Introduction:

Multidetector (or multidetector-row) computed tomography (MDCT) has revolutionized the

medical diagnostic imaging field due to its advanced two dimensional array of detectors. The
introduction of this advanced detector system together with spiral scanning and reconstruction
algorithm has significantly improved CT performance in terms of image quality in the
imaging range. Also, there has been reduced radiation exposure to patients due to the
possibility of choosing from a wide range of examination settings that can further shortening
scan time. Despite these advantages, the ionizing radiation based CT examinations is
considered a potential risk for developing wide range of cancers like leukemia. Additionally,
radiation exposure exceeding deterministic thresholds is more likely to yield erythema and
acute cataract. The resulting collective dose from all medical procedures between 1990-2006
has increased more than seven fold. Of which 18 percent account for the conducted CT scans,
which contribute over 50 percent of this collective dose. Due to this growing concern, efforts
have been made to quantify the dose delivered to individual organs by CT examinations.

Monte Carlo (MC) software packages have been widely used to estimate the radiation dose
from MDCT. An accurate simulation of MDCT using the MC requires the information about
the scanner geometry represented by focal spot to iso-center distance, fan angle and z-axis
collimation, which can be obtained from the provided documentation of the scanner. It is of
paramount importance to know the x-ray spectra of CT emissions for a precise MC based
simulations. All commercial CT scanners make use of filtrations that act to harden the x-ray
beam. However, the information on the filtrations design, shape and composition is
proprietary, which limits a researchers accessibility to such information by researchers and
thereby impeding the accurate modeling of the x-ray spectra of a given scanner.

In order to overcome the restrictions on the specific information of the scanner source,
methods were developed to estimate the x-ray spectra using physical measurements. One such
method described by Turner et al, where the fixed x-ray source was used to estimate the x-ray
spectra based on the measured half value layer (HVL) and BT filter profile by measuring the
air kerma as a function fan angle, in turn, determining an equivalent filter. Although this
method can estimate the number of photons in the off-centerline spectra, but since only one
material thickness (Aluminum) was varied, it would not be possible to match the relative
number of photons and the spectral shape. Another method was proposed by Boone (2010), in
which a radiation dosimeter was placed at the edge of x-ray field generated by a rotating
source and kerma rate verses time was used to determine angle dependent BT attenuation.
While this method was demonstrated experimentally, however, there were some limitations in
terms of the need for a real time dosimeter with sufficient sensitivity and high temporal
resolution together with the inability to determine the HVL of a rotating x-ray source.

The estimated thickness of BT filter was generally based on the physical measurements of the
fixed x-ray source in service mode. Although this requires a special personal agreement to get
accessed to the scanner, however, this mode is not a part of the clinical use of the CT scan. To
compensate this, the fixed x-ray source could be easily accessed from the CT localizer
radiograph of the clinical protocols. The importance of this comes from the possibility of
substantial contribution of the CT localizer to the total dose of the whole CT scan. Hence, it is
important to determine whether the same thickness of BT filter in terms of thickness and
composition is being installed in both of fixed x-ray source of CT localizer radiograph and
rotating x-ray source of clinical protocols for a given scanner. In this study, the profile of BT
filter is determined based on the measured air kerma across the fan of the fixed x-ray source
in the scout view. These air kerma are then mathematically integrated across all the incident
angles in a full 360o cycle. The resulting BT filter profile is then compared with the measured
profile of the rotating x-ray source of the clinical protocols. This might provide a depiction of
BT filter profile that is implemented in both situations of x-ray source.

