A routine quality assurance test for CT automatic exposure control systems

The study purpose was to develop and validate a quality assurance test for CT automatic exposure control (AEC) systems based on a set of nested polymethylmethacrylate CTDI phantoms. The test phantom was created by offsetting the 16 cm head phantom within the 32 cm body annulus, thus creating a three part phantom. This was scanned at all acceptance, routine, and some nonroutine quality assurance visits over a period of 45 months, resulting in 115 separate AEC tests on scanners from four manufacturers. For each scan the longitudinal mA modulation pattern was generated and measurements of image noise were made in two annular regions of interest. The scanner displayed CTDIvol and DLP were also recorded. The impact of a range of AEC configurations on dose and image quality were assessed at acceptance testing. For systems that were tested more than once, the percentage of CTDIvol values exceeding 5%, 10%, and 15% deviation from baseline was 23.4%, 12.6%, and 8.1% respectively. Similarly, for the image noise data, deviations greater than 2%, 5%, and 10% from baseline were 26.5%, 5.9%, and 2%, respectively. The majority of CTDIvol and noise deviations greater than 15% and 5%, respectively, could be explained by incorrect phantom setup or protocol selection. Barring these results, CTDIvol deviations of greater than 15% from baseline were found in 0.9% of tests and noise deviations greater than 5% from baseline were found in 1% of tests. The phantom was shown to be sensitive to changes in AEC setup, including the use of 3D, longitudinal or rotational tube current modulation. This test methodology allows for continuing performance assessment of CT AEC systems, and we recommend that this test should become part of routine CT quality assurance programs. Tolerances of ± 15% for CTDIvol and ± 5% for image noise relative to baseline values should be used.