{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:45:09Z","timestamp":1788788709183,"version":"build-2803163510"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"3\u20134","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Localizer orientation can significantly impact the automatic tube-current modulation (ATCM) in computed tomography (CT). The purpose of this study was to introduce a methodology for assessing ATCM consistency and to compare the outcomes in image noise and radiation dose between a single anterior\u2013posterior (AP) localizer and a combination of lateral and AP (LAT\u00a0+\u00a0AP) localizers. A total of 299 prospective patients referred for a routine CT thorax examination were randomly assigned to a single AP or LAT\u00a0+\u00a0AP localizer. Measurements of image noise and patient size were performed in the thorax and liver, and the corresponding effective milliampere-second (mAseff) at these positions were collected. Performance analysis was conducted using the normalized root mean squared error (nRMSE) of mAseff and image noise relative to patient size. A smaller nRMSE indicates more consistent inter-patient variance in image noise and mAseff for a given size. The LAT\u00a0+\u00a0AP group had a statistically significant lower nRMSE for mAseff and image noise in the thorax region, and for mAseff (but not image noise) in the liver region. A post-hoc finding indicated that a subgroup of female patients with laterally protruding breasts was overexposed (+57% radiation dose) in the thorax region when using the AP localizer. Using LAT\u00a0+\u00a0AP localizer resulted in more consistent image noise levels and radiation doses compared to single AP localizer. The effect was small, except for the subgroup of females, where radiation doses were higher in the AP group. The findings are specific to the CT system used in this study and may not be generalizable to other CT models or software versions. Nonetheless, the proposed methodology provides a valuable approach for evaluating ATCM consistency.<\/jats:p>","DOI":"10.1093\/rpd\/ncaf190","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T12:57:26Z","timestamp":1766149046000},"page":"393-401","source":"Crossref","is-referenced-by-count":1,"title":["A methodology for assessing the effect of localizer orientation on the consistency of tube current modulation in CT"],"prefix":"10.1093","volume":"202","author":[{"given":"Daniel","family":"Thor","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital , SE-141 83 Stockholm ,","place":["Sweden"]},{"name":"Department of Oncology-Pathology, Karolinska Institutet , SE-141 83 Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2481-5506","authenticated-orcid":false,"given":"Marcus","family":"S\u00f6derberg","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Medical Radiation Physics, Sk\u00e5ne University Hospital, Lund University , SE-205 02 Malm\u00f6 ,","place":["Sweden"]},{"name":"Department of Hematology, Oncology and Radiation Physics, Radiation Physics, Sk\u00e5ne University Hospital , SE-205 02 Malm\u00f6 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9945-0543","authenticated-orcid":false,"given":"Gavin","family":"Poludniowski","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital , SE-141 83 Stockholm ,","place":["Sweden"]},{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet , SE-141 83 Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torkel B","family":"Brismar","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet , SE-141 83 Stockholm ,","place":["Sweden"]},{"name":"Department of Radiology, Karolinska University Hospital in Huddinge , SE-141 83 Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"2026031302442722100_ref1","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.ejmp.2008.01.012","article-title":"Technical approaches to the optimisation of CT","volume":"24","author":"Kalender","year":"2008","journal-title":"Phys Med"},{"key":"2026031302442722100_ref2","doi-asserted-by":"publisher","first-page":"20160308","DOI":"10.1259\/bjr.20160308","article-title":"Evaluating the impact of scan settings on automatic tube current modulation in CT using a novel phantom","volume":"90","author":"Merzan","year":"2017","journal-title":"Br J Radiol"},{"key":"2026031302442722100_ref3","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1067\/j.cpradiol.2018.12.010","article-title":"Effect of CT localizer radiographs on radiation dose associated with automatic tube current modulation: a multivendor study","volume":"49","author":"Paolicchi","year":"2020","journal-title":"Curr Probl Diagn Radiol"},{"key":"2026031302442722100_ref4","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1093\/rpd\/ncv459","article-title":"Overview, practical tips and potential pitfalls of using automatic exposure control in CT: Siemens CARE dose 4D","volume":"169","author":"S\u00f6derberg","year":"2016","journal-title":"Radiat Prot Dosim"},{"key":"2026031302442722100_ref5","doi-asserted-by":"publisher","first-page":"673","DOI":"10.2214\/AJR.04.1513","article-title":"Comparison of angular and combined automatic tube current modulation techniques with constant tube current CT of the abdomen and pelvis","volume":"186","author":"Rizzo","year":"2006","journal-title":"AJR Am J Roentgenol"},{"key":"2026031302442722100_ref6","volume-title":"Somatom Definition Flash \u2013 System Owner Manual","author":"Siemens AG Medical Solutions","year":"2012"},{"key":"2026031302442722100_ref7","doi-asserted-by":"publisher","first-page":"6764","DOI":"10.1118\/1.4754303","article-title":"Attenuation-based estimation of patient size for the purpose of size specific dose estimation in CT. 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