The study is aimed at calculating the appropriate thickness of the BT filter of the MDCT
system. The accuracy of the calculated thickness of BT is assessed by comparing the
simulated MC and measured air kerma for the fixed x-ray source. Also, the verification is
done for the rotating source by comparing the measured and simulated MC of the air kerma
for CT dose index phantoms (CTDI).
II. MATERIALS AND METHODS
II.A.1. CT scanner model
All measurements were performed on a SOMATOM Definition 64 CT scanner (Siemens
Medical Solutions, Forchheim, Germany). The x-ray tube anode angle is 7 degrees. The
distance from the focal spot to the iso-center (SID) is 59.5 cm and 1085 cm from the focal
spot to the detector (SDD). The scanner operates in both axial and helical modes at tube
voltages of 80, 100,120 and 140 kV. Two different focal spots sizes are available with
dimensions of 0.70.7 mm, 0.91.1 mm corresponding to small and large focal spots
respectively. The principle of flying focal spot of the x-ray straton tube allows for the source
to change in its position along the z-axis. The system operates at different x-ray beam
collimation (given in the format of N T, where N represents the number of data channels and
T represents the nominal width of each data channel): 6*0.6mm (3.6mm) and 64*0.6
(38.4mm). The system is equipped with BT filter and used to compensate for beam hardening
effect resulting from the variation in the body thickness across the transverse sections of the
body.

II.A.2. Ionization chamber

The ionization chamber type 30009 connected to a Unidos electrometer (PTW, Freiburg,
Germany) was used in the physical measurements of air kerma. The nominal active volume of

the ionization chamber is 3.14 cm3 and a sensitive measuring length of 10 cm with an outer
diameter of 0.9 cm. The calibration accuracy is about 5% in the range of 80 to 150 kV.

II.A.4. Nomex Multimeter

The NOMEX multimeter is a non-invasive miniaturized multi parameter measuring device
combining semi-conductor detectors and electronics according to IEC 61674 [1]. The
calibration accuracy falls within 5% for all x-ray beam energies 80 to 150 kV.

II.A.3. Phantoms
The standard CTDI phantoms body, head and child phantoms of 32 cm, 16 cm, and 10 cm
diameter respectively, were used to perform measurements. These phantoms are homogeneous
cylindrical made of polymethylmethacrylate (PMMA) with a length of 15 cm. Also they
have five hole for inserting ionization chamber located at different positions, one center and
four at periphery (1 cm below the surface of the phantom) each 90 apart from its neighbor.
II.B. Experiments:
II.B.1 Fixed x-ray source measurements.
The BT filter depends on energy and more importantly on the Field of View (FOV), where
Small Field of View (SFOV) by default uses small BT filter and large BT filter for Large
Field of View (LFOV). Based on this, CT localizer radiographs of neck child's protocol and
abdomen adult protocol that represent SFOV and LFOV respectively were selected to perform
measurements on BT filter of the scanner. X-ray source was operated to be fixed at 12 clock
position and table movement was adjust to not interrupt the measuring field. Air kerma was
measured across the fan angle using the ionization chamber . These measurements were done
with the aid of a plastic ruler was used containing on drilled holes of 1 cm diameter for
placing the ionization chamber. These holes are 2 cm apart from each other and placed across
the opening of the CT gantry. The measurements were done for all beam energies
80,100,120,140 kv with other default settings: 300 mA, collimation width of 3.6 mm, scan
time of 2.7s and 5.3s for SFOV and LFOV CT localizer radiographs respectively.
C). Integration method:
The following is an overview of the integration method which was used to
compare the BT filter attenuation profiles calculated from the fixed x ray source
of the CT localizer radiograph with the rotating x-ray source of the clinical
protocol. To measure the BT filter attenuation across the fan angle of the fixed x-
ray source of the given scanner, the ionization chamber was horizontally placed
in a holes of plastic ruler which was centered in the scan field across the CT
gantry as seen figure (). The bow-tie attenuation profile was obtained with the x-
ray tube parked at the 12 oclock position. For each horizontal ionization chamber
arrangement across the CT gantry, with even spacing of dx, is described by:

N +1
(
x i= i
2 )dx [1]

Where i = 1N (measurement positions across the CT gantry) and N the total

number of measurements points = 29, so that x=0 corresponds to the isocenter.

