Optimization of patient dose and image quality with z-axis dose modulation for computed tomography (CT) head in acute head trauma and stroke

The purpose of this study is to retrospectively analyze the effect of z-axis modulation for CT head protocols on patient dose and image quality in patients with acute head trauma and stroke. The study was approved by the Institutional Review Board. We retrospectively evaluated the effect of dose modulation on unenhanced CT head examinations in patients with acute head trauma and stroke. Two series of 100 consecutive studies were reviewed: 100 studies performed without dose modulation, 100 studies performed with z-axis dose modulation. Multidetector 16-section CT was performed sequentially and axial 5-mm-thick slices were obtained from base of skull to vertex. With z-axis dose modulation, the same tube current range was maintained, but a computer algorithm altered the tube current applied to each CT section. For each examination, the weighted volume CT dose index (CTDI (vol)) and dose-length product (DLP) were recorded and noise was measured. Each study was also reviewed for image quality by two independent, blinded readers. The variables (CTDI (vol) and DLP, image quality, and noise) in the two groups were compared by using student t test and Wilcoxon rank-sum test. For unenhanced CT head examinations, the CTDI (vol) and DLP, respectively, were reduced by 35.8% and 35.2%, respectively, by using z-axis dose modulation. Image quality and noise were unaffected by the use of this dose modulation technique (P<0.004). Utilization of z-axis modulation technique for CT head examination in patients with acute head trauma and stroke offers significant radiation dose reduction while image quality is optimally maintained.