COMPARISON OF RADIATION DOSE AND IMAGE QUALITY BETWEEN THE SINGLE DETECTOR CT AND MULTI DETECTOR CT ON HEAD EXAMINATION: STUDY PHANTOM

International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163
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COMPARISON OF RADIATION DOSE AND IMAGE QUALITY
BETWEEN THE SINGLE DETECTOR CT AND MULTI
DETECTOR CT ON HEAD EXAMINATION: STUDY PHANTOM
Samburi
Master of Physics,
University of Diponegoro, Indonesia
Agency of Testing For Health Facilities (BPFK Jakarta),
Ministry Of Health, Indonesia
Wahyu Setia Budi
Department of Physics, Faculty of Science and Mathematics,
University Diponegoro, Indonesia
Eko Hidayanto
Department of Physics, Faculty of Science and Mathematics,
University Diponegoro, Indonesia
Manuscript History
Number: IJIRAE/RS/Vol.04/Issue04/APAE10105
Received: 19, March 2017
Final Correction: 30, May 2017
Final Accepted: 15, August 2017
Published: August 2017
Citation: Samburi; Wahyu, S. B. & Hidayanto, E. (2017), 'Comparison of Radiation Dose and Image Quality
Between the Single Detector CT and Multi Detector CT on Head Examination: Study Phantom’, in IJIRAE
Journal.
Editor: Dr.A.Arul L.S, Chief Editor, IJIRAE, AM Publications, India
Copyright: ©2017 This is an open access article distributed under the terms of the Creative Commons
Attribution License, Which Permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited.
Abstract— Research has been done by comparing radiation dose profile and image quality to single detector CT
(SDCT) and multi detector CT (MDCT). The method of measuring dose accuracy and linearity of the output dose is
done by placing a dose pencil on the iso center position in the middle of the gantry. The scanning parameters use
axial mode with the acquisition factor of 120 kV, 25 - 250 mAs, 1 sec rotation time and 5 -10 mm slice thickness.
Head Phantom CTDI diameter of 16 cm is used for CT dose index (CTDI) measurement. These measurements use a
routine head examination protocol provided by CT Scan. Evaluation of image quality using fantom Gammex ACR
464. The resulting data is normalized to obtain constant image noise between SDCT and MDCT. SDCT resulted in a
linearity coefficient of radiation dose output ranging from 0.017 to 0.085 higher than MDCT ranging from 0.007 to
0.055. The accuracy of DOSIS radiation at 120 kV / 100 mAs from SDCT is 23.3 mGy and 31.2 mGy whereas MDCT
ranges from 11.17 - 28.57 mGy. The standard deviation of radiation dose distribution pattern with CTDI head
phantom ranged from 1.7 to 5.8. While the results of image quality measurement, linearity response to 5 standard
materials indicate that they are within the range of HU reference values. Evaluation of homogeneity of CT number
accuracy, uniformity of noise and uniformity of CT,center and CT,edge respectively are in the range -7 and + 7 HU,
0,258 and 1,123 HU and 0,93 - 3,85 HU. Contrast to Noise Ratio (CNR) measurements range from 1.03 - 2.72. In
addition, the results of spatial resolution measurements range from 6 - 7 lp / cm. From the overall evaluation
shows, that MDCT has a better score than a SDCT. However, when compared with standard reference values, a
single CT detector can be retained as an imaging modality to support the patient's diagnostic process.
Keywords— SDCT, MDCT, Linearitas Dosis, CTDI, Kualitas Citra.

