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We investigated how patient age, size and composition, together with the choice of x-ray technique factors, affect radiation doses in head computed tomography (CT) examinations. Head size dimensions, cross-sectional areas, and mean Hounsfield unit (HU) values were obtained from head CT images of 127 patients. For radiation dosimetry purposes patients were modeled as uniform cylinders of water. Dose computations were performed for 18 x 7 mm sections, scanned at a constant 340 mAs, for x-ray tube voltages ranging from 80 to 140 kV. Values of mean section dose, energy imparted, and effective dose were computed for patients ranging from the newborn to adults. There was a rapid growth of head size over the first two years, followed by a more modest increase of head size until the age of 18 or so. Newborns have a mean HU value of about 50 that monotonically increases with age over the first two decades of life. Average adult A-P and lateral dimensions were 186+/-8 mm and 147+/-8 mm, respectively, with an average HU value of 209+/-40. An infant head was found to be equivalent to a water cylinder with a radius of approximately 60 mm, whereas an adult head had an equivalent radius 50% greater. Adult males head dimensions are about 5% larger than for females, and their average x-ray attenuation is approximately 20 HU greater. For adult examinations performed at 120 kV, typical values were 32 mGy for the mean section dose, 105 mJ for the total energy imparted, and 0.64 mSv for the effective dose. Increasing the x-ray tube voltage from 80 to 140 kV increases patient doses by about a factor of 5. For the same technique factors, mean section doses in infants are 35% higher than in adults. Energy imparted for adults is 50% higher than for infants, but infant effective doses are four times higher than for adults. CT doses need to take into account patient age, head size, and composition as well as the selected x-ray technique factors.

We investigated how patient head characteristics, as well as the choice of x-ray technique factors, affect lesion contrast and noise values in computed tomography (CT) images. Head sizes and mean Hounsfield unit (HU) values were obtained from head CT images for five classes of patients ranging from the newborn to adults. X-ray spectra with tube voltages ranging from 80 to 140 kV were used to compute the average photon energy, and energy fluence, transmitted through the heads of patients of varying size. Image contrast, and the corresponding contrast to noise ratios (CNRs), were determined for lesions of fat, muscle, and iodine relative to a uniform water background. Maintaining a constant image CNR for each lesion, the patient energy imparted was also computed to identify the x-ray tube voltage that minimized the radiation dose. For adults, increasing the tube voltage from 80 to 140 kV changed the iodine HU from 2.62 x 10(5) to 1.27 x 10(5), the fat HU from -138 to -108, and the muscle HU from 37.1 to 33.0. Increasing the x-ray tube voltage from 80 to 140 kV increased the percentage energy fluence transmission by up to a factor of 2. For a fixed x-ray tube voltage, the percentage transmitted energy fluence in adults was more than a factor of 4 lower than for newborns. For adults, increasing the x-ray tube voltage from 80 to 140 kV improved the CNR for muscle lesions by 130%, for fat lesions by a factor of 2, and for iodine lesions by 25%. As the size of the patient increased from newborn to adults, lesion CNR was reduced by about a factor of 2. The mAs value can be reduced by 80% when scanning newborns while maintaining the same lesion CNR as for adults. Maintaining the CNR of an iodine lesion at a constant level, use of 140 kV increases the energy imparted to an adult patient by nearly a factor of 3.5 in comparison to 80 kV. For fat and muscle lesions, raising the x-ray tube voltage from 80 to 140 kV at a constant CNR increased the patient dose by 37% and 7%, respectively. Our two key findings are that for head CT examinations performed at a constant CNR, the mAs can be substantially reduced when scanning infants, and that use of the lowest x-ray tube voltage will generally reduce patient doses.

A 49-year-old man developed a gliosarcoma with prominent osteoid components 15 months after surgical resection and postoperative radiation and chemotherapy for a right frontal glioblastoma multiforme. The recurrent tumor was distinguished from the original lesion by the presence of dense ossification, visible on CT, at the original tumor site. The relevant literature is reviewed.

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