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To clarify: I had been going on the assumption that 70 kg correlated with a patient with an abdomen of about 21 cm in diameter. Maybe I had gotten it mixed up with the phantom diameter somewhere down the line. The point is, I don't really have</div>
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To clarify: I had been going on the assumption that 70 kg correlated with a patient with an abdomen of about 21 cm in diameter. Maybe I had gotten it mixed up with the phantom diameter somewhere down the line.</div>
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The point is, I don't really have any idea what the abdomen of a 70 kg patient "looks like". It would be much easier to have a rough estimate of an abdomen diameter range to use.</div>
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<div id="divRplyFwdMsg" dir="ltr"><font face="Calibri, sans-serif" style="font-size:11pt" color="#000000"><b>From:</b> Douglas Pfeiffer <xraydoug@me.com><br>
<b>Sent:</b> Monday, September 14, 2026 1:47 PM<br>
<b>To:</b> Matt Wait <Matt.Wait@kp.org><br>
<b>Cc:</b> DxMedPhys List <intl_dxmedphys_wd_osu_list@lists.osu.edu>; Bob Kobistek <bob@rjkmedphys.com><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</font>
<div> </div>
</div>
<div style="line-break:after-white-space">The 21 cm DFOV is to make it easier to analyze - nothing to do with patient size. It doesn’t impact dose in any way. Using a small Scan FOV is to reduce non-uniformities due to the bowtie not being matched to the object
size on some scanners.
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<div style="orphans:2; widows:2">Best regards,</div>
<div style="orphans:2; widows:2">Doug</div>
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<div style="orphans:2; widows:2"><br>
</div>
<div style="orphans:2; widows:2">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</div>
<div style="orphans:2; widows:2">Medical Physicist, Radiation Safety Officer</div>
<div style="orphans:2; widows:2">Boulder Community Health</div>
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<div>xraydoug@me.com</div>
<div>303.415.7515</div>
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<div>The opinions expressed in this message are the product of the gray and white matter loitering in my cranium. I speak for myself and no one else, unless I say otherwise.</div>
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<div>On Sep 14, 2026, at 2:42 PM, Matt Wait <Matt.Wait@kp.org> wrote:</div>
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That's good to hear, that's the practice I've been using. But I have never found a good reference for correlating the abdomen diameter (21 cm?) with 70 kg.</div>
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<div style="margin:0in; background-color:white; font-family:Aptos,sans-serif"><span style="font-family:Arial,Helvetica,sans-serif; font-size:10pt; color:rgb(0,120,179)"><b>Matt Wait, MS, DABR, DABSNM, MRSE</b></span><span style="font-family:Arial,Helvetica,sans-serif; font-size:10pt"><br>
Senior Diagnostic Physicist</span></div>
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<font face="Calibri, sans-serif" style="font-size:11pt"><b>From:</b><span class="x_Apple-converted-space"> </span>Douglas Pfeiffer <xraydoug@me.com><br>
<b>Sent:</b><span class="x_Apple-converted-space"> </span>Monday, September 14, 2026 1:35 PM<br>
<b>To:</b><span class="x_Apple-converted-space"> </span>Matt Wait <Matt.Wait@kp.org><br>
<b>Cc:</b><span class="x_Apple-converted-space"> </span>DxMedPhys List <intl_dxmedphys_wd_osu_list@lists.osu.edu>; Bob Kobistek <bob@rjkmedphys.com><br>
<b>Subject:</b><span class="x_Apple-converted-space"> </span>Re: [Intl_DxMedPhys] ACR CT test question</font>
<div> </div>
</div>
<div style="font-family:Helvetica; font-size:12px; font-style:normal; font-variant-caps:normal; font-weight:400; letter-spacing:normal; orphans:2; text-align:start; text-indent:0px; text-transform:none; white-space:normal; widows:2; word-spacing:0px; text-decoration-line:none; text-decoration-style:solid; line-break:after-white-space">
Going through the list of scanned patients on the scanner and looking for abdomens that look about the right size, and looking at the mA at mid-liver (belly button-ish).