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I. INTRODUCTION
Total use of CT scans in Indonesia continues to experience a significant increase from year to year. From about
7300-an X-ray machine data are registered in the Nuclear Energy Regulatory Agency (BAPETEN) in 2015, about 5-
6% of that amount is the modality of CT Scan with various brands and types. From these data the amount of
approximately 10% is a machine with a single detector CT (single slice CT Scan), which is still used in the
examination of patients. While the rest are multi-slice CT with a variation of the dual slice to slice 128 that began
circulating. Slowly and surely conventional CT displaced population and is replaced with the latest generation in
line with technological developments. One problem that still complained of by the physicists is that the use of CT
contributing to provide 35-45% of the dose of radiation of all existing diagnostic radiology modalities [1]. Results
of research on comparative dose on conventional CT and spiral air by Bouzarjomehri F., et al, 2006, indicating the
patient's radiation dose using conventional CT examination is higher than spiral CT [2]. The amount of radiation
dose in CT scan parameters determined by parameters such as tube voltage (kV), tube current production - timer
(mAs), slice thickness (mm), rotation time and pitch. The relationship between the dose of radiation to the current
production of tube-timer linear. The higher mAs then the higher the output radiation from CT scans. MDCT
development to further enhance the ability of CT to improve image quality and reduce radiation dose. [3].
Among the use of CT scans, CT examination was the dominant case in every hospital / clinic. More than 50% CT
scan is a head examination [Lisa W]. The study of image quality and dose eyepiece using a head examination
protocol with helical and sequential modes was performed by Abdeen et al (2010). The results showed that the
relative helix mode resulted in smaller doses than sequential, while the image quality was relatively similar
[Abdeen]. Another study in 2013, comparing different CT Scan engines to recognize some types of CT that have the
lowest dose of radiation and diagnostic image quality adequate for diagnostic purposes. The study used human
observers to evaluate image quality and record radiation doses from selected hospitals [Haytham Ahmad]. In line
with Haytham (2013) research, we conducted the same research using a set of measuring instruments, fantom
CTDI head and fantom image quality. The goal is to compare the radiation dose and image quality between a single
CT detector and a multi-detector to obtain valid data about the advantages and disadvantages of both.
II. METHODS
A. SURVEY STUDY AND INSTRUMENTATION
During the period of March 2016 s.d March 2017, we conducted a research survey of 6 CT Scans consisting of 2
types of CT single detectors and 4 Multi Slices of four different hospital radiology facilities. The six CT Scan aircraft
are shown in table 1 below.
Table I - Characteristics of CT model Scan survey research.
Scanner Type Manufactur Model Slice Class Production
A HITACHI PRATICO 1 2000
B TOSHIBA CXXG-010A 1 2003
C PHILIPS MX 4000 DUAL 2 2010
D TOSHIBA AQUILION 16 2009
E HITACHI ROBUSTA 16 2010
F PHILIPS MX-16 SLICE 16 2013
The equipment used for this study consisted of a fantom image quality accreditation, Gammex ACR 464, RTI type
piranha 657 and a fantom dose CT head index (figure.1).
Figure 1. The equipment used in research

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B. MEASUREMENT PARAMETER.
Linearity dose calculated with linearity coefficient (CL), aims to determine the consistency of performance
response of certain significant components of the x-ray plane when given different inputs. The linearity coefficient
is formulated as [7]:
CTDI describe the sum of all contributions dose along a line parallel to the axis of rotation of the scanner (ie the z-
axis) is formulated as[8]:
D (z) is the value of the dose at a given location along the z axis, N is the number of images and T is the nominal
slice thickness. While the present CTDI100 dose accumulation of multiple scans in the middle of 100 mm along the
detector and does not calculate the accumulated dose of scan length exceeding 100 mm [8].
The relationship between CTDI100 with CTDIw formulated as :
CTDI100,p showed the average doses edge and CTDI100, c is the result of the measurement at the center. CTDI100
relationship with CTDIV:
the quantity p is called the pitch factor and is defined as the ratio of the total width of the beam (N.T) divided by
increments of movement of the patient table per rotation of the tube [8]. In CT Scan some determinants of image
quality characteristics are CT Number accuracy, homogeneity and contrast image resolution. According to the
reference of the imagery imagery used, for CT number accuracy evaluation, CT HU reference values for
polyethylene (- 95 HU), equivalent water material (0 HU), acrylic (+120 HU) and air (-1000 HU) [ACR CT ]. (Figure
2).
Figure 2: CT number linearity response image.
To evaluate the homogeneity of the image, the acceptance criteria mean CT number difference between the center
and the edge is less than 5 HU fourth edge position. Value CT number in the middle between -7 and +7 HU HU HU
selected with ± 5 [9].

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Figure 3: Image homogeneity of CT HU.
To quantify low contrast resolution is to calculate the value of contrast-to-noise ratio (CNR) is formulated with
Figure 4: Low Contrast Image Resolution
A Rod Where is the ROI on nodule diameter of 50 cm, and Rod B is the ROI on the left of Rod A. SD is the standard
deviation value of Rod B. criterion noise level contrast ratio allowable absolute value of contrast noise ratio in
adult abdominal examination protocol and adult head ≥ 1.0.
Figure 5: High Contrast Image Resolusi.
To assess the spatial resolution of the CT image of the scan, window width and window level (contrast and
brightness) is set at 100 WW and 1100 WL. Be visually seen eight bar pattern composed resolution 4, 5, 6, 7, 8, 9,
10 and 12 lp / cm, each measuring 15 mm x 15 mm square. The acceptance criteria for the spatial resolution is a
scanner capable of detecting a minimum of 6 lp / cm.

