{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T12:21:18Z","timestamp":1775132478923,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,9,24]],"date-time":"2018-09-24T00:00:00Z","timestamp":1537747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000070","name":"National Institute of Biomedical Imaging and Bioengineering","doi-asserted-by":"publisher","award":["R01\u2010EB017095"],"award-info":[{"award-number":["R01\u2010EB017095"]}],"id":[{"id":"10.13039\/100000070","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32\u2010EB002101"],"award-info":[{"award-number":["T32\u2010EB002101"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to estimate the radiation dose to the lung and breast as well as the effective dose from tube current modulated (TCM) lung cancer screening (LCS) scans across a range of patient sizes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Monte Carlo (MC) methods were used to calculate lung, breast, and effective doses from a low\u2010dose LCS protocol for a 64\u2010slice CT that used TCM. Scanning parameters were from the protocols published by AAPM's Alliance for Quality CT. To determine lung, breast, and effective doses from lung cancer screening, eight GSF\/ICRP voxelized phantom models with all radiosensitive organs identified were used to estimate lung, breast, and effective doses. Additionally, to extend the limited size range provided by the GSF\/ICRP phantom models, 30 voxelized patient models of thoracic anatomy were generated from LCS patient data. For these patient models, lung and breast were semi\u2010automatically segmented. TCM schemes for each of the GSF\/ICRP phantom models were generated using a validated method wherein tissue attenuation and scanner limitations were used to determine the TCM output as a function of table position and source angle. TCM schemes for voxelized patient models were extracted from the raw projection data. The water equivalent diameter, <jats:italic>Dw<\/jats:italic>, was used as the patient size descriptor. <jats:italic>Dw<\/jats:italic> was estimated for the GSF\/ICRP models. For the thoracic patient models, <jats:italic>Dw<\/jats:italic> was extracted from the DICOM header of the CT localizer radiograph. MC simulations were performed using the TCM scheme for each model. Absolute organ doses were tallied and effective doses were calculated using ICRP 103 tissue weighting factors for the GSF\/ICRP models. Metrics of scanner radiation output were determined based on each model's TCM scheme, including CTDI<jats:sub>vol<\/jats:sub>, dose length product (DLP), and CTDI<jats:sub>vol, Low Att<\/jats:sub>, a previously described regional metric of scanner output covering most of the lungs and breast. All lung and breast doses values were normalized by scan\u2010specific CTDI<jats:sub>vol<\/jats:sub> and CTDI<jats:sub>vol, Low Att<\/jats:sub>. Effective doses were normalized by scan\u2010specific CTDI<jats:sub>vol<\/jats:sub> and DLP. Absolute and normalized doses were reported as a function of <jats:italic>Dw<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Lung doses normalized by CTDI<jats:sub>vol, Low Att<\/jats:sub> were modeled as an exponential relationship with respect to <jats:italic>Dw<\/jats:italic> with coefficients of determination (<jats:italic>R<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>) of 0.80. Breast dose normalized by CTDI<jats:sub>vol, Low Att<\/jats:sub> was modeled with an exponential relationship to <jats:italic>Dw<\/jats:italic> with an <jats:italic>R<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> of 0.23. For all eight GSF\/ICRP phantom models, the effective dose using TCM protocols was below 1.6 mSv. Effective doses showed some size dependence but when normalized by DLP demonstrated a constant behavior.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Lung, breast, and effective doses from LCS CT exams with TCM were estimated with respect to patient size. Normalized lung dose can be reasonably estimated with a measure of a patient size such as <jats:italic>Dw<\/jats:italic> and regional metric of CTDI<jats:sub>vol<\/jats:sub> covering the thorax such as CTDI<jats:sub>vol, Low Att<\/jats:sub>, while normalized breast dose can also be estimated with a regional metric of CTDI<jats:sub>vol<\/jats:sub> but with a larger degree of variability than observed for lung. Effective dose normalized by DLP can be estimated with a constant multiplier.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.13131","type":"journal-article","created":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T14:15:55Z","timestamp":1534515355000},"page":"4667-4682","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Estimating lung, breast, and effective dose from low\u2010dose lung cancer screening CT exams with tube current modulation across a range of patient sizes"],"prefix":"10.1002","volume":"45","author":[{"given":"Anthony J.","family":"Hardy","sequence":"first","affiliation":[{"name":"Department of Radiology David Geffen School of Medicine University of California, Los Angeles Los Angeles CA 90024 USA"},{"name":"Physics and Biology in Medicine Graduate Program David Geffen School of Medicine University of California, Los Angeles Los Angeles CA 90024 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam","family":"Bostani","sequence":"additional","affiliation":[{"name":"Department of Radiology David Geffen School of Medicine University of California, Los Angeles Los Angeles CA 90024 USA"},{"name":"Physics and Biology in Medicine Graduate Program David Geffen School of Medicine University of California, Los Angeles Los Angeles CA 90024 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle","family":"McMillan","sequence":"additional","affiliation":[{"name":"Formerly with Department of Radiology Mayo Clinic Rochester MN 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Zankl","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen, German Research Center for Environmental Health (GmBH) Institute of Radiation Protection Ingolstaedter Landstrasse 1 Neuherberg 85764 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"McCollough","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic Rochester MN 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Cagnon","sequence":"additional","affiliation":[{"name":"Department of Radiology David Geffen School of Medicine University of California, Los Angeles Los Angeles CA 90024 USA"},{"name":"Physics and Biology in Medicine Graduate Program David Geffen School of Medicine University of California, Los Angeles Los Angeles CA 90024 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"McNitt\u2010Gray","sequence":"additional","affiliation":[{"name":"Department of Radiology David Geffen School of Medicine University of California, Los Angeles Los Angeles CA 90024 USA"},{"name":"Physics and Biology in Medicine Graduate Program David Geffen School of Medicine University of California, Los Angeles Los Angeles CA 90024 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,9,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.111.6.1710"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.10091808"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1102873"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2006.08.015"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.11.6533"},{"key":"e_1_2_7_7_1","unstructured":"Centers for Medicare & Medicaid Services.Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG\u201000439N). 2015 [cited 2017 Sep 10];1\u201397. 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