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<div style="orphans:2; widows:2">Best regards,</div>
<div style="orphans:2; widows:2">Doug</div>
<div style="orphans:2; widows:2"><br>
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<div style="orphans:2; widows:2"><br>
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<div style="orphans:2; widows:2"><br>
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<div style="orphans:2; widows:2">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</div>
<div style="orphans:2; widows:2">Medical Physicist, Radiation Safety Officer</div>
<div style="orphans:2; widows:2">Boulder Community Health</div>
<span class="x_x_Apple-style-span" style="border-collapse:separate; border-spacing:0px"><span class="x_x_Apple-style-span" style="border-collapse:separate; border-spacing:0px"><span class="x_x_Apple-style-span" style="border-collapse:separate; border-spacing:0px">
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<div>xraydoug@me.com</div>
<div>303.415.7515</div>
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<div>The opinions expressed in this message are the product of the gray and white matter loitering in my cranium. I speak for myself and no one else, unless I say otherwise.</div>
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<blockquote type="cite">
<div>On Sep 14, 2026, at 2:16 PM, Matt Wait <Matt.Wait@kp.org> wrote:</div>
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<div class="x_x_elementToProof" style="font-style:normal; font-variant-caps:normal; font-weight:400; letter-spacing:normal; orphans:2; text-align:start; text-indent:0px; text-transform:none; white-space:normal; widows:2; word-spacing:0px; text-decoration-line:none; text-decoration-style:solid; font-family:Arial,Helvetica,sans-serif; font-size:12pt">
Doug, how did you envision determining the automatic tube current selection for Standard Man?</div>
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<div style="margin:0in; background-color:white; font-family:Aptos,sans-serif"><span style="font-family:Arial,Helvetica,sans-serif; font-size:10pt; color:rgb(0,120,179)"><b>Matt Wait, MS, DABR, DABSNM, MRSE</b></span><span style="font-family:Arial,Helvetica,sans-serif; font-size:10pt"><br>
Senior Diagnostic Physicist</span></div>
<div style="margin:0in; background-color:white; font-family:Aptos,sans-serif"><span style="font-family:Arial,Helvetica,sans-serif; font-size:10pt">Associate Radiation Safety Officer</span></div>
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<font face="Calibri, sans-serif" style="font-size:11pt"><b>From:</b><span class="x_x_Apple-converted-space"> </span>Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list-bounces+matt.wait=kp.org@lists.osu.edu">intl_dxmedphys_wd_osu_list-bounces+matt.wait=kp.org@lists.osu.edu</a>>
on behalf of Douglas Pfeiffer via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Sent:</b><span class="x_x_Apple-converted-space"> </span>Monday, September 14, 2026 1:12 PM<br>
<b>To:</b><span class="x_x_Apple-converted-space"> </span>Bob Kobistek <<a href="mailto:bob@rjkmedphys.com">bob@rjkmedphys.com</a>><br>
<b>Cc:</b><span class="x_x_Apple-converted-space"> </span>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><span class="x_x_Apple-converted-space"> </span>Re: [Intl_DxMedPhys] ACR CT test question</font>
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For what it’s worth now, the intent when I was working on the manual was Standard Man (i.e., 70 kg). It was an unfortunate oversight on my part that I did not catch that and state it explicitly way back when. I’m not sure what is assumed now by the ACR, but
that was the original thinking.
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<div style="orphans:2; widows:2">Best regards,</div>
<div style="orphans:2; widows:2">Doug</div>
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<div style="orphans:2; widows:2">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</div>
<div style="orphans:2; widows:2">Medical Physicist, Radiation Safety Officer</div>
<div style="orphans:2; widows:2">Boulder Community Health</div>
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<div>xraydoug@me.com</div>
<div>303.415.7515</div>
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<div>The opinions expressed in this message are the product of the gray and white matter loitering in my cranium. I speak for myself and no one else, unless I say otherwise.</div>
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<blockquote type="cite">
<div>On Sep 9, 2026, at 1:45 PM, Bob Kobistek via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list@lists.osu.edu> wrote:</div>
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<div class="x_x_x_WordSection1" style="font-family:Helvetica; font-size:12px; font-style:normal; font-variant-caps:normal; font-weight:400; letter-spacing:normal; orphans:2; text-align:start; text-indent:0px; text-transform:none; white-space:normal; widows:2; word-spacing:0px; text-decoration-line:none; text-decoration-style:solid">
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt">Hi.</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt">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.</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt">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.</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt">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.</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt">There is very little guidance on how to chose mAs (and kVp when applicable) for automated technique selection. So we use out best judgment.</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt; font-family:Arial,sans-serif; color:rgb(165,0,33)">Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt; font-family:Arial,sans-serif; color:rgb(165,0,33)">Medical Physicist</span><span style="font-size:11pt"></span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:22pt; font-family:Castellar,serif; color:rgb(165,0,33)">RJK</span><span style="font-size:22pt; font-family:"Colonna MT"; color:rgb(165,0,33)"><span class="x_x_x_Apple-converted-space"> </span></span><span style="font-size:14pt; color:rgb(165,0,33)">Medical