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C. Measurement Technique.
Multimeter x-ray RTI piranha type 657 and pencil dose detector used for measurement accuracy and linearity of
the output radiation and a phantom head CT dose index of 16 cm diameter is used for the measurement of CTDI
head. For measurement of dose linearity and accuracy, the position detector is placed on the holder in the free
state in the air on a gantry isocenter. First do a scan of the entire detector to obtain a projection image detector
positions. Furthermore, the scanning fixed by setting 8-10 mm thick slices of the image against a predetermined
area of the detector. Used tube voltage of 120 kV was fixed for the fourth variation CT with tube current of 25 mA
to 300 mA. Measurements are converted to dose per rotation and CTDI in air. All measurements are normalized to
100 mAs CTDIair and performed with axial mode. From this measurement process resulting output value of
radiation dose at 120 kV per 100 mAs and the coefficient of linearity of the output radiation. For the measurement
of CT dose index used multimeter x-ray detector and a pencil and CTDI phantom head. Parameter measurements
refer to the user guide of the manufacturer or using measurement information from the monitor console by using
the mode of examination of the head. Measurements performed 5 times from middle position, top, right, bottom
and left. The measurement results in the form of exposure dose (CTDI) is converted into a number of CT dose
descriptors. Phantom image quality accreditation, Gammex ACR 464, used for evaluation of image quality
assessment. Parameters assessed restricted to the measurement results CT number, low contrast resolution,
homogeneity and high contrast spatial resolution.
III. RESULTS AND DISCUSSION
A. The output accuracy and linearity of the output radiation
Point dose measurements at the free in air position detector are expressed in dosage form in units of mGy /
100mAs and linearity coefficient of radiation output. The used tube voltage is 120 kV. The measurement results
are shown by Table 2. The measurement data shows that the average of the dosage in the air varies greatly,
whereas for the linearity coefficient dose in air type A and type B which is the representation of CT single detector
is between 0,017 - 0,0085 and type C, D , E and F are repren- sations of CT Multi Slices ranging from 0.007 to 0.055.
However, the overall linearity coefficient scanner value is still below the threshold (CL Threshold ≤ 0.1).
Table II.
LINEARITY DOSE MEASUREMENT DETECTOR WITH FLOATING IN THE AIR.
Scanner
Type
acquisition parameter
Average
(mGy/100mAs)
Coeffisien of
LinearityTube Voltage
(kV)
Range of Tube
Current (mA)
Rotation
Time (sec)
Slice Thicknes
(mm)
A 120 25 - 200 1,0 10 26,77 0,085
B 120 30 - 200 1,0 10 29,60 0,017
C 120 50 - 200 1,0 5 11,17 0,024
D 120 50 - 300 1,0 10 28,57 0,018
E 120 50 - 200 1,0 10 23,82 0,055
F 120 25 - 250 1,0 5 13,31 0,007
B. CTDI and dose distribution pattern.
Measurements of CT dose index (CTDI) with the head diameter of fantom are shown in table 3 and histogram 6.
The radiation dose pattern of CT Scan at 5 detector positions is shown in 6-histogram. The magnitude of the dose
is influenced by various acquisition parameters, such as tube voltage (kV), tube current (mA), rotation time (sec),
pitch, slice thickness and collimation options with reference to manufacturer-specified acquisition parameters,
each shown on the monitor Console except for single-slice CT scanners. In general, the multi-slice CT plane on the
console has provided an estimate of the main CTDI values for CTDI vol and DLP descriptors. This value is at least
the physicist's reference to the radiation dose received by the patient.

