{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:59:32Z","timestamp":1791381572910,"version":"4.3.3"},"reference-count":43,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":33,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal tube voltage in clinical CT depends on the patient's attenuation and the imaging task. Although the patient's attenuation changes with view angle and longitudinal position of the X\u2010ray tube, the tube voltage remains constant throughout the scan in current clinical practice. In general, the optimum tube voltage increases with patient diameter. For iodine\u2010enhanced scans, the tube voltage is ideally low to increase contrast. However, 70\u2009kV, the lowest clinically available tube voltage today, can not always be used due to tube current restrictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine the additional relative reduction in effective dose of a tube voltage modulation in addition to a tube current modulation for unenhanced and iodine\u2010enhanced CT scans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>For patient models based on CT scans, the effective dose was simulated per projection for different voltages using Monte Carlo simulations. Using these dose data and analytical estimations of noise and iodine contrast, tube voltage and tube current curves were optimized for circular scans. For unenhanced scans, the dose\u2010weighted noise was minimized, and for iodine\u2010enhanced scans, the dose\u2010weighted contrast\u2010to\u2010noise ratio (CNRD) was maximized. The effective dose values of the optimized tube voltage and tube current curves (riskTCTVM) were compared at the same noise or same contrast\u2010to\u2010noise ratio (CNR) to a pure tube current modulation minimizing the effective dose (riskTCM) and to conventional mAs\u2010minimizing tube current modulation (mAsTCM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For unenhanced scans, riskTCTVM reduces the effective dose by less than  compared to riskTCM at its optimal tube voltage. For iodine\u2010enhanced scans, the effective dose benefit increases with the availability of low tube voltages and the eccentricity of the patient's anatomy. For a lowest voltage of 70\u2009kV, we found average effective dose benefits of riskTCTVM to riskTCM of less than  for thorax and abdomen,  for the pelvis, and  for the shoulder. For a lowest voltage of 50\u2009kV, we found average effective dose benefits of  for the thorax,  for the abdomen,  for the pelvis, and  for the shoulder. However, the maximum requested tube current was multiple times higher than for mAsTCM at 70\u2009kV. Only for eccentric anatomies in the pelvis and the shoulder, riskTCTVM could lower tube current demands for a lowest available voltage of 70\u2009kV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For unenhanced scans, tube voltage modulation in addition to a modulated tube current yields a negligible effective dose benefit. However, for iodine\u2010enhanced circular scans, all studied anatomical regions from shoulder to pelvis would benefit from tube current and tube voltage modulation if X\u2010ray generators with voltages down to 50\u2009kV were available at sufficient tube power. For a lowest voltage of 70\u2009kV, riskTCTVM can considerably reduce the effective dose for eccentric anatomies in the shoulder and the\u00a0pelvis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.18047","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T05:39:21Z","timestamp":1756964361000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk\u2010minimizing tube current and tube voltage modulation for CT: A simulation study"],"prefix":"10.1002","volume":"52","author":[{"given":"Edith","family":"Baader","sequence":"first","affiliation":[{"name":"Division of X\u2010Ray Imaging and CT German Cancer Research Center (DKFZ) Heidelberg Germany"},{"name":"Department of Physics and Astronomy Heidelberg University Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Kachelrie\u00df","sequence":"additional","affiliation":[{"name":"Division of X\u2010Ray Imaging and CT German Cancer Research Center (DKFZ) Heidelberg Germany"},{"name":"Medical Faculty Heidelberg University Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2403060698"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598779"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598738"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.10.6061"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-020-06888-5"},{"issue":"2","key":"e_1_2_8_7_1","first-page":"1","article-title":"The 2007 Recommendations of the International Commission on Radiological Protection","volume":"37","author":"ICRP","year":"2007","journal-title":"ICRP Publication 103. 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