Evaluation of automatic tube current modulation of CT scanners using a dedicated and the CTDI dosimetry phantoms

PURPOSE: To investigate the operation principles of the automatic tube current modulation (ATCM) of a CT scanner, using a dedicated phantom and the CT dosimetry index (CTDI) phantom. MATERIAL AND METHODS: The Mercury 4.0 phantom and three different configurations of the CTDI dosimetry phantom were employed. A frequently used clinical scanning protocol was employed as a basis for the acquisitions performed with all phantoms, using both scanning directions. Additional acquisitions with different pitch and examination protocols were performed with Mercury phantom, to further explore their effect on ATCM and the resulting image quality. Different software named DICOM Info Extractor, ImageJ, and imQuest, were used to derive CTDI(vol) and table position, image noise, and water equivalent diameter (WED) of each phantom CT image, respectively. ImQuest was also used to derive the detectability index (d’) of five different materials (air, solid water, polystyrene, iodine, and bone) embedded in the Mercury phantom. RESULTS: It was exhibited with all four phantoms that the scanning direction greatly affects the modulation curves. The fitting of the dose modulations curves suggested that for each table position what determines the CTDI(vol) value is the WED values of the phantom structures laying ahead towards the scanning direction, for a length equal to the effective width of the X‐ray beam. Furthermore, it was also exhibited that ATCM does not fully compensate for larger thicknesses, since images of larger WED phantom sections present more noise (larger SD) in all four phantoms and in Mercury 4.0 phantom smaller detectability (d’). CONCLUSION: Mercury 4.0 is a dedicated phantom for a complete and in‐depth evaluation of the ATCM operation and the resulting image quality. However, in its absence, different CTDI configurations can be used as an alternative to investigate and comprehend some basic operation principles of the CT scanners’ ATCM systems.