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Table III –
CTDI DISTRIBUTION PATTERNS IN 5 POSITION DETECTORS IN MEASURING HEAD WITH FANTOM CTDI.
Scanner Type
The results of measurements dose (mGy) Standard
DeviationCenter Top edge Right edge Bottom edge Left edge
A 29,94 34,16 31,81 23,43 28,85 4,61
B 44,70 49,34 45,85 41,92 43,93 3,07
C 33,12 30,37 34,39 31,35 28,93 1,79
D 25,07 39,2 34,03 32,3 36,26 5,84
E 25,92 27,49 24,64 23,59 24,87 1,68
F 40,29 40,56 40,10 35,86 38,23 2,24
Figure 1. Graph CTDI distribution pattern of four types of scanners at the 5 position of the detector with CTDI
phantom head.
C. Comparison of linearity response accuracy
The measurement data of the CT number of the six scanners is shown in table 4, the slope curve is shown in table
5. The value of CT number is obtained from the measurement of the region of interest (ROI) to five standard
materials that have certain CT HU reference value (table 4). The electron density of the five reference materials is
shown in Table 4.
Table IV - MEASUREMENT OF THE VALUE OF CT HU 4 TYPE SCANNER FOR RESPONSE ASSESSMENT LINEARITY.
Material
Electron
Density
Measured Value (CT HU) HU –
ReferenceA B C D E F
Polyethelene 4 -94,34 -95 -93,57 -94,34 -98,8 -96,54 -95
Bone 3235 958,53 955 818,1 958,53 1110,1 967,16 955
Air 3345 -971,26 -1000 -1009,96 -971,26 -990,2 -976,75 -1000
Acrylic 3865 120,17 120 127,96 120,17 120,1 119,59 120
Water 6772 1,26 0 -2,69 1,26 2,5 -0,46 0
Tabel V - LINEAR REGRESSION OF CT-HU MEASUREMENT RESULTS
Tipe Scanner Nilai CT-HU Scanner Regresi Linear
(R)Polyethelene Bone Air Acrylic Water
A -94,34 958,53 -971,26 120,17 1,26 0,996
B -98,19 962,12 -996,09 122,23 2,77 0,997
C -93,57 818,1 -1009,96 127,96 -2,69 0,999
D -94,34 958,53 -971,26 120,17 1,26 0,996
E -98,8 1110,1 -990,2 120,1 2,5 0,991
F -96,54 967,16 -976,75 119,59 -0,46 0,996

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Phantom scanning uses axial mode or sequential routine head examination, with a 120 kV, 200-300 mAs
acquisition factor and 5-10 cm thick wedges. The CT-HU values generated by each scanner were compared with
the reference HU and the linear regression value (R) was calculated. Limit of linearity response tolerance is
expressed with value R ≥ 0,99.
D. Comparison of Homogeneity CT-HU.
The comparison of the images homogeneity is shown in Table 6. The data were extracted from a scan of the
fantom that has a homogeneous material equivalent to water. The value of CT number is obtained from the
measurement of the region of interest (ROI) on the five position of the scanned image. Phantom scanning also uses
axial mode or sequential routine head checking, with a 120 kV, 200-300 mAs acquisition factor and 5-10 cm thick
wedges. To draw closer to the same measurement parameters all scanners of homogeneity measurements were
converted to acquisition parameters of 120 kV, 300 mAs and 8 mm thickness of the slice. The results of the
evaluation of the measurements of CT summation are shown in Table 5. From the table, it can be concluded that
the CT scores of the four types of scanners are included in the range (- 7 HU and + 7 HU). Similarly, for the
uniformity parameters of noise and maximum deviation of CT HU centers and edges entered in the acceptance
criteria of the test (-5 CT HU and +5 CT HU).
Table VI- ACCURACY AND UNIFORMITY CT NUMBER OF WATER EQUIVALENT MATERIAL.
Scanner Type Parameter
ROI Potition (CT HU)
Top Edge Right Edge Left Edge Bottom Edge Center
A
Mean ROI 0,46 0,78 -0,10 0,25 -0,15
Noise 3,63 3,23 3,34 3,61 3,20
Deviation – Mean ROI 0,46 0,78 0,10 0,25
Noise converted 0,45 0,76 -0,10 0,24
B
Mean ROI 3,26 3,82 3,28 2,92 3,61
Noise 4,08 4,02 3,95 3,95 4,02
Noise converted 3,16 3,70 3,18 2,83
C
Mean ROI -0,49 -4,12 -4,29 -2,65 -4,14
Noise 3,70 3,27 3,07 3,07 3,13
Noise converted -0,45 -3,80 -3,96 -2,44
D
Mean ROI -0,27 -1,70 -1,64 -1,34 -1,57
Noise 5,44 3,68 3,78 3,76 3,50
Noise converted -0,26 -1,65 -1,59 -1,30
E
Mean ROI 1,60 2,50 2,30 1,60 2,20
Noise 3,55 2,79 2,91 2,81 2,83
Noise converted 1,55 2,42 2,23 1,55
F
Mean ROI -3,40 -3,20 -2,90 -2,70 -3,00
Noise 2,90 2,60 2,40 2,40 2,30
Noise converted -3,04 -2,86 -2,59 -2,41
Table VII- EVALUATION OF MEASUREMENT ACCURACY CT NUMBER OF MATERIAL AND WATER EQUIVALENT
NUMBER UNIFORMITY CT.
Parameter Evaluation
Measured Values
Acceptance Criteria
A B C D E F
Accuracy of CT Number (water) 0,76 -4,29 0,45 -1,65 2,42 3,04 -7 s.d +7
Noise Uniformity 0,85 0,35 3,50 1,38 0,87 0,63 -5 s.d +5
Maximum Deviation
(CT HUcenter – CT HUedge)
0,78 3,28 4,29 1,70 2,50 3,40 -5 s.d +5