figure 1. Schematic of the detector arrangement. The X-ray source position

shown is for the static source configuration.
The raw air kerma measurement recorded at each measurement point denoted
by D raw
i . An adjustment is made to the measurement to account for distance
from the source to the given measurement point.

adj raw R
D i =Di [2]
Li

Where Li= R2 + xi2 is the distance from the static X-ray source and the i th
ionization chamber. For each ionization chamber position, the angle of incident of
the x-ray from the isocenter to the ith detector was calculated using the source to
isocenter distance (R) and the horizontal distance (x i) of chamber position to
isocenter,

xi
i=tan 1 ( )
R
[3]
 Figure 2. Geometry of the system during a rotating source test. Z denotes the
detector at the isocenter and Qi is the x-ray path to the i th detector.

In the case of the experimental fixed x-ray source (figure 1) was rotated (figure
2), the air kerma profile (at each ionization chamber position) can actually be
calculated from the static source profile by integrating over the angle range
swept by the rotating source. For this case, the rotating source completed a full
360o cycle, and so

360

rot ( x ) = D
D calc adj
( x ,a ) d [9]
0

where
[10
D adj ( x , )=D adj ( ( x , ) ) ]

is the static source air kerma value recorded at an angle equivalent to the x-
ray incident angle experienced by a given detector during the integrated rotating
source. Using some geometric relations is can be shown that:

( x , ) =sin1 (| |( ) )
x sin
A x,
[11
]

where

2
2 2 g ( ) ( R+ x ) [12
A ( x , )= g ( ) + ( R+ x ) ]
R
And

g ( ) =2 R sin ( 2 ) [13
]

In summary, for every detector location along the horizontal x-axis, all possible x-
ray beam angles incident on an ionization chamber from a rotating source are
determined. These angles are then used to look-up the equivalent air kerm from
a static source profile. These dose rates are then integrated across all the
incident angles experienced in a full 360o cycle.
B) Rotating x-ray source measurements.
The attenuation BT profile was also characterized for the rotating x-ray source of the clinical
protocols that represent SFOV and LFOV at only 120 kv. For SFOV, the neck and abdomen
childs protocols were selected with default settings of 90 mA, collimation width of 38.4 mm,
and the time for scan of 7s and 1s for neck and abdomen childs protocols respectively. For
LFOV, the clinical protocols of abdomen and thorax were used with settings of 4s scan time,
collimation width of 38.4 mm, and mA of 210 and 110 and for abdomen and thorax protocols
respectively. Using these protocols, the rotating x-ray tube was automatically operated and air
kerma free in air was measured using the ionization chamber as a function of angle with the
aid of the already used a plastic ruler (section II.B.1) for the holes that represent the odd
numbers (1,3,7..etc), as seen in Fig ().
D). Bowtie filter calculation:
It is of paramount importance to know the precise specification and characteristics of the BT
for a precise MC simulation. The proprietary aspect of the design and composition of BT
made it necessary for finding out an alternative methods for estimating the appropriate
thickness of BT for a given scanner. Such methods have been proposed and developed
previously by turner et al (ref). For clarity, a concise description of the approach adopted in
this paper is given here.

The method is based on a 2 (chi-squared) least-squares fitting technique between

measured air kerma experimentally and calculated air kerma theoretically at each detector
position. Firstly, the theoretical air kerma is calculated as follows:

i. An initial energy spectrum output from the X-ray source is assumed

ii. The spectrum is modified over the distance (and angle) travelled to the bowtie filter
iii. An initial bowtie filter shape (given by Eqn. X) and thickness profile is assumed
iv. For every detector position (which corresponds to a particular X-ray beam fan angle
), the attenuation of the X-ray beam through the filter is calculated using the
attenuation equation given by Eqn. Y. (where XAL() denotes the beam path length
through the filter)
v. This theoretical X-ray dose is then compared with the experimentally measured value
using a 2 least-squares fitting technique (across all detector positions).
vi. The perpendicular thickness of the bowtie filter d() (which is related to XAL() via
Eqn. Z) is then adjusted depending on whether the theoretical value is larger or smaller
than the experimental data.
2
vii. Steps (iv vi) are iteratively repeated until a minimum value for is achieved.
The thickness profile which corresponds to this minimum is then accepted as the
bowtie filter shape.

