Purpose Modern CT scanners use automatic exposure control (AEC) techniques, such as tube current modulation (TCM), to reduce dose delivered to patients while maintaining image quality. In contrast to conventional approaches that minimize the tube current time product of the CT scan, referred to as mAsTCM in the following, we herein propose a new method referred to as riskTCM, which aims at reducing the radiation risk to the patient by taking into account the specific radiation risk of every dose‐sensitive organ. Methods For current mAsTCM implementations, the mAs product is used as a surrogate for the patient dose. Thus, they do not take into account the varying dose sensitivity of different organs. Our riskTCM framework assumes that a coarse CT reconstruction, an organ segmentation, and an estimation of the dose distribution can be provided in real time, for example, by applying machine learning techniques. Using this information, riskTCM determines a tube current curve that minimizes a patient risk measure, for example, the effective dose, while keeping the image quality constant. We retrospectively applied riskTCM to 20 patients covering all relevant anatomical regions and tube voltages from 70 to 150 kV. The potential reduction of effective dose at same image noise is evaluated as a figure of merit and compared to mAsTCM and to a situation with a constant tube current referred to as noTCM. Results Anatomical regions like the neck, thorax, abdomen, and the pelvis benefit from the proposed riskTCM. On average, a reduction of effective dose of about 23% for the thorax, 31% for the abdomen, 24% for the pelvis, and 27% for the neck has been evaluated compared to today's state‐of‐the‐art mAsTCM. For the head, the resulting reduction of effective dose is lower, about 13% on average compared to mAsTCM. Conclusions With a risk‐minimizing TCM, significant higher reduction of effective dose compared to mAs‐minimizing TCM is possible.

Various studies have demonstrated that additional prefilters and/or reduced tube voltages have the potential to significantly increase the contrastto-noise ratios at unit dose (CNRDs) and thereby to significantly reduce patient dose in clinical CT. An exhaustive analysis, accounting for a wide range of filter thicknesses and a wide range of tube voltages extending beyond the 70 to 150 kV range of today's CT systems, including their specific choice depending on the patient size, is, however, missing. Therefore, this work analyzes the dose reduction potential for patient-specific selectable prefilters combined with a wider range of tube voltages. We do so for soft tissue and iodine contrast in single energy CT. The findings may be helpful to guide further developments of x-ray tubes and automatic filter changers. Methods: CT acquisitions were simulated for different patient sizes (semianthropomorphic phantoms for child, adult, and obese patients), tube voltages (35-150 kV), prefilter materials (tin and copper), and prefilter thicknesses (up to 5 mm). For each acquisition soft tissue and iodine CNRDs were determined. Dose was calculated using Monte Carlo simulations of a computed tomography dose index (CTDI) phantom. CNRD values of acquisitions with different parameters were used to evaluate dose reduction. Results: Dose reduction through patient-specific prefilters depends on patient size and available tube current among others. With an available tube current time product of 1000 mAs dose reductions of 17% for the child, 32% for the adult and 29% for the obese phantom were achieved for soft tissue contrast. For iodine contrast dose reductions were 57%, 49%, and 39% for child, adult, and obese phantoms, respectively. Here, a tube voltage range extended to lower kV is important. Conclusions: Substantial dose reduction can be achieved by utilizing patientspecific prefilters. Tube voltages lower than 70 kV are beneficial for dose reduction with iodine contrast, especially for small patients. The optimal implementation of patient-specific prefilters benefits from higher tube power. Tin prefilters should be available in 0.1 mm steps or lower, copper prefilter in 0.3 mm steps or lower. At least 10 different prefilter thicknesses should be used to cover the dose optima of all investigated patient sizes and contrast mechanisms. In many cases it would be advantageous to adapt the prefilter thickness rather than the tube current to the patient size, that is, to always use the maximum available tube current and to control the exposure by adjusting the thickness of the prefilter.