Radiation dose differences between thoracic radiotherapy planning CT and thoracic diagnostic CT scans

Purpose: To compare the absorbed dose from computed tomography (CT) in radiotherapy planning (RP-CT) against those from diagnostic CT (DG-CT) examinations and to explore the possible reasons for any dose differences. Method: Two groups of patients underwent CT-scans of the thorax with either DG-CT (n = 55) or RP-CT (n = 55). Patients from each group had similar weight and body mass index (BMI) and were divided into low (<25) and high BMI (>25). Parameters including CTDIvol, DLP and scan-length were compared. Results: The mean CTDIvol and DLP values from RP-CT (38.1 mGy, 1472 mGy cm) are approximately four times higher than for DG-CT (9.63 mGy, 376.5 mGy cm). For low BMI group, the CTDIvol in the RP-CT scans (36.4 mGy) is 6.3 times higher than the one in the DG-CT scans (5.8 mGy). For the high BMI group, the CTDIvol in the RP-CT (39.6 mGy) is 2.5 times higher than the one in the DG-CT scans (15.8 mGy). In the DG-CT scans a strong negative linear correlation between noise index (NI) and mean CTDIvol was observed (r = -0.954, p = 0.004); the higher NI, the lower CTDIvol. This was not the case in the RP-CT scans. Conclusion: The absorbed radiation dose is significantly higher and less BMI dependent for RP-CT scans compared to DG-CT. Image quality requirements of the examinations should be researched to ensure that radiation doses are not unnecessarily high.