Physics, Inc.</span><span style="font-size:12pt"></span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:14pt; color:rgb(165,0,33)">440-463-7879</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:11pt"> </span></div>
<div style="border-width:1pt medium medium; border-style:solid none none; border-color:rgb(225,225,225) currentcolor currentcolor; padding:3pt 0in 0in">
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><b><span style="font-size:11pt; font-family:Calibri,sans-serif">From:</span></b><span style="font-size:11pt; font-family:Calibri,sans-serif"><span class="x_x_x_Apple-converted-space"> </span>Intl_dxmedphys_wd_osu_list
<<a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu" style="color:rgb(70,120,134); text-decoration:underline">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</a>><span class="x_x_x_Apple-converted-space"> </span><b>On Behalf Of<span class="x_x_x_Apple-converted-space"> </span></b>David
S. Winter via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b><span class="x_x_x_Apple-converted-space"> </span>Monday, September 7, 2026 4:02 PM<br>
<b>To:</b><span class="x_x_x_Apple-converted-space"> </span>DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" style="color:rgb(70,120,134); text-decoration:underline">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Subject:</b><span class="x_x_x_Apple-converted-space"> </span>[Intl_DxMedPhys] ACR CT test question</span></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"> </div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:1pt; 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</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt">All,</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt">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.)</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt">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.<span class="x_x_x_Apple-converted-space"> </span></span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt">“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. <span class="x_x_x_Apple-converted-space"> </span></span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt">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?</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt">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.<span class="x_x_x_Apple-converted-space"> </span></span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt"> </span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt">Sincerely,</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt">Scott</span></div>
<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:12pt"> </span></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:9pt; font-family:"Trebuchet MS",sans-serif; color:rgb(110,117,125)">MS</span></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:9pt; font-family:"Trebuchet MS",sans-serif; color:rgb(110,117,125)">, </span></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><span style="font-size:9pt; font-family:"Trebuchet MS",sans-serif; color:rgb(110,117,125)">39501</span></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><a href="https://urldefense.com/v3/__https:/www.wearememorial.com/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFYF5vxZV$" target="_blank" style="color:rgb(70,120,134); text-decoration:underline"><span style="font-size:1pt; color:blue; text-decoration:none"><map name="x_x_x_MicrosoftOfficeMap0"></map><span id="x_x_x_cid:image001.gif@01DD3FA6.7592D120"><image001.gif></span></span></a><span style="font-size:1pt"></span></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><a href="https://urldefense.com/v3/__https:/www.wearememorial.com/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFYF5vxZV$" target="_blank" title="WeAreMemorial Home Page" style="color:rgb(70,120,134); text-decoration:underline"><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,116,116); text-decoration:none">WeAreMemorial.com</span></b></a><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,116,116)"></span></b></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,161,156)">|</span></b></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><a href="https://urldefense.com/v3/__https:/www.facebook.com/MemorialHospitalMS/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFdPd1EsI$" target="_blank" title="WeAreMemorial Facebook Page" style="color:rgb(70,120,134); text-decoration:underline"><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,116,116); text-decoration:none">Facebook</span></b></a><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,116,116)"></span></b></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,161,156)">|</span></b></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><a href="https://urldefense.com/v3/__https:/www.youtube.com/user/gulfportmemorial__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFUp5zZIl$" target="_blank" title="WeAreMemorial YouTube Channel" style="color:rgb(70,120,134); text-decoration:underline"><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,116,116); text-decoration:none">YouTube</span></b></a><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,116,116)"></span></b></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,161,156)">|</span></b></div>
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<div style="margin:0in; font-size:10pt; font-family:Aptos,sans-serif"><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" style="color:rgb(70,120,134); text-decoration:underline"><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,116,116); text-decoration:none">LinkedIn</span></b></a><b><span style="font-family:"Trebuchet MS",sans-serif; color:rgb(0,116,116)"></span></b></div>
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