Influence of tube and patient positioning in thoracoabdominal CT examinations on radiation exposure - towards a better patient positioning.

&#xD;Although iso-centric patient positioning is enormously important in CT, it is complicated in thoracoabdominal imaging by the varying dimensions of the body. Patient positioning can affect the appearance of the patient on the localizer. Positioned too close to the x-ray tube, a patient appears considerably more voluminous. The goal of this study is to assess the difference in radiation exposure of combined chest and abdomen CT scans between scans with prior 0°- and 180°-localizers in conjunction with patient positioning. &#xD;&#xD;Materials and Methods: &#xD;In this IRB-approved retrospective study, patients who had two routine thoracoabdominal CT scans on the same CT scanner, one with a prior 0°- and one with a prior 180°-localizer, were included. To evaluate the radiation exposure of the thoracoabdominal CT examination regarding the tube position during the localizer, CTDIvol, SSDE, patient diameter and positioning within the iso-center for three positions (heart, abdomen, femur level) were compared with regard to the tube position during the prior localizer. &#xD;&#xD;Results: &#xD;CT examinations of 114 patients were included. Despite similar patient weight and diameter between the two examinations, SSDE and CTDIvol was significantly larger (up to 73%) with 180°-localizers. Patient offset from the iso-center ranged between -9 mm at the center slice (abdomen level) to -43 mm at the most caudal slice at the pelvis (femur level), causing a significant magnification (p<0.001) on 180°-localizers with a subsequent increase of the apparent attenuation. &#xD;&#xD;Conclusions: &#xD;The results of this study emphasize the use of 0°-localizers in thoracoabdominal CTs, since 180°-localizers caused patient magnification with subsequent increase in radiation exposure. The advantage of 180°-localizers, namely reducing the dose in thyroid and breast, is eliminated if the dose of the CT scan increases significantly in the abdomen and pelvis. &#xD.