Radiation dose reduction using two orthogonal topograms associated with automatic tube voltage selection for lung CT scanning as compared with a single anteroposterior topogram

  • Xiaofei Liu
  • Mingming Zhang
  • Liang Zhang
  • Yu Zhao
  • Wenge SunEmail author
Original Article



To evaluate the effectiveness of two orthogonal topograms on radiation dose and image quality (IQ) associated with topogram-based automatic tube voltage selection (ATVS) for lung CT scanning.


Thirty-seven patients were enrolled in this study. At baseline, only an anteroposterior topogram was obtained and at follow-up, both anteroposterior and lateral topograms were performed. ATVS was turned on during all scans. Objective and subjective IQ evaluations were performed and compared; tube voltage and radiation dose of each scan were noted and analyzed.


A significant difference was observed regarding the objective parameters between baseline and follow-up only in image noise and signal–noise ratio (SNR) in the upper one-third of the image (image noise: 7.49 ± 1.08 vs. 9.10 ± 1.13, p < 0.001; SNR: 4.08 ± 0.87 vs. 3.37 ± 0.63, p < 0.001). No differences were found between baseline and follow-up in the subjective assessment of IQ. The radiation dose was significantly lower at follow-up than that at baseline (2.73 ± 0.83 mSv vs. 3.55 ± 1.24 mSv, respectively; p < 0.001).


Using two orthogonal topograms associated with ATVS could significantly reduce the total radiation dose for lung CT scanning, while subjective IQ was maintained.


Radiation dose Topogram Automatic tube voltage selection ATVS Lung CT scanning 



No funding was received for this work.

Compliance with ethical standards

Conflict of interest

All authors report no conflicts of interest.

Ethical standards

This study was approved by the Ethic Committee of the First Hospital of China Medical University, and all patients provided written informed consent.