It should be noted that in this paper it is assumed that the X-ray attenuation through the
bowtie filter is from one material, thus one material thickness is iteratively adjusted. However,
it is possible to extend this technique to calculate a bowtie filter shape based on two different
attenuating materials. This has been demonstrated previous by (e.g. REF: Alikhani &
Buermann 2015).
II.B.2 The measurements of the total filtration (TF).
The beam qualities at 80, 100, 120, and 140 kV, respectively was assessed by measuring the
TF thickness at the isocenter. The measurements were done on SFOV and LFOV CT localizer
radiographs respecpectively. The x-ray tube was fixed at 12 clock position so that the nomex
multimeter detector was placed at the isocenter, as
seen in Fig (). The SpekCalc program was then used
to generate the x-ray spectra filtered with measured
TF at the isocenter at 80, 100, 120, and 140 kV for
both SFOV and LFOV respectively.
Overview of monte carlo
1.Monte carlo simulation
The verifications of experimental measurements were done by using the EGSnrc (version V4-
2-3-0) MC particle transport code (ref). The EGSnrc code tracks particles at all energies
necessary for simulations. Photons were only simulated in this study where the lower energy
cutt off was 2 keV the remaining kinetic particle energy is deposited locally. The radiation
interaction processes considered are photoelectric absorption Rayleigh scattering and pair
production. The material cross-sections for those physical processes are in agreement with the
values of the XCOM/NIST database (ref). Other parameters that are taken into account in the
EGSnrc simulation code are bound Compton scattering and photo-electrons from K, L and M
shells.

2. Modeling of the CT source

The source subroutine of the EGSnrc was written so that the different settings of the CT
scanner can be modelled by the user-definable input parameters. These parameters are
geometry based CT scanner (see section II.A.1). The source energy spectra for the CT scanner
was simulated for all available beam energies (80,100,120,140 kv) and determined using the
spectrum generator SpekCalc (see section II.B.2 ), which is based on theoretical
bremsstrahlung cross sections. A very good agreement was achieved with the measurements
using this method. The x-ray source was modelled so that fixed and contiguous axial scan
corresponding to the conducted measurements on CT scanner. The source model assumes that
the photons are emitted from a point at the location of the x-ray tube anode. The radiation
transport through the filter is not simulated explicitly, as a full MC simulation does not alter
the results significantly (). instead linear attenuation coefficients (ICRU 1989) are used to
attenuate the beam by assigning a weighting factor (between zero and one) to each photon
depending on the thickness from the incident angle of the photon using a look up table the
filter material and path length corresponding to the trajectory of the photon from the filtration
description. The linear attenuation coefficient for a photon of that energy is used to assign a
weight to each photon according to the amount of attenuation it suffers. This weight is used
by MC to calculate the energy deposited in the voxel during interaction.
4. CTDI phantoms measurements
The measurements were performed on the standard CTDI phantoms (body, head and child).
All the scans were performed using helical mode, while the scan length covered the entire
phantom. The childs Neck clinical protocol was selected to represent SFOV and the scan
parameters were 90 mA, 5s scan time, pitch of 0.6 and 38.4 mm beam collimation. Also using
Adults Thorax clinical protocol that represent LFOV, where the parameters were 110 mA, 2s
scan time and 38.4 mm beam collimation. The measurements with body phantom was done
by placing it exactly in the center of the gantry on the patient table, while for head and child
were done by placing them on the patient head holder. The air kerma was measured by
inserting the active length of ionization chamber for each of these phantoms at the center
holes and at four periphery holes ( Right, Left, Top, Bottom) at all available beam energies
80, 100, 120, and 140 kvp.

3. The CT dosimetry phantoms

The standard CTDI phantoms (see section4) were simulated for verification purpose with the
physical measurements. A cartesian coordinate system is defined by the model dimensions so
that the isocenter of the modelled phantoms are coincide with the isocenter of the scanner, the
Z-axis collinear with the axis of the scanner and the x-y plane coplanar with the CT slice
plane. The computational models have a defined rectangular volume (36 x 33 x 15 cm for the
body, 36 x 17 x 15 cm for the head and 36 x 11 x 15 cm for child) and consist of rectangular
voxels size of 1*1*150 mm. The computational model for the body phantom, head and
inclide includes the CT scanner's patient table. Voxels within the defined volume but outside
of the simulated phantoms are defined to contain air, while the voxels within the phantoms
contain PMMA.

(The CT dosimetry phantoms The standard CTDI phantoms (see section4) were simulated for
verification purpose with measurements. For the simulations, the phantoms were simulated as
a voxelized geometry with dimensions of 1*1*5 mm in x,y and z. The volume consist of
cylinders filled with PMMA material and outside is defined to contain air. A mathematical
model of this phantom was previously developed in (ref).)

(The calculated Bowtie filter thickness made ouf of two materials (Al and Teflon materials)
for SFOV and LFOV at all energy levels (80,100,120,140 kvp) was implemented in EGSnrc
software to compare the output of EGSnrc with the experiments. )
Findings:
A) Comparison between the integrated fixed source measurements and rotating Source
measurements

Figure () illustrates the normalized attenuation profile of BT filter for SFOV and LFOV. The
resulted profile of the integrated fixed measurements showed a very good agreements
compared to BT profile of the rotating x-ray source at 120 kv in all measurements points with
the RMSE of 0.83 % and 1.11% for SOFV and LFOV respectively.
A) Total filtration measurements
The measured filtration thickness (mm Al) was measured at the iso-center for SFOV and
LFOV for all beam energies 80,100,120,140 kvp are summarized in table 1. Nagel (2010)
claimed that new CT scanners operate with the total beam filtration up to 12 mm aluminum
quality equivalent filtration.

Energy/FOV SFOV LFOV

80 125% 115%

100 125% 115%

120 125% 115%

140 125% 115%

1) The calculated bowtie filter for all energy (SFOV)

The bowtie filter thickness of aluminum and Teflon was calculated for
all available beam energies (80-140 kvp).
 2) Simulation Results of the Fixed X-Ray Source (SFOV)

Figure () illustrates the attenuation profile of BT filter resulted from MC

compared with the measured BT profile for the localizer fixed x-ray
source at 80,100,120,140 kv. The BT profile of the measured and
simulated air kerma showed a very good agreement with the measured
air kerma in all measurement points with RMSE of .

The results of the comparison between the physical measurements and

simulation are presented in figure (). illustrates the attenuation profile of
BT filter for the mesured and simulated air kerm of the fixed localizer x-
ray source. The simulation values for all beam energies showed a very
good

The results of the comparisons between the physical measurements and

simulations are presented below. Because no absolute dose values are
given for either method (e.g. no TLD calibrations were performed), all
results were normaliz ed before comparison.
6) Simulation Results of Rotating X-Ray Source (SFOV)
The mean percentages difference at 80, 100, 120 and 140 kv are
2.1484%, 3.6567%, 2.9917% and 1.7930% respectively.
The mean percentages difference at 80, 100, 120 and 140 kv are
1.8173%, 1.6108%, 3.2380% and 2.1669% respectively.
The mean percentages difference at 80, 100, 120 and 140 kv are
4.3945%, 4.0149%, 3.2678% and 3.2431% respectively.

PS: I just reported the results for SFOV and the results for LFOV are the
same.

References:
[1] IEC 61674: International Electrotechnical Commission. Medical
electrical equipment - Dosemeters with ionization chambers and/or
semiconductor detectors as used in X-ray diagnostic imaging.