: Doses from Computed Tomography

Examinations in the UK – 2011 Review
CT Dose Index (CTDI)
• Measure of radiation output
• Dose to specific phantoms
• Related: dose length product (DLP)

Universal Medical
Size-Specific Dose Estimate (SSDE)

• Accounts for patient size

• AAPM TG204 (2011)
• CTDI correction coefficients
 𝑆𝑆𝐷𝐸 =𝐶𝑇𝐷𝐼 𝑝h𝑎𝑛𝑡𝑜𝑚
𝑣𝑜𝑙 , 𝑚𝑎𝑥 × 𝑓 𝑝𝑎𝑡𝑖𝑒𝑛𝑡

AAPM TG204

AAPM TG204
Size-Specific Dose Estimate (SSDE)
• TG 220 (2014): Attenuation most accurate   ( 𝑥 , 𝑦 )=
𝐶𝑇
( 𝜇 ( 𝑥 , 𝑦 ) − 𝜇 𝑤𝑎𝑡𝑒𝑟
) × 1000
𝜇𝑤𝑎𝑡𝑒𝑟

  𝜇(𝑥 , 𝑦)
𝐴 𝑤 =∑
( ) 𝜇𝑤𝑎𝑡𝑒𝑟
× 𝐴 𝑝𝑖𝑥𝑒𝑙

  𝐶𝑇 ( 𝑥 , 𝑦 )
¿∑( + 1) × 𝐴 𝑝𝑖𝑥𝑒𝑙
1000
  𝐶𝑇 (´𝑥 , 𝑦 )
¿ ( 1000 )
+1 × 𝐴 𝑅𝑂𝐼

• How to get quick & easy patient size  

𝐴 𝑅𝑂𝐼 𝐶𝑇 (´𝑥 , 𝑦 )
estimates? 𝐷 𝑤 =2
𝜋 √1000 (+1 )
Overview
• Introduction
• Motivation
• Dose metrics
• Methods
• Attenuation-based
• Geometry-based
• Data set
• Results and Analysis
• Potential issues
• Impact of inaccuracy in measurement
Attenuation Methods
• Reconstruction slice analysis
• Water-equivalent diameter
• Central slice approximation
Geometric Methods

• Physical measurement
• Localizer radiograph measurement
• Scaling
• LAT only
Geometric Methods
• Slice dimensions
• AP+LAT
• Variable tissue properties
• Thorax correction factor

AAPM TG220
Methods to Compare

• Full scan attenuation (“true”)

• Central slice attenuation
• Central slice AP+LAT geometry
• Localizer radiograph LAT
geometry
Study

• 35 sets of slices
• 18 abdomen
• 17 thorax
• Judgement metric: 20% margin
around reference value
• Whole scan, attenuation-based Dw
Overview
• Introduction
• Motivation
• Dose metrics
• Methods
• Attenuation-based
• Geometry-based
• Data set
• Results and Analysis
• Potential issues
• Impact of inaccuracy in measurement
Results
Center Slice Attenuation Center Slice AP+LAT
Results

• 13 sets outside 20% margin

• 8 thorax, 5 abdomen
Potential Issues

• Edge detection
• Localizer
• Correct image
• Centering
• Attenuation
• Complete reconstruction data
 Impact of Inaccuracy on SSDE
Percent Difference in Consecutive Conversion Factors

Water Equivalent Diameter (AP+LAT)/2 Dimension Lateral Dimension

6.0% 6.0%

5.0% 5.0%

4.0% 4.0%

3.0% 3.0%

2.0% 2.0%

1.0% 1.0%

0.0% 0.0%
5 10 15 20 25 30 35 40 45 50 5 10 15 20 25 30 35 40 45 50

Dimension Value (cm) Dimension Value (cm)

Conclusions

• Small subset of slices can represent whole scan

• Localizer-based geometry method not as accurate
• Any method has its own calibration requirements
• Inaccuracy errors scale differently based on method
Acknowledgements

• Chris Martel, Philips Healthcare

• Dave Medich, Worcester Polytechnic Institute
• Syed Yasir Andrabi, Lahey Medical Center
Thank you!