  1. 1.
    Kalra MK, Maher MM, Toth TL, Schmidt B, Westerman BL, Morgan HT, et al. Techniques and applications of automatic tube current modulation for CT. Radiology. 2004;233(3):649–57.CrossRefGoogle Scholar
  2. 2.
    McCollough CH, Bruesewitz MR, Kofler JM Jr. CT dose reduction and dose management tools: overview of available options. Radiographics. 2006;26(2):503–12.CrossRefGoogle Scholar
  3. 3.
    Raman SP, Johnson PT, Deshmukh S, Mahesh M, Grant KL, Fishman EK. CT dose reduction applications: available tools on the latest generation of CT scanners. J Am Coll Radiol. 2013;10(1):37–41.CrossRefGoogle Scholar
  4. 4.
    Soderberg M, Gunnarsson M. The effect of different adaptation strengths on image quality and radiation dose using Siemens Care Dose 4D. Radiat Prot Dosimetry. 2010;139(1–3):173–9.CrossRefGoogle Scholar
  5. 5.
    Frellesen C, Stock W, Kerl JM, Lehnert T, Wichmann JL, Nau C, et al. Topogram-based automated selection of the tube potential and current in thoraco-abdominal trauma CT—a comparison to fixed kV with mAs modulation alone. Eur Radiol. 2014;24(7):1725–34.CrossRefGoogle Scholar
  6. 6.
    Mangold S, Wichmann JL, Schoepf UJ, Poole ZB, Canstein C, Varga-Szemes A, et al. Automated tube voltage selection for radiation dose and contrast medium reduction at coronary CT angiography using 3(rd) generation dual-source CT. Eur Radiol. 2016;26(10):3608–16.CrossRefGoogle Scholar
  7. 7.
    O’Daniel JC, Stevens DM, Cody DD. Reducing radiation exposure from survey CT scans. AJR Am J Roentgenol. 2005;185(2):509–15.CrossRefGoogle Scholar
  8. 8.
    Strauss KJ, Goske MJ, Kaste SC, Bulas D, Frush DP, Butler P, et al. Image gently: ten steps you can take to optimize image quality and lower CT dose for pediatric patients. AJR Am J Roentgenol. 2010;194(4):868–73.CrossRefGoogle Scholar
  9. 9.
    Singh S, Petrovic D, Jamnik E, Aran S, Pourjabbar S, Kave ML, et al. Effect of localizer radiograph on radiation dose associated with automatic exposure control: human cadaver and patient study. J Comput Assist Tomogr. 2014;38(2):293–8.CrossRefGoogle Scholar
  10. 10.
    Feng R, Tong J, Liu X, Zhao Y, Zhang L. High-pitch coronary CT angiography at 70 kVp adopting a protocol of low injection speed and low volume of contrast medium. Korean J Radiol. 2017;18(5):763–72.CrossRefGoogle Scholar
  11. 11.
    Zhang LJ, Qi L, Wang J, Tang CX, Zhou CS, Ji XM, et al. Feasibility of prospectively ECG-triggered high-pitch coronary CT angiography with 30 mL iodinated contrast agent at 70 kVp: initial experience. Eur Radiol. 2014;24:1537–46.CrossRefGoogle Scholar
  12. 12.
    Bongartz G, Golding SJ, Jurik AG, et al. European guidelines for multislice computed tomography: appendix c funded by the European Commission. Contract number FIGM-CT2000-20078-CT-TIP. 2013. Accessed 7 Sept 2016.
  13. 13.
    AAPM Task Group 204. Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations, 2011. Accessed 7 Sept 2016.
  14. 14.
    Christner JA, Braun NN, Jacobsen MC, Carter RE, Kofler JM, McCollough CH. Size-specific dose estimates for adult patients at CT of the torso. Radiology. 2012;265:841–7.CrossRefGoogle Scholar
  15. 15.
    Mangold S, De Cecco CN, Schoepf UJ, Kuhlman TS, Varga-Szemes A, Caruso D, et al. CT angiography for planning transcatheter aortic valve replacement using automated tube voltage selection: image quality and radiation exposure. Eur J Radiol. 2017;86:276–83.CrossRefGoogle Scholar
  16. 16.
    Mangold S, De Cecco CN, Wichmann JL, Canstein C, Varga-Szemes A, Caruso D, et al. Effect of automated tube voltage selection, integrated circuit detector and advanced iterative reconstruction on radiation dose and image quality of 3rd generation dual-source aortic CT angiography: an intra-individual comparison. Eur J Radiol. 2016;85(5):972–8.CrossRefGoogle Scholar
  17. 17.
    Park C, Gruber-Rouh T, Leithner D, Zierden A, Albrecht MH, Wichmann JL, et al. Single-source chest-abdomen-pelvis cancer staging on a third generation dual-source CT system: comparison of automated tube potential selection to second generation dual-source CT. Cancer Imaging. 2016;16(1):33.CrossRefGoogle Scholar
  18. 18.
    Zhang LJ, Qi L, Wang J, Tang CX, Zhou CS, Ji XM, et al. Feasibility of prospectively ECG-triggered high-pitch coronary CT angiography with 30 mL iodinated contrast agent at 70 kVp: initial experience. Eur Radiol. 2014;24(7):1537–46.CrossRefGoogle Scholar
  19. 19.
    Achenbach S, Marwan M, Ropers D, Schepis T, Pflederer T, Anders K, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J. 2010;31(3):340–6.CrossRefGoogle Scholar
  20. 20.
    Ghoshhajra BB, Engel LC, Major GP, Verdini D, Sidhu M, Karolyi M, et al. Direct chest area measurement: a potential anthropometric replacement for BMI to inform cardiac CT dose parameters? J Cardiovasc Comput Tomogr. 2011;5(4):240–6.CrossRefGoogle Scholar
  21. 21.
    Li JL, Huang MP, Liang CH, Zhao ZJ, Liu H, Cui YH, et al. Individualized radiation dose control in 256-slice CT coronary angiography (CTCA) in retrospective ECG-triggered helical scans: using a measure of body size to adjust tube current selection. Eur J Radiol. 2012;81(11):3146–53.CrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  1. 1.Department of RadiologyThe First Hospital of China Medical UniversityShenyangPeople’s Republic of China
  2. 2.Department of Clinical MedicineJining Medical UniversityJiningPeople’s Republic of China
  3. 3.Department of Interventional RadiologyFudan University Shanghai Cancer CenterShanghaiPeople’s Republic of China

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