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E. Comparison of Low Contrast Resolution
The contrast resolution can be defined as the ability of a CT-scanner to distinguish relatively large objects that
differ only slightly in the density of the background. To avoid subjectivity in the assessment of low-contrast
images, the quantity of contrast to noise ratio (CNR) is used. The CNR value limit for adult head examination is ≥
1.0. The result of measurement CNR value is shown in table 8. From the table it can be concluded all scanners
meet the acceptance criteria.
Table VIII - CONTRAST TO NOISE RATIO VALUE.
Scanner System ROI Target
background
ROI
background
noise
CNR measured
Acceptance
Criteria
A 93,5 87,4 3,7 1,7
≥ 1,0
B 93,5 87,2 4,1 1,5
C 96,4 88,7 3,7 2,1
D 85,6 78,6 3,7 1,9
E 86,3 82,5 3,7 1,0
F 93,1 86,9 3,1 2,0
F. Comparison of Hight Contrast Resolution
In this test verified the ability of scanners to detect small lesions that have very different attenuation values than
the surrounding tissue. This characterizes the ability of the imaging system to distinguish between two very small
objects in adjacent positions. Spatial resolution measurements are performed with objects that have high contrast
from a uniform background. The criteria for acceptance of high-contrast spatial resolution of CT Scan according to
AAPM with the image imagery of Gammex 464 ACR is 6 lp / cm. From the results of the test table 9, it can be
concluded that all CT scans meet the acceptance of the same or above the acceptability limit.
Table VIII - MEASUREMENT OF SPATIAL RESOLUTION
Scanner Type
Acquisition factors
Spatial Resolution (lp/cm) Acceptance Criteria
kV mAs slice
A 120 300 10 6
≥ 6 lp/cm
B 120 200 5 7
C 140 200 5 6
D 120 112,5 5 7
E 120 300 7,5 6
F 120 320 6 7
Scanner Type Spatial Resolution (lp/cm) Acceptance Criteria
CT Scan –A 6
6 (lp /cm)
CT Scan –B 7
CT Scan –C 6
CT Scan –D 6
IV. CONCLUSIONS
The result of comparison of radiation dose and image quality of the six CT types shows that all CT Scan
performance is in accordance with standard criteria. Quantitatively there is no significant difference between
SDCT and MDCT. A number of other variables that affect the reliability level of CT Scanner is maintenance
program, production year, frequency of use and brand of tool manufacturer. If performance grading of all six CT
Scan types is seen, it is relatively superior in terms of radiation dose and image quality compared to SDCT.
However, if SDCT is compared to the threshold value of passing the test of internationally accepted standards,
SDCT can still be maintained as imaging modalities to support the patient's diagnostic process. In the
measurement of radiation doses at 120 kVp / 100mAs, 2 types of SDCT scanners had 26.77 mGy and 29.60 mGy, 2
MDCT scanners scored 23.82 mGy and 28.57 mGy and the other two MDCT types were 11.17 mGy and 13, 31 mGy.

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The CT Scan test method from BAPETEN provides dose guidance at 120 kVp / 100mAs ranging from 20 - 40 mGy
[7]. The dose range is intended to ensure adequate quality in obtaining diagnostic image quality. If you look at the
measurement results, MDCT with 120 kV / 100mAs resulting in dose below that range with adequate image
quality, it is necessary to propose amendment of the guidelines. The linearity coefficient of this measurement
ranges from 0.007 - 0.085, below the guideline level threshold (CL ≤ 0.1). The standard deviation of the radiation
radiation pattern at 5 detector positions shows varying values. To some extent, the higher standard deviation of
the radiation distribution pattern will have an impact on the homogeneity of the image. In the image quality
measurement shows all types of CT Scan meet the acceptance criteria test. The linearity response ratio shows the
slope curve (R) of all CT scans at the threshold (≥ 0.99). Evaluation of measurement accuracy of CT number, noise
uniformity and maximum deviation between edge and center HU CT is in tolerance range (± 5 HU). Low-contrast
resolution is shown in CNR quantification. CNR measurement results are in the acceptance range (≥ 1.0). Similarly,
the results of high contrast resolution measurements of all CT scans are within tolerable limits (6 lp / cm)
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COMPARISON OF RADIATION DOSE AND IMAGE QUALITY BETWEEN THE SINGLE DETECTOR CT AND MULTI DETECTOR CT ON HEAD EXAMINATION: STUDY PHANTOM