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Hi. I also beat my head against a wall searching for answers to these questions when the ACR CT accreditation program was started. I stopped overthinking it, and now I pretty much wing it. For average size patient, I look through patient scans</div>
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<p class="MsoNormal"><span style="font-size:11.0pt">Hi.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">I also beat my head against a wall searching for answers to these questions when the ACR CT accreditation program was started. I stopped overthinking it, and now I pretty much wing it.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">For average size patient, I look through patient scans to find one with an A-P dimension through the abdomen of around 23 cm. If I can find more than one (hard to find nowadays), I’ll toss out the outliers
and take an average of the mAs values.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">For new scanners I use nearly all the options you presented. If it’s a scanner with a similar model in use at the facility, I refer to patients scanned on the existing scanners. If it’s a scanner that I see
at other facilities, I’ll make adjustments for differences in protocols and use that. If it’s a scanner I’ve never seen before, I’ll pull up the manufacturer’s suggested protocols and take a guess at the mAs when TCM is used. If I use the second or third option,
I’ll take a look at patient scans once the scanner has been operating for a few weeks. If I can make adjustments to my measurements based on the clinical data, I will. If I have to, I’ll repeat the measurements using the clinical protocols. If the site is
going to be ACR accredited I will always make a second trip so I can use the actual protocols and clinical mAs values for accreditation, not matter which of the three options above that I use.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">There is very little guidance on how to chose mAs (and kVp when applicable) for automated technique selection. So we use out best judgment.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#A50021;mso-ligatures:standardcontextual">Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#A50021;mso-ligatures:standardcontextual">Medical Physicist</span><span style="font-size:11.0pt;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:22.0pt;font-family:"Castellar",serif;color:#A50021;mso-ligatures:standardcontextual">RJK</span><span style="font-size:22.0pt;font-family:"Colonna MT";color:#A50021;mso-ligatures:standardcontextual">
</span><span style="font-size:14.0pt;color:#A50021;mso-ligatures:standardcontextual">Medical Physics, Inc.</span><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt;color:#A50021;mso-ligatures:standardcontextual">440-463-7879<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<div style="border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in">
<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</a>>
<b>On Behalf Of </b>David S. Winter via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Monday, September 7, 2026 4:02 PM<br>
<b>To:</b> DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Subject:</b> [Intl_DxMedPhys] ACR CT test question<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">All, I apologize as this has no doubt been discussed in the past, but I have a two part inquiry related to ACR CT testing. I am happy to clarify directly with the
ACR, but I figured I would touch base with this forum first. (Especially since<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">All,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">I apologize as this has no doubt been discussed in the past, but I have a two part inquiry related to ACR CT testing. I am happy to clarify directly with the ACR, but I figured
I would touch base with this forum first. (Especially since only part 1 would be good to ask the ACR directly.)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">Part 1: The ACR’s scanning instructions webpage and the CT QC manual both give a weight range for the pediatric abdominal exam of 40-50lbs, but only the QC manual has a weight
for the adult abdomen (i.e. 70 kg, ~154 lbs). The webpage merely says “average sized patient”. The exclusion of the 70 kg reference could be an accidental omission, but that requires the same omission to have been repeated in multiple different locations on
their webpage. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">“Average sized” could be interpreted to mean average across the entire US population, the region a CT scanner is in, or the specific patient population a specific CT scanner
sees (which could be massively different if the scanner is the go-to scanner for bariatric patients.) The CDC says the current adult average weights are 199 lbs for men and 171.8 lbs for women. (Both significantly more than 154). In addition, the ACR’s mandatory
dose calculation sheet calculates the adult abdomen SSDE for a 35 cm water equivalent diameter. While you can’t exactly convert abdominal water equivalent diameter to a patient weight, that value would likely correspond to a patient significantly heavier than
154 lbs. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">Has anyone specifically seen anything that dictates which is definitively correct for determining what techniques to set, and by extension, determine whether or not the scanner
is really passing the CNR test?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">Part 2: In practice, I am curious how people are determining the mA that CT scanners are selecting for the “average”, particularly for brand new scanners without much/any historic
patient data. I can imagine four different general approaches. 1) Analysis of historical data aggregated by a dose metric monitoring system like Radimetrics. 2) Manually looking for a few historical patients that look to be roughly “average size” and then
averaging the mA from a representative slice from a few of those studies. 3) For new systems, using values from a similar system with similar settings. 4) Conducting scans of a standard (e.g. their CTDI phantom), seeing what the CT scanner picks for mA, and
then applying a scaling factor to that mA to adjust for the size difference. <o:p>
</o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">Sincerely,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">Scott<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
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<p class="MsoNormal"><a href="https://urldefense.com/v3/__https:/www.wearememorial.com/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFYF5vxZV$" target="_blank"><span style="font-size:1.0pt;color:blue;text-decoration:none"><map name="MicrosoftOfficeMap0"></map><img border="0" width="200" height="99" style="width:2.0833in;height:1.0333in" id="Picture_x0020_1" src="cid:image001.gif@01DD3FA6.7592D120" usemap="#MicrosoftOfficeMap0"></span></a><span style="font-size:1.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal"><a href="https://urldefense.com/v3/__https:/www.wearememorial.com/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFYF5vxZV$" target="_blank" title="WeAreMemorial Home Page"><b><span style="font-family:"Trebuchet MS",sans-serif;color:#007474;text-decoration:none">WeAreMemorial.com</span></b></a><b><span style="font-family:"Trebuchet MS",sans-serif;color:#007474"><o:p></o:p></span></b></p>
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<p class="MsoNormal"><a href="https://urldefense.com/v3/__https:/www.facebook.com/MemorialHospitalMS/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFdPd1EsI$" target="_blank" title="WeAreMemorial Facebook Page"><b><span style="font-family:"Trebuchet MS",sans-serif;color:#007474;text-decoration:none">Facebook</span></b></a><b><span style="font-family:"Trebuchet MS",sans-serif;color:#007474"><o:p></o:p></span></b></p>
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<p class="MsoNormal"><a href="https://urldefense.com/v3/__https:/www.youtube.com/user/gulfportmemorial__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFUp5zZIl$" target="_blank" title="WeAreMemorial YouTube Channel"><b><span style="font-family:"Trebuchet MS",sans-serif;color:#007474;text-decoration:none">YouTube</span></b></a><b><span style="font-family:"Trebuchet MS",sans-serif;color:#007474"><o:p></o:p></span></b></p>
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<p class="MsoNormal"><a href="https://urldefense.com/v3/__https:/www.linkedin.com/company/memorial-hospital-at-gulfport__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFbsk9WzQ$" target="_blank" title="WeAreMemorial LinkedIn Page"><b><span style="font-family:"Trebuchet MS",sans-serif;color:#007474;text-decoration:none">LinkedIn</span></b></a><b><span style="font-family:"Trebuchet MS",sans-serif;color:#007474"><o:p></o:p></span></b></p>
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