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This message was sent securely using Zix® I had struggled a while with this very question as trying to find the average patient from some recent scans did not seem very representative at all. The comments I agree with that each health system</div>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">I had struggled a while with this very question as trying to find the average patient from some recent scans did not seem very representative at all. The comments I agree with that each health
system has a different “average” patient. So I moved to using DMS data by looking at the WED (water-equivalent diameter) vs. modulated output. The data was restricted to the WED for which our medium abdomen protocols were set (we have mainly GE scanners
and use sm/med/lg auto modulated protocols to compensate for extreme body types), which include diameters from 25 – 32 cm.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Six months of data is analyzed, about 10,000 exams, and the mean and median patient weight for this sample is always around 70-74 kg. So I felt pretty good that this was our “average” patient.
The corresponding mAs values are then used for the CTDI phantom test and image quality test. It has also helped to properly set the manual backup techniques, which I usually pick the 75%ile values because there is enough dose headroom to stay under the DRL
and guarantee decent image quality for patients at the extreme of the size limit. The small and large protocols are then adjusted by noise index from these data. So far, unless I am missing something fundamental, out DIR results have been very decent and
I believe this is a representative sample of our average patients.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">One caveat I do see, though, is that our average patient is bigger than the ACR phantom by maybe 6-8 cm, and so the image quality result is overstated. Would it be more appropriate to scale the
test mAs down from our 27cm “average” patient dose to the 20cm ACR phantom and see if the CNR is still acceptable?<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Dan<o:p></o:p></span></p>
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<p class="MsoNormal"><b><i><span style="font-family:"Calibri",sans-serif;color:black">Daniel J. Januseski, M.S., DABR<o:p></o:p></span></i></b></p>
<p class="MsoNormal"><i><span style="font-family:"Calibri",sans-serif;color:black">Director, Department of Diagnostic Imaging Physics<o:p></o:p></span></i></p>
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<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 <intl_dxmedphys_wd_osu_list-bounces+djanuseski=virtua.org@lists.osu.edu>
<b>On Behalf Of </b>Donna Davis-Urgo via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Wednesday, September 16, 2026 12:06 PM<br>
<b>To:</b> 'Bob Kobistek' <bob@rjkmedphys.com>; 'Tyler Fisher' <sdtyler@gmail.com>; 'Matt Wait' <Matