Organ doses, effective doses, and risk indices in adult CT: Comparison of four types

of reference phantoms across different examination protocols

Yakun Zhang, Xiang Li, W. Paul Segars, and Ehsan Samei

Citation: Medical Physics 39, 3404 (2012); doi: 10.1118/1.4718710

View online: http://dx.doi.org/10.1118/1.4718710
View Table of Contents: http://scitation.aip.org/content/aapm/journal/medphys/39/6?ver=pdfcov
Published by the American Association of Physicists in Medicine

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Organ doses, effective doses, and risk indices in adult CT: Comparison of
four types of reference phantoms across different examination protocols
Yakun Zhang
Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Carl E. Ravin
Advanced Imaging Laboratories, Duke University, Durham, North Carolina 27705
Xiang Li
Carl E. Ravin Advanced Imaging Laboratories, Duke University, Durham, North Carolina 27705 and
Department of Radiology, Duke University, Durham, North Carolina 27705
W. Paul Segars
Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705; Carl E. Ravin
Advanced Imaging Laboratories, Duke University, Durham, North Carolina 27705; and Department of
Radiology, Duke University, Durham, North Carolina 27705
Ehsan Sameia)
Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705; Carl E. Ravin
Advanced Imaging Laboratories, Duke University, Durham, North Carolina 27705; Department of Radiology,
Duke University, Durham, North Carolina 27705; and Departments of Physics, Biomedical Engineering, and
Electrical and Computer Engineering, Duke University, Durham, North Carolina 27705
(Received 16 December 2011; revised 26 March 2012; accepted for publication 28 April 2012;
published 24 May 2012)
Purpose: Radiation exposure from computed tomography (CT) to the public has increased the con-
cern among radiation protection professionals. Being able to accurately assess the radiation dose
patients receive during CT procedures is a crucial step in the management of CT dose. Currently,
various computational anthropomorphic phantoms are used to assess radiation dose by different
research groups. It is desirable to better understand how the dose results are affected by different
choices of phantoms. In this study, the authors assessed the uncertainties in CT dose and risk esti-
mation associated with different types of computational phantoms for a selected group of represen-
tative CT protocols.
Methods: Routinely used CT examinations were categorized into ten body and three neurological
examination categories. Organ doses, effective doses, risk indices, and conversion coefficients to
effective dose and risk index (k and q factors, respectively) were estimated for these examinations
for a clinical CT system (LightSpeed VCT, GE Healthcare). Four methods were used, each employ-
ing a different type of reference phantoms. The first and second methods employed a Monte Carlo
program previously developed and validated in our laboratory. In the first method, the reference
male and female extended cardiac-torso (XCAT) phantoms were used, which were initially created
from the Visible Human data and later adjusted to match organ masses defined in ICRP publication
89. In the second method, the reference male and female phantoms described in ICRP publication
110 were used, which were initially developed from tomographic data of two patients and later
modified to match ICRP 89 organ masses. The third method employed a commercial dosimetry
spreadsheet (ImPACT group, London, England) with its own hermaphrodite stylized phantom. In the
fourth method, another widely used dosimetry spreadsheet (CT-Expo, Medizinische Hochschule,
Hannover, Germany) was employed together with its associated male and female stylized phantoms.
Results: For fully irradiated organs, average coefficients of variation (COV) ranged from 0.07 to
0.22 across the four male phantoms and from 0.06 to 0.18 across the four female phantoms; for par-
tially irradiated organs, average COV ranged from 0.13 to 0.30 across the four male phantoms and
from 0.15 to 0.30 across the four female phantoms. Doses to the testes, breasts, and esophagus
showed large variations between phantoms. COV for gender-averaged effective dose and k factor
ranged from 0.03 to 0.23 and from 0.06 to 0.30, respectively. COV for male risk index and q factor
ranged from 0.06 to 0.30 and from 0.05 to 0.36, respectively; COV for female risk index and q fac-
tor ranged from 0.06 to 0.49 and from 0.07 to 0.54, respectively.
Conclusions: Despite closely matched organ mass, total body weight, and height, large differences
in organ dose exist due to variation in organ location, spatial distribution, and dose approximation
method. Dose differences for fully irradiated radiosensitive organs were much smaller than those for
partially irradiated organs. Weighted dosimetry quantities including effective dose, male risk indices,
k factors, and male q factors agreed well across phantoms. The female risk indices and q factors
varied considerably across phantoms. V C 2012 American Association of Physicists in Medicine.

[http://dx.doi.org/10.1118/1.4718710]

3404 Med. Phys. 39 (6), June 2012 0094-2405/2012/39(6)/3404/20/$30.00 C 2012 Am. Assoc. Phys. Med.
V 3404
3405 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3405

Key words: CT, Computed Tomography, dose, CT dose, organ dose, effective dose, risk index,
k factor, q factor, reference phantom, comparison of phantoms

I. INTRODUCTION developed by several research groups.23,24,27 Hybrid phan-

Over the past few decades, technological advances in x-ray toms are also based on segmented tomographic data of real
computed tomography (CT) have made CT an essential diag- patients. However, the segmented data are further used to
nostic imaging tool. While this technology is bringing con- generate polygon mesh surfaces, which are then fitted to
venience and high quality tomography to the medical sophisticated mathematical descriptors such as nonuniform
imaging world, it also introduces radiation exposure to rational B-splines (NURBS). They represent anatomy realisti-
the public.1 From the data published in 2006, the use of cally since they are based on tomographic data from real
CT has increased at a rate of 8%–15% per year for the last patients, while at the same time they offer the flexibility to
7–10 years.2 In 2006, nearly half of the total medical radia- model variations in anatomical geometry.
tion exposure was from CT.2 This has increased concern Some comparisons between hybrid and stylized phantoms
about CT imaging among radiation protection professionals used in CT dosimetry have been made by Liu et al.15 and
as well as the general public.3–5 Therefore, it is important to Lee et al.10,11 However, earlier studies included only limited
be able to accurately estimate the radiation dose that patients examination types, leaving out some other important and
receive during CT procedures so that any potential risk can routinely used CT examinations, such as liver examinations.
be estimated and minimized. Furthermore, in the clinical environment, the effective dose
Computational anthropomorphic phantoms combined with is often estimated by a dose length product (DLP) to effec-
Monte Carlo simulation of radiation transport have proven to tive dose conversion coefficient, called the k factor. These
be an accurate and reliable method to estimate organ doses earlier studies did not examine the choice of phantoms on
during CT examinations.6–19 Such phantoms have evolved the resulting dose conversion coefficients. In addition, com-
from the original stylized phantoms,20 to voxelized phan- parisons between anatomically realistic reference phantoms
toms,21,22 and to more advanced hybrid phantoms.11,23,24 developed by different research groups have not yet been
Stylized phantoms define the organs and structures in the explored.
human body through mathematical equations and simple geo- The purpose of this study was to extend the earlier com-
metric primitives. While highly flexible, stylized phantoms parison efforts to four types of widely used reference phan-
are limited in their ability to model the complexities of the toms, to a wide range of body and neurological examination
human anatomy accurately.25,26 To overcome the unrealistic types, and to dose and risk conversion coefficients.
nature of the stylized phantoms, voxelized phantoms have
been developed over the last 20 years. These phantoms are II. METHODS
based directly on segmented patient data from high resolution Figure 1 demonstrates the methodology used in this study.
MRI or CT whole body scans and have a high degree of real- Four types of reference phantoms were employed: male and
ism. However, voxelized phantoms do not have the flexibility female hybrid phantoms in the extended cardiac-torso
of stylized phantoms and cannot be easily used to model ana- (XCAT) family,24 male and female voxelized phantoms pro-
tomical variations. To overcome this limitation, more vided in ICRP publication 110,21 the hermaphrodite stylized
advanced phantoms, hybrids of stylized and voxelized phan- phantom used in the ImPACT CT dose spreadsheet,28 and
toms seeking to combine the advantages of both, have been male and female stylized phantoms used in the CT-Expo

FIG. 1. Flow chart of the methodology used in this study. RI: risk index; ED: effective dose.

Medical Physics, Vol. 39, No. 6, June 2012

3406 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3406

dose spreadsheet. For the XCAT (Ref. 24) and ICRP 110 II.A.1. XCAT hybrid phantoms
phantoms,21 a validated Monte Carlo program modeling a
The first set of phantoms was the reference male and
64-slice CT scanner (LightSpeed VCT, GE Healthcare,
female XCAT phantoms [Figs. 2(a) and 2(b)].24 The XCAT
Waukesha, WI) was employed to simulate organ doses,
reference phantoms were initially created from the Visible
which were then used to calculate effective doses, risk indi-
Human anatomical data distributed by the National Library
ces (RIs), and conversion coefficients from DLP to effective
of Medicine (NLM).29 Segmentation of anatomical struc-
dose and risk index (k and q factors). For the ImPACT and
tures was applied semi-automatically by using a tablet PC
CT-Expo phantoms, organ doses were obtained directly
with the help of a custom graphical application IMAGESEG-
from their associated dosimetry spreadsheets for the same
MENT (RAI Laboratories, Duke University, Durham, NC).
CT scanner model, which were then used in the effective
The resulting segmented structure was converted to a 3D
dose and risk index calculations.
polygon model and later fitted to cubic NURBS surfaces for
a more compact mathematical description of the objects.
II.A. Computational phantoms
Brains were modeled separately using MRI data of a normal
The four types of reference phantoms used in this study are male subject. After segmentation and conversion to a poly-
detailed below. Their organ masses are tabulated in Table I. gon model of the brain, subdivision surfaces replaced

TABLE I. Organ masses for the four types of reference phantoms employed in this study. Reference organ masses published in ICRP 89 are also listed for com-
parison. Note that the CT-Expo male and female phantoms were matched to ICRP publication 23.

Mass (g)

XCAT XCAT ICRP 110 ICRP 110 ImPACT CT-Expo CT-Expo ICRP 89 ICRP 89
Organ/structure reference male reference female reference male reference female herma-phrodite male female male female

Breast 24 474 25 491 302 — 532 25 500

Soft tissuea 58 548 49 796 48 294 45 166 48 893 49 111 40 924 47 930 40 600
Heart 850 646 819 605 830 595 494 840 620
Kidneys 307 274 304 270 310 284 236 310 275
Lungsb 1105 986 1141 915 999 1000 830 1200 950
Liver 1736 1335 1765 1373 1810 1806 1471 1800 1400
Gall bladderc 68 56 14 10 10 10 8.1 10 8
Spleen 151 131 149 129 180 174 144 150 130
Stomachc 391 355 149 139 350 150 125.3 150 140
Bladderd 50 41 50 40 147 45 45 50 40
Large intestinec 671 599 366 357 722 367 304 370 360
Pancreas 138 116 137 118 100 96 79.6 140 120
Prostate 16 — 17 — — — — 17 —
Adrenals 14 13 14 13 14 15.5 12.9 14 13
Thyroid 21 16 20 17 20 20 16.4 20 17
Thymus 25 20 25 20 20 20 20 25 20
Larynx–pharynx 30 19 28 14 — — — 28 19
Trachea–bronchi 117 104 76 17 — — — — —
Testes 34 — 35 — 37 37 — 35 —
Eyes 14 15 15 15 — — — 15 15
Small intestinec 1009 875 644 594 640 1046 894 1000 600
Esophagus 39 36 40 35 90 — — 40 35
Brain 1452 1306 1422 1275 1400 1349 1120 1450 1300
Skin 7033 6362 3668 2599 2862 3130 2803 3300 2300
Ovaries — 11 — 11 — — 11 — 11
Uterus — 75 — 80 — — 80 — 80
Skeletone 10 904 10 307 10 629 7246 9516 10 175 8360 10 450 7760
Total body weight 84 746 74 031 73 000 60 000 70 910 70 450 59 193 73 000 60 000
Height (cm) 176 163 176 163 — 170 160 176 163

a
Soft tissue included skeletal muscle, adipose tissue, cartilage, blood, lymphatic tissues, and connective tissues. For ICRP 110 phantoms, teeth, tongue, tonsils,
and ureters were all set to soft tissue for comparison with the XCAT phantoms.
b
Lungs were compressed in the ICRP 110 phantoms, but dilated in the XCAT reference phantoms. The densities of the lungs were set such that the total mass
of the lungs matched the reference lung mass.
c
These GI track organs included both wall and contents for XCAT reference phantoms but only wall for ICRP 110 reference phantoms. The ICRP 89 reference
values were organ walls.
d
Bladder included only wall.
e
Skeleton included cortical bone, trabecular bone, yellow marrow, red marrow, and various connective tissues.

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3407 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3407

FIG. 2. Lateral and frontal views of the four types of phantoms used in this study. (a) and (b) XCAT reference male and female hybrid phantoms after voxeli-
zation. (c) and (d) ICRP 110 reference male and female voxelized phantoms. The organs were relabeled to be consistent with the XCAT phantoms. (e)
ImPACT stylized/mathematical hermaphrodite phantom. (f) and (g) CT-Expo male and female stylized/mathematical phantoms.

NURBS surfaces in order to more accurately represent the along the body long axis and 2.137 mm in the transverse plane.
arbitrary topological structure in the brain.24 The respective values for the female phantom were 4.84 and
The NURBS based phantoms developed from the Visible 1.775 mm. Similar to the XCAT phantoms, the skin was also
Human data were subsequently modified to match ICRP ref- modeled as a single voxel layer on the surface, causing the
erence values. The body measurements and organ volumes skin mass to be higher than the ICRP 89 reference mass.
were first matched to a 50th percentile (height and weight)
male and female with desired data obtained using the survey II.A.3. ImPACT stylized phantom
data of U.S. adults from the “PEOPLESIZE Program” (avail-
able URL: http://www.openerg.com/psz/index.html). The The third type of phantom [Fig. 2(e)] was a stylized/math-
organ masses were then matched to ICRP publication 89 val- ematical phantom—the ImPACT hermaphrodite phantom—
ues. Thus, the resulting phantoms were named reference which is available commercially from the ImPACT website
male and female phantoms in the XCAT phantoms family. (ImPACT CT Patient Dosimetry Calculator, version 1.0.3;
In the voxelized versions of the XCAT phantoms, skin was ImPACT, London, England).28 This phantom is composed
modeled as a single voxel layer on the surface, which caused of 208 contiguous 5 mm thick slabs extending from upper
the skin mass to be higher than the ICRP 89 reference mass. legs to head. It was first designed for a UK national survey
of doses to patients from conventional x-ray examinations.33
Definition of individual organs and cross-section data can be
II.A.2. ICRP 110 voxelized phantoms found in NRPB-R186.34
The second set of phantoms was the reference male and
II.A.4. CT-Expo stylized phantoms
female phantoms [Figs. 2(c) and 2(d)] provided in ICRP publi-
cation 110.21 The phantoms were constructed from tomo- The fourth set of phantoms was stylized/mathematical
graphic data of individuals whose body heights closely phantoms [Figs. 2(f) and 2(g)] based on the design character-
matched to the reference values defined in ICRP publication istics of the MIRD-5 phantom.35 The two sex-specific adult
89. Initially, radiosensitive organs were directly segmented phantoms ADAM and EVA were originally created in the
from the tomographic data using commercial image process- German National Research Center for Environment and
ing software by applying CT number thresholding. The result- Health (GSF) based on reference male and female organ
ing male and female voxelized phantoms, referred to as masses given by ICRP publication 23. The ratios of refer-
Golem and Laura, were then modified to match the following ence female to male organ masses were analyzed, yielding
reference body parameters: height, organ mass, and total body an average value of 0.89 and the whole body mass ratio of
mass. Specifically, the voxels were scaled along the body long 0.83. As the MIRD-5 phantom had similar dimensions of the
axis to match the reference height and then adjusted again to male reference adult, the female phantom was derived to a
match the skeletal mass according to ICRP publication 70, first approximation by shrinking all relevant volumes of the
ICRP publication 89, and ICRU report 46.30–32 Subsequently, MIRD-5 phantom with the total whole body mass ratio of
individual organ volume was modified to match the reference 0.83. Then, female organ masses were modified to match the
mass. Finally, additional tissues and different body regions reference ratios. Finally, sex-specific organs including testes,
were modified to match the total reference mass.21 The result- ovaries, uterus, and breasts were added to the phantoms. The
ing voxel sizes for the reference male phantom were 8 mm resulting phantoms consisted of an elliptical cylinder for the

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3408 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3408

TABLE II. CT examination categories investigated in this study. simulate organ doses (Fig. 1).13 This program was based on
a benchmarked Monte Carlo subroutine package (PENELOPE,
Simulated image coverage
version 2006, Universitat de Barcelona, Spain) specialized
Examination Start End for photon, electron, and positron transport.37,38 This pro-
categories (1 cm above) (1 cm below) gram explicitly simulates the geometry of the GE Light-
Body Chest–abdomen–pelvis Lung apex Inferior ischium
Speed VCT system (GE Healthcare, Waukesha, WI),
Chest Lung apex Lung base including the complex 3D bowtie filters as well as the trajec-
Abdomen–pelvis Superior liver Inferior ischium tories of x-ray tube motion during axial and helical scans.
Abdomen Superior liver Superior iliac crest The accuracy of the simulated dose was previously validated
Pelvis Superior iliac crest Inferior ischium in a cylindrical phantom and two anthropomorphic phantoms
Adrenals Superior adrenals Inferior adrenals in both axial and helical scanning modes. Simulations agreed
Liver Superior liver Inferior liver with measurements to within 1%–11% on average and
Kidneys Superior kidney Inferior kidney 5%–17% maximum.13 Arms of XCAT reference phantoms
Liver-to-kidneys Superior liver Inferior kidney were positioned up for body examinations and down for neu-
Kidneys-to-bladder Superior kidney Inferior bladder
rological examinations; arms of ICRP 110 phantoms were
Neurological Head Vertex of skull Scalp bottom
set to vacuum for body examinations and remained
Neck C1 C7
Head-and-neck Vertex of skull C7
unchanged for neurological examinations. Organ labels and
densities for ICRP 110 phantoms were adapted in order to
run the phantoms through the Monte Carlo simulation.
trunk and arms, two truncated circular cones for the legs, Energy deposited in organs and tissues was tallied for the
and a circular cylinder with an elliptical cylinder capped by dose computation.14 To estimate dose to the red bone mar-
half an ellipsoid for the neck and head.35 Organ masses, total row, volume-averaged photon fluence spectrum was tallied
body mass, and height was tabulated in Table I. individually at each skeletal site and used to calculated dose
to the red bone marrow via fluence-to-dose conversion coef-
II.B. CT examination categories ficients.20 A single active marrow dose was then calculated
as its skeletal average using the age-dependent fractional dis-
Body and neurological CT protocols routinely used at our
tribution of active marrow tabulated in ICRP 89.31 Dose to
institution were reviewed. Thirteen examination categories
the bone surface was approximated by the mass-weighted
were selected for this study, consisting of ten body categories
average of dose to the homogeneous bones.39 Doses to
and three neurological categories (Table II). Each examina-
organs that were not explicitly modeled were approximated
tion category represented a class of protocols that cover the
by doses to neighboring organs.14 A total of 8  107 histories
same anatomical region and share the same scan parameters,
were simulated to achieve relative errors of less than 1% for
including tube voltage, pitch, beam collimation, and the type
organs inside the scan coverage.
of scan field-of-view (Table III). These scan parameters were
explicitly modeled in the Monte Carlo simulations. Before
simulating a given protocol, relevant organ locations were II.C.2. ImPACT phantom
computed along the longitudinal body axis to locate the start-
ing and ending anatomical landmarks (Table II). For helical For the ImPACT phantom, the ImPACT CT dosimetry
scans, over-ranging (necessary for data interpolation in heli- spreadsheet provides organ doses based on 23 Monte Carlo
cal reconstruction) was added to the total scan length. For the data sets from National Radiological Protection Board
helical scan parameters in Table III, the total over-ranging (NRPB)’s SR250 report.40 The Monte Carlo techniques were
distance (a sum of the over-ranging distances at the beginning initially developed at the NRPB in support of a UK national
and the end of the scan) was estimated to be 6.4 cm.36 This survey of doses to patients from conventional x-ray examina-
value was used for all but the CT-Expo phantoms; an over- tions.33,34 Modifications, including rotating fan beam spectral
ranging distance of 5.55 cm was automatically considered by x-ray source and bow-tie shaped filter, were accommodated
the CT-Expo dosimetry spreadsheet. to the Monte Carlo program to simulate commercial CT scan-
ners. Doses generated by this program were compared to
II.C. Organ doses simulations doses from GSF Monte Carlo code using a female GSF phan-
tom. Good agreements among doses were found between
II.C.1. XCAT and ICRP 110 phantoms
these two programs for the same input conditions.40
For XCAT and ICRP 110 phantoms, a Monte Carlo pro- The data set for one model of CT scanner included doses
gram previously developed in our laboratory was used to received when each of 208 contiguous 5 mm thick slabs of

TABLE III. Scan parameters for body and neurological examination categories.

Scan mode Tube voltage Pitch Beam collimation Scan field-of-view

Body examination categories Helical 120 kVp 1.375 40 mm Large body

Neurological examination categories Axial 120 kVp 1 20 mm Head

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3409 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3409

the hermaphrodite phantom is individually irradiated. The VCT scanner simulated in this study. After calculation of
dose was expressed as absorbed dose in the organ relative to DLP for each anthropomorphic phantom, DLPs for XCAT
the dose on the axis of rotation of the scanner in the absence phantoms and ICRP 110 phantoms were averaged over their
of the phantom, i.e., free-in-air axial dose. In order to use male and female phantoms. Gender-averaged k factor was
the normalized organ dose data to estimate patient dose for a determined by dividing the obtained effective dose over the
specific CT examination on a specific scanner, several steps gender-averaged DLP.
were employed by the spreadsheet. These steps involved In order to estimate cancer risk, RI was obtained as
obtaining scan volume, total normalized organ doses X
P RI ¼ rT ðgender;ageÞ HT ; (2)
( V Df ), packing factor (p), and CTDIn. DosesP to organs T
were calculated by the multiplication of V Df , p, and
CTDIn. Over-ranging was also added to the total scan region where rT is the gender-, age-, and tissue-specific risk coeffi-
when defining the start and end position of the scan. cient with the unit of cases/100 000 exposed to 0.1 Gy and
HT is the equivalent dose to organ T. The values of rT were
tabulated in BEIR VII report for lifetime attributable risk of
II.C.3. CT-Expo phantoms cancer incidence.42 In this study, all phantoms were assumed
For the CT-Expo male and female phantoms, similar to the to be 20 yr old for a conservative risk estimation. For males,
ImPACT dosimetry spreadsheet, the CT-Expo dosimetry values of rT are available for leukemia and for cancers of
spreadsheet provides organ doses. The spreadsheet is based stomach, colon, liver, lung, prostate, bladder, and thyroid.
on computational methods for evaluating the data collected in For females, values of rT are available for leukemia and for
two German surveys on CT exposure practice in 1999 and cancers of stomach, colon, liver, lung, breast, uterus, ovary,
2002. The methods used Monte Carlo simulation to transport bladder, and thyroid. Cancers of other radiosensitive organs
radiation in the phantoms. Doses were calculated as conver- share a collective risk coefficient rother, also provided in
sion factors (f) of individual mean organ doses per axial free- BEIR VII report.42 rother was applied to a weighted average
in-air kerma for single slices at positions varying contigu- of the dose to other radiosensitive organs as described by Li
ously from 10 cm below the bottom of the trunk up to the top et al.14 For the XCAT, the ICRP 110, and the CT-Expo
of the head with slice thickness of 1 cm. Mean organ doses phantoms, risk index was calculated for each gender sepa-
rately. For the ImPACT hermaphrodite phantom, since only
can then be obtained by summing up the values Pof f (organ, z)
over the scanned region as D (organ) ¼ Kair  zzul f ðorgan; zÞ, one set of organ doses was provided for each examination
where zl and zu indicate the lower and upper boundaries of the category, that set of data was used to calculated risk index
scanned region and Kair is the axial free-in-air kerma. with different rT values for male and female. Risk index val-
ues were then normalized over their corresponding DLPs to
obtain q factors (Fig. 1).
II.D. Effective dose and cancer risk index calculations
Effective dose was calculated from the obtained organ doses III. RESULTS
using the tissue weighting factors defined in ICRP publication
103.41 Effective dose for the ImPACT and the CT-Expo phan- III.A. Comparison of organ doses
toms were conveniently provided by the dosimetry spread- Figure 3 shows the organ doses estimated using the four
sheets. For XCAT and ICRP 110 reference phantoms, which types of phantoms for the 13 examination categories. Some
were run through the validated Monte Carlo simulation code, organs received noticeably different doses between phan-
effective dose was calculated as follows. Organ doses obtained toms for the same examination. For example, in the chest–
from the Monte Carlo method were first averaged over male abdomen–pelvis and abdomen–pelvis examinations, doses to
and female for each type of phantoms. Dose to the testes or the testes for the XCAT and the ICRP 110 male phantoms
ovaries was averaged to obtain the dose to gonads. Following were less than half of the doses to the testes for the ImPACT
the recommendations of ICRP 103, dose to the remainder tis- and the CT-Expo male phantoms. In the pelvis examination,
sues was first calculated separately for each gender, including doses to the testes for the ICRP 110 phantoms differed by
gender-specific reproductive organ (male: prostate; female: fourfold from the XCAT phantom and even more from the
uterus/cervix). The results were then averaged across genders ImPACT and the CT-Expo phantoms. In the abdomen–
to obtain gender-averaged dose to the remainder tissues. These pelvis, abdomen, liver, and liver-to-kidneys examinations,
gender-averaged organ doses were then weighted by the tissue dose to breasts for the ImPACT phantom was much smaller
weighting factors and summed to obtain effective dose, as compared to doses for the other three female phantoms.
X H Male þ H Female Esophageal doses for the two voxelized phantoms (XCAT
ED ¼ wT T T
; (1) and ICRP 110) were smaller than the two stylized phantoms
T
2
(ImPACT and CT-Expo) in the chest–abdomen–pelvis and
where wT is the tissue weighting factor defined by ICRP pub- chest examinations, but were larger in the abdomen–pelvis,
lication 103 and HT is the dose for organ T. DLP was calcu- abdomen, liver, and liver-to-kidneys examinations.
lated as the product of volume-weighted CT dose index The quantitative differences between phantoms are sum-
(CTDIvol) and total scan length, where the CTDIvol was marized in Tables IV and V for fully irradiated organs
obtained from the technical manual of the GE LightSpeed (organs directly irradiated and completely within the scan

Medical Physics, Vol. 39, No. 6, June 2012

3410 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3410

FIG. 3. Comparison between different types of phantoms in terms of organ doses and effective doses (ED) in 13 examination categories: (a) chest–abdomen–
pelvis; (b) chest; (c) abdomen–pelvis; (d) abdomen; (e) pelvis; (f) adrenals; (g) liver; (h) kidneys; (i) liver-to-kidneys; (j) kidneys-to-bladder; (k) head; (l)
neck; (m) head-and-neck. Note that doses for ImPACT are the same for male and female except for testes and ovaries. Doses are normalized to 100 mAs. The
quantitative differences were tabulated in Tables IV and V. The coefficient of variation for ED is displayed above the bars for each examination.

coverage for all four types of phantoms) and partially irradi- cient of variation (COV) and the difference between the
ated organs (organs directly irradiated in four types of phan- ICRP 110 phantoms used as the reference standard and the
toms and partially inside the scan coverage for at least one other three types of phantoms. It is obvious that the average
type of phantoms). Two comparison methods were used: COV for fully irradiated organs were smaller than the COV
comparisons across all four types of phantoms using coeffi- for partially irradiated organs.

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3411 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3411

FIG. 3. (Continued).

In general, the average differences between each type of (ranging from 13% to 37% for fully irradiated and 12% to
phantoms and ICRP 110 phantoms were also smaller for 72% for partially irradiated organs) or between the CT-Expo
fully irradiated organs than those for partially irradiated and the ICRP 110 phantoms (ranging from 8% to 38% for
organs [Tables IV and V]. For male phantoms, the average fully irradiated and 16% to 66% for partially irradiated).
differences between the XCAT and the ICRP 110 phantoms This trend was not demonstrated as prominently in the
(ranging from 3% to 22% for fully irradiated and 6% to 21% female phantoms. For fully irradiated female organs, the av-
for partially irradiated organs) were overall smaller than erage differences between the CT-Expo and the ICRP 110
those between the ImPACT and the ICRP 110 phantoms phantoms appeared to be the smallest (ranging from 3% to

Medical Physics, Vol. 39, No. 6, June 2012

3412 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3412

FIG. 3. (Continued).

20%), and the average differences between the XCAT and in organ doses. COV of effective doses across all four types
the ICRP 110 phantoms for partially irradiated female of phantoms was calculated for each examination category
organs were the smallest (ranging from 8% to 56%). and displayed in Fig. 3. The effective dose COV for all the
examinations other than pelvis (0.21) and head (0.23) exami-
III.B. Comparison of effective doses and risk indices nations, were less than 0.2, with the lowest value being 0.03
(abdomen–pelvis examination). Percent differences for
The differences between effective doses of the four types effective doses using ICRP 110 phantoms as the reference
of phantoms (Fig. 3) were not as dramatic as the differences standard showed that the XCAT and the ICRP 110 were

Medical Physics, Vol. 39, No. 6, June 2012

3413 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3413

FIG. 3. (Continued).

very close; the percent differences between the two were Figure 4 illustrates the risk indices for the 13 examination
under 10% for most examination categories except the head categories with the COV of all four phantoms displayed
examination, which had a percent difference of 20%. In con- above the bars. The COV for the male phantoms were all
trast, the maximum percent difference between the ImPACT under 0.20 except in the pelvis (0.28) and head (0.30) exami-
and the ICRP 110 phantoms was 42% (pelvis examination) nations, indicating the risk indices agreed well across male
and between the CT-Expo and the ICRP 110 phantoms was phantoms. The COV for female phantoms were larger than
34% (pelvis examination). for male phantoms with maximum value of 0.49 (neck

Medical Physics, Vol. 39, No. 6, June 2012

3414 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3414

FIG. 3. (Continued).

examination). The risk indices also fluctuated more across nation agreed well across phantoms, providing that the COV
examinations for females. were all equal to or less than 0.20, with the exception of the
head examination (0.30). Average difference with respect to
the ICRP 110 phantoms showed that k factors from the
III.C. Comparison of k and q factors
XCAT phantoms were the closest to the ICRP 110 phantoms
Figure 5 and Table VI show DLP to effective dose con- (average difference of 11% across 13 examination catego-
version coefficient (k factor) for each examination category ries). The k factors from the ImPACT and CT-Expo phan-
on all four types of phantoms. The k factors for each exami- toms had similar average differences relative to ICRP 110

Medical Physics, Vol. 39, No. 6, June 2012

3415 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3415

FIG. 3. (Continued).

phantoms (20% for ImPACT and 21% for CT-Expo). As examinations in this study, but no apparent trend was
expected, the k factors for body examinations were signifi- observed for neurological examinations.
cantly higher than those of neurological examinations. For Figure 6 and Table VI show the DLP to risk index con-
body examinations, k factors for ICRP 110 phantoms were version coefficient (q factor) for all four types of phantoms.
the largest among all four types of phantoms except for the The q factors from the four male phantoms agreed well, hav-
pelvis examination. The k factors from AAPM publication ing COV all equal to or less than 0.20, with the exception of
96 are displayed in the same graph for reference. These val- head examinations (0.36). For females, q factors showed
ues are smaller than any of the values calculated for body more variance across different types of phantoms with the

Medical Physics, Vol. 39, No. 6, June 2012

3416 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3416

FIG. 3. (Continued).

TABLE IV. COV and average differences of fully irradiated organs for all 13 examination categories. The average COV was obtained by first calculating COV
for each organ across four phantoms, and then averaged over all fully irradiated organs. The average difference was calculated using: |DXCAT/DICRP110  1|,
|DImPACT/DICRP110  1|, and |DCT-Expo/DICRP110  1|, and then averaged over all fully irradiated organs. The CT-Expo male phantom does not have any breasts,
so breasts were excluded in the calculation for male. The female only organs were bracketed in the organ list. Note that for the adrenals, kidneys, and neck
examinations, there were no fully radiosensitive organs.

Fully irradiated

Average Average Average

Average COV difference difference difference
across four between XCAT between ImPACT between CT-Expo
phantoms and ICRP 110 and ICRP 110 and ICRP 110

Fully irradiated radiosensitive organs Male Female Male Female Male Female Male Female

Chest–abdomen–pelvis Colon, lungs, stomach, bladder, 0.13 0.13 8 17 22 12 20 10

liver (ovaries, breasts)
Chest Lungs (breasts) 0.16 0.14 8 16 37 13 38 14
Abdomen–pelvis Colon, stomach, bladder, liver (ovaries) 0.11 0.12 8 18 18 13 14 8
Abdomen Stomach, liver 0.12 0.10 7 21 18 8 19 4
Pelvis Bladder (ovaries) 0.22 0.18 22 21 33 19 13 14
Adrenals
Liver Stomach, liver 0.11 0.10 7 20 15 9 19 3
Kidneys
Liver-to-kidneys Stomach, liver 0.11 0.10 6 20 14 10 18 5
Kidneys-to-bladder Colon, bladder (ovaries) 0.13 0.15 10 16 20 18 10 11
Head Brain 0.07 0.06 5 3 18 13 8 9
Neck
Head-and-neck Brain, salivary glands 0.09 0.09 3 5 13 10 17 20

Medical Physics, Vol. 39, No. 6, June 2012

3417 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3417

TABLE V. COV and average differences of partially irradiated organs for all 13 examination categories.

Partially irradiated

Average Average Average

Average difference difference difference
COV across between XCAT between ImPACT between CT-Expo
four phantoms and ICRP 110 and ICRP 110 and ICRP 110

Partially irradiated radiosensitive organs Male Female Male Female Male Female Male Female

Chest–abdomen–pelvis Marrow, esophagus, thyroid, skin, bones 0.25 0.24 12 13 37 30 43 40

Chest Marrow, stomach, liver, esophagus, 0.30 0.29 7 13 44 39 46 44
thyroid, skin, bones
Abdomen–pelvis Marrow, lungs, skin, bones (breasts) 0.14 0.27 13 12 12 32 19 32
Abdomen Marrow, colon, lungs, skin, bones 0.13 0.15 11 14 14 12 16 21
Pelvis Marrow, colon, skin, bones 0.21 0.19 17 18 42 15 40 30
Adrenals Marrow, lungs, stomach, liver, skin, bones 0.27 0.28 10 20 72 58 66 61
Liver Marrow, colon, lungs, skin, bones 0.19 0.30 7 56 22 27 25 77
Kidneys Marrow, colon, stomach, liver, skin, bones 0.22 0.22 10 34 32 15 32 27
Liver-to-kidneys Marrow, colon, lungs, skin, bones 0.19 0.23 6 32 21 20 24 41
Kidneys-to-bladder Marrow, stomach, liver, skin, bones 0.21 0.18 19 24 24 8 30 16
Head Marrow, skin, bones 0.22 0.21 21 12 22 14 25 32
Neck Marrow, thyroid, skin, bones 0.18 0.19 15 8 45 31 37 34
Head-and-neck Marrow, thyroid, skin, bones 0.18 0.19 11 14 35 40 34 45

maximum COV of 0.54 from the head-and-neck examina- cancer risk using the risk index concept14,36 and calculated
tion. For both males and females, q factors calculated from DLP-to-risk index conversion coefficient (q factor).
the XCAT and the ICRP 110 phantoms agreed well, with an Our study showed that sizable differences in organ dose
average difference of 10% for males and 13% for females exist among different types of reference phantoms despite
across all examination categories. The q factors from CT- their closely matched organ masses, total body weight, and
Expo phantoms had a higher percent difference from ICRP height. One major cause of the organ dose differences is the
110 phantoms, with an average difference of 17% for males difference in organ locations. For example, the locations of
and 22% for females. The q factors from the ImPACT phan- testes in the two stylized male phantoms (ImPACT and CT-
tom had the highest percent difference from ICRP 110, with Expo) are superior to the corresponding locations in the two
an average difference of 20% for males and 31% for voxelized male phantoms (XCAT and ICRP 110). In the
females. chest–abdomen–pelvis and abdomen–pelvis examinations,
The q factors showed drastic variation between male and where the scans both end at 1 cm below inferior ischium,
female. For males, the q factors were small and consistent testes in the four male phantoms were irradiated differently.
across body examinations (COV of 0.11 across all body The percentages of the testes length that were irradiated for
examinations and male phantoms), while for females, the q the ImPACT, the CT-Expo, the XCAT, and the ICRP 110
factors showed a high degree of variability. male phantoms were 100%, 82%, 47%, and 0%, respec-
tively. This resulted in the dose to the testes being highest
for ImPACT, second highest for CT-Expo, third highest for
IV. DISCUSSION XCAT, and minimal for ICRP 110. Another example is the
In this study, we compared organ doses, effective doses, colon. In the XCAT female phantom, the transverse colon
risk indices, k factors, and q factors across four types of was superior in the body in comparison to the location of the
phantoms. Several comparison studies between voxelized transverse colon in the ICRP 110 female phantom. There-
phantoms and stylized phantoms in CT have been conducted fore, during the chest examination, part of the colon was irra-
by two other research groups.10,11,15 These studies were diated in the XCAT phantom, while the colon in the ICRP
focused on only one type of voxelized phantom and only 110 phantom was completely outside of the scan field. This
examined a small number of protocols. In this study, two resulted in an 18-fold difference in colon dose.
types of voxelized phantoms were studied, the voxelized ver- In addition to organ location, the spatial distribution (the
sion of the hybrid XCAT reference phantoms and the voxel- spread) of an organ also plays an important role. The breasts
ized ICRP 110 reference phantoms. Monte Carlo simulated of the ImPACT hermaphrodite phantom have a length of
organ doses were compared for 13 routinely used body and 4.1 cm, which is much shorter than the female breasts in the
neurological CT examination categories. DLP to effective XCAT (15.2 cm), the ICRP 110 (13.6 cm), and the CT-Expo
dose conversion coefficient (k factor) was reported for each (11.6 cm) phantoms. While the breasts were out of the scan
category to expand on the limited amount of published data coverage for abdomen–pelvis, abdomen, liver, and liver-to-
available for various anatomical regions. Recognizing the kidneys examinations on the ImPACT hermaphrodite phan-
limitations of the effective dose,43–45 we further estimated tom, they were fully irradiated on the ICRP 110 female

Medical Physics, Vol. 39, No. 6, June 2012

3418 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3418

FIG. 4. Comparison of risk index (RI) over four types of phantoms for the 13 examination categories for male (a) and female (b) phantoms. The coefficient of
variation for each examination is displayed above the bars.

phantom and partially irradiated on the XCAT and the CT- esophagus was approximated by dose to the thymus, which
Expo female phantoms for these examinations. This caused was much shorter than a real esophagus, causing the esopha-
the breast dose in the ImPACT phantom to be much lower geal dose in the stylized phantoms to be very different from
than in the other three female phantoms. that in the voxelized phantoms. Thus, in the stylized phan-
Because no phantoms have all the radiosensitive organs, toms, dose to esophagus was high for upper body examina-
approximation methods had to be used, which also resulted tions where thymus was fully irradiated, as in chest and
in organ dose differences between phantoms. For example, chest–abdomen–pelvis exams, but really low for other
in the ImPACT and the CT-Expo phantoms, dose to the examinations compared to the voxelized phantoms. Another

Medical Physics, Vol. 39, No. 6, June 2012

3419 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3419

FIG. 5. Comparison of k factor among four types of phantoms for 13 examination categories. The k factor for XCAT, ICRP 110, and CT-Expo phantoms used
gender-averaged effective dose and DLP. The tabulated k values for six protocol classes from the AAPM were also included for comparison in this graph. The
coefficient of variation for each examination is displayed above the bars.

example of this effect is the salivary glands. For the tom was much higher than those in the XCAT or the ICRP
ImPACT phantom, dose to the salivary glands was approxi- 110 phantoms. The location of the larynx–pharynx in XCAT
mated by dose to the brain, while for the XCAT and the phantoms are greatly inferior to that of the ICRP 110 phan-
ICRP 110 phantoms, it was approximated by dose to the toms, resulting in even smaller dose in the XCAT phantoms.
larynx–pharynx. In the head examination, the brain was fully The opposite trend was found in the neck examination,
irradiated, but the larynx–pharynx was partially irradiated. where the brain was out of the scan coverage and the
Therefore, dose to the salivary glands in the ImPACT phan- larynx–pharynx was mostly within the scan coverage.

TABLE VI. k and q factor over three types of phantoms for the 13 examination categories.

k (mSv/mGy-cm) q (cases/1,000,000 exposed/mGy-cm)

Male Female
a
XCAT ICRP110 ImPACT CT-Expo COV XCAT ICRP110 ImPACT CT-Expo COV XCAT ICRP110 ImPACTa CT-Expo COV

Chest-abdomen- 0.018 0.019 0.018 0.017 0.06 1.6 1.7 1.8 1.7 0.05 3.2 3.8 2.9 3.3 0.11
pelvis
Chest 0.025 0.026 0.020 0.019 0.17 1.8 1.8 1.6 1.5 0.09 5.1 6.2 4.7 5.4 0.12
Abdomen–pelvis 0.018 0.019 0.016 0.016 0.08 1.7 1.7 1.9 1.8 0.06 2.8 2.9 1.9 2.1 0.21
Abdomen 0.023 0.024 0.019 0.019 0.12 1.8 1.8 1.6 1.7 0.06 3.7 3.5 2.0 2.6 0.26
Pelvis 0.011 0.012 0.014 0.013 0.11 1.6 1.4 2.2 1.9 0.20 1.3 1.8 1.6 1.6 0.13
Adrenals 0.026 0.029 0.020 0.022 0.17 2.1 2.2 1.6 1.6 0.18 3.0 2.9 2.6 3.5 0.12
Liver 0.026 0.029 0.020 0.020 0.20 1.9 2.1 1.6 1.7 0.13 4.4 4.9 2.2 2.7 0.36
Kidneys 0.020 0.024 0.021 0.020 0.09 1.7 2.1 1.5 1.7 0.13 2.2 2.3 1.8 2.1 0.10
Liver-to-kidneys 0.024 0.027 0.020 0.020 0.15 1.8 2.0 1.6 1.7 0.11 3.9 3.8 2.2 2.7 0.26
Kidneys-to- 0.015 0.018 0.016 0.016 0.05 1.7 1.7 1.9 1.7 0.04 1.9 2.2 1.9 1.9 0.07
bladder
Head 0.0014 0.0022 0.0030 0.0023 0.30 0.1 0.2 0.3 0.2 0.36 0.2 0.3 0.5 0.3 0.37
Neck 0.0051 0.0054 0.0058 0.0076 0.19 0.4 0.4 0.4 0.6 0.19 1.1 1.3 1.4 1.8 0.21
Head-and-neck 0.0034 0.0037 0.0045 0.0046 0.15 0.3 0.3 0.3 0.4 0.11 0.7 0.7 0.2 1.0 0.54

a
The same set of organ doses data is used for each examination but with different risk coefficients for male and female.

Medical Physics, Vol. 39, No. 6, June 2012

3420 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3420

FIG. 6. Comparison of q factor over four types of phantoms for the 13 examination categories for male (a) and female (b) phantoms. The coefficient of varia-
tion for each examination is displayed above the bars.

As mentioned in Sec. II.A, the organ masses in the XCAT toms, but some of the organ doses received were consider-
reference, the ICRP 110 reference, and the ImPACT refer- ably different. This indicated that the anatomical locations
ence phantoms in this study were matched to the organ and spatial distributions of organs in a phantom affected
masses recommended in the ICRP publication 89; the organ radiation dose much more than the masses of the organs.
masses in the CT-Expo reference phantoms were matched to When comparing phantoms using ICRP 110 phantoms as
the ICRP publication 23. Nevertheless, the masses of the the reference standard, XCAT male was the closest match to
organs (Table I) were very similar for all four types of phan- ICRP 110 male for both fully and partially irradiated organs.

Medical Physics, Vol. 39, No. 6, June 2012

3421 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3421

For female, XCAT was not the closest match to the ICRP of examinations, which did not include some routinely used
110 female for fully irradiated organs. Average diameters CT examinations that were incorporated in this study. We
for the XCAT and the ICRP 110 phantoms were calculated showed that the k factors for the unreported scan regions
for chest and abdomen using the following method. The were rather different from the body regions reported in
body volume was first calculated by multiplying the voxel AAPM 96. Take the ICRP 110 phantoms, for example, the k
volume by the total number of voxels for chest and abdo- factor of the adrenal examination is 0.0294 mSv/mGy cm,
men. The total volume was then divided by the z-axis length about 1.5 times the value of chest–abdomen–pelvis examina-
of each part to obtain the average axial plane area. This area tion. The result is that the effective dose calculated using the
was used to calculate the average diameters for chest and ab- chest–abdomen–pelvis examination k factor represents a
domen assuming the axial plane to be a circle. The average gross underestimation. Therefore, the k factor reported here
diameters for the XCAT female phantom are 29.32 cm for is of great utility for clinical effective dose estimation. The k
chest and 27.54 cm for abdomen, while for ICRP 110 these factor for each examination agreed well across phantoms,
values are 27.1 and 25.75 cm, respectively. The average which can be explained using the same argument as effective
diameters for the XCAT female are 2.22 and 1.79 cm larger dose. For the head examination, the COV for k factors was
than the diameters for the ICRP 110 female. The larger di- much higher than any other examination. This was due to
ameter in the XCAT female was partially due to single voxel the significant difference in doses to the salivary glands,
layer skin. Both phantoms used one single voxel layer skin, mentioned earlier in this section.
but the transverse plane voxel size for the XCAT female Note that the k factors in this study were all calculated
(3.45 mm) was slightly larger than the voxel size for the using the tissue weighting factors from the ICRP publication
ICRP 110 female (1.775 mm). The average diameter differ- 103, while the commonly used k factors in AAPM 96 were
ence caused major radiosensitive organs in the chest and ab- calculated based on weighting factors from the ICRP publi-
domen regions (lungs, stomach, and liver) to receive less cation 60. The k factors from AAPM 96 were smaller than
doses in the XCAT female phantom when these organs were the corresponding k factors calculated with the four types of
fully irradiated. The effect of body diameters on radiation reference phantoms for all examinations and the head-and-
dose has been explored in the literature.16,36 neck examination. In contrast, the k factor for the neck ex-
The variability in effective doses of the four types of phan- amination published in AAPM 96 report is larger than any of
toms (Fig. 3) was not as dramatic as the variability in organ the k factors obtained in this study. Given the sizable differ-
doses because effective dose was weighted and summed over ences, the published k factors should be updated to reflect
all radiosensitive organs. The organs that received small the new tissue weighting factors.
doses tended to show higher differences in dose between The effect of new tissue weighting factors on conversion
phantoms but were not as important in the summation. The coefficients has also been reported by other researchers.47–49
same argument can be applied to risk indices for males. How- Table VII shows the results from three other groups and
ever, risk indices for females varied considerably across compares this data with the data from the ImPACT and the
phantoms due to the large variance of lung and breast doses, CT-Expo phantoms. These two types of phantoms were cho-
which were the two highest risk organs for females. sen because the three groups all used stylized phantoms in
In a clinical environment, estimating effective dose using their studies. Since the same phantom and software were
Monte Carlo simulation is not practical. An easy and fast used, the results from Huda et al.49 and Christner et al.47
way to estimate effective dose is to use DLP to effective were very similar to the data from the ImPACT phantom in
dose conversion coefficients, also known as k factors. The this study. The only examination that showed a noticeable
accuracy of k factors is therefore very important. In this difference was the head exam. The inconsistency was caused
study, we examined how k factors would vary when obtained by a variation in scan region. The data from Deak et al.48
from different types of phantoms and compared our results showed more variance than other groups’ but closer match
with the commonly used k factors published in AAPM 96.46 to the data from the CT-Expo phantoms in this study. This
The AAPM values were only available for a small number was expected because the CT-Expo phantoms were derived

TABLE VII. Comparison of k factors obtained using ImPACT and CT-Expo phantoms in this study and from other 3 research groups. All the k factors here
were calculated using ICRP 103 tissue weighting factors.

DLP to ED conversion coefficient—k (mSv/mGy cm)

Scan region ImPACT from this study CT-Expo from this study Huda et al. (Ref. 49) Christner et al. (Ref. 47) Deak et al. (Ref. 48)

Head 0.0030 0.0023 0.0024 0.0013 0.0019

Neck 0.0058 0.0076 0.0053 0.0051
Chest 0.0205 0.0185 0.0204 0.021 0.0145
Abdomen 0.0195 0.0191 0.0163 0.0153
Pelvis 0.0133 0.0134 0.0143 0.0129
Abdomen and pelvis 0.0161 0.0163 0.017
Liver 0.0206 0.0198 0.018

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3422 Zhang et al.: Organ doses, effective doses, and risk indices in adult CT 3422

from the ORNL phantoms, which were used in the study of observed differences were mainly introduced by variation in
Deak et al. However, the two set of data still differed consid- organ location (e.g., testes in the pelvis examination; colon
erably because of the differences in scan length, anatomic in the female chest examinations), spatial distribution (e.g.,
variations, and Monte Carlo codes implemented in computer female breasts in abdomen–pelvis, abdomen, liver, and liver-
simulation. to-kidneys examinations), as well as the approximation
Since the effective dose is based on tissue weighting fac- method implemented (e.g., esophagus in chest and chest–
tors that have been calculated from an extremely broad pool abdomen–pelvis examinations; salivary glands in head-and-
of data,41 it is not appropriate to use this concept on patients neck examinations). The weighted dosimetry quantities
with specific age and gender. The effective dose provides do- including effective doses, male risk indices, k factors, and
simetry information on radiobiological risk associated detri- male q factors agreed well across phantoms, because organs
ment, but it is meant to be used in a general sense. In order that received small doses tended to show higher variation in
to gain better understanding of dose received by different dose between phantoms, but were not as important in the
genders, the risk index was calculated for male and female summation. The female risk indices varied considerably
separately in this study. The q factors for each examination across phantoms due to high risk of lung and breast cancer
agreed well across male phantoms. The q factors were also incidence.
consistent across body examinations with the COV of 0.11
across all body examinations, indicating the possibility of
using one q factor for all male body examinations.12 The ACKNOWLEDGMENTS
female q factors have a high degree of fluctuation across var- The authors are thankful to Dr. Georg Stamm for provid-
ious phantoms and examinations for several reasons. The ing information on CT-Expo phantoms. This work was sup-
primary reason is the high risk of lung and breast cancer ported in part by the National Institutes of Health (Grant No.
incidences. For female abdomen, liver and liver-to-kidneys RO1 EB001838).
examinations, the q factors of the ImPACT and the CT-
a)
EXPO phantoms were much smaller than q factors obtained Author to whom correspondence should be addressed. Electronic mail:
from the other two phantoms. This can be explained by the samei@duke.edu
1
D. J. Brenner and E. J. Hall, “Computed tomography—An increasing
relatively small dose to the breasts in the two stylized phan- source of radiation exposure,” N. Engl. J. Med. 357, 2277–2284 (2007).
toms. Although gender-specific effective dose has been pro- 2
National Council on Radiation Protection and Measurements. and
posed, the real gender difference cannot be represented by National Council on Radiation Protection and Measurements. Scientific
the effective dose unless the gender-specific tissue weighting Committee 6-2 on Radiation Exposure of the U.S. Population, Ionizing
radiation exposure of the population of the United States: Recommenda-
factors are used. tions of the National Council on Radiation Protection and Measurements
One limitation of this study was that only one CT scanner (National Council on Radiation Protection and Measurements, Bethesda,
model was explored. The dose values for other scanners may MD, 2009).
3
be different from what we obtained here. However, when ICRP, “Radiation protection in medicine. ICRP Publication 105,” Ann.
ICRP 37, 1–63 (2007).
normalized to CTDI and DLP, doses from various scanner 4
A. Berrington de Gonzalez, M. Mahesh, K. P. Kim, M. Bhargavan, R.
models show similar results.16 Furthermore, the major find- Lewis, F. Mettler, and C. Land, “Projected cancer risks from computed to-
ing, i.e., organ dose differences across reference phantoms mographic scans performed in the United States in 2007,” Arch. Intern
Med. 169, 2071–2077 (2009).
were mainly introduced by the locations, spatial distribu- 5
E. S. Amis, Jr., P. F. Butler, K. E. Applegate, S. B. Birnbaum, L. F. Brate-
tions, and dose approximation methods, should still be appli- man, J. M. Hevezi, F. A. Mettler, R. L. Morin, M. J. Pentecost, G. G.
cable to other scanners. Additionally, the risk data used in Smith, K. J. Strauss, and R. K. Zeman, “American College of Radiology
the cancer risk estimation is based on studies of atomic white paper on radiation dose in medicine,” J. Am. Coll. Radiol. 4,
272–284 (2007).
bomb survivors and other limited research studies involving 6
E. Angel, N. Yaghmai, C. M. Jude, J. J. Demarco, C. H. Cagnon, J. G.
occupational exposures and thus suffers from large uncer- Goldin, A. N. Primak, D. M. Stevens, D. D. Cody, C. H. McCollough, and
tainty. Finally, this study only addressed k and q factors M. F. McNitt-Gray, “Monte Carlo simulations to assess the effects of tube
across reference size adult phantoms. The effect of patient current modulation on breast dose for multidetector CT,” Phys. Med. Biol.
54, 497–512 (2009).
size requires a presentation of its own. Again, the main pur- 7
M. Caon, G. Bibbo, and J. Pattison, “An EGS4-ready tomographic compu-
pose of this study was to provide insight into the effects that tational model of a 14-year-old female torso for calculating organ doses
different types of reference phantoms have on CT dosimetry 8
from CT examinations,” Phys. Med. Biol. 44, 2213–2225 (1999).
and thus lead to a better understand of radiation dose P. Deak, M. van Straten, P. C. Shrimpton, M. Zankl, and W. A. Kalender,
“Validation of a Monte Carlo tool for patient-specific dose simulations in
received by patients undergoing CT examinations. multi-slice computed tomography,” Eur. Radiol. 18, 759–772 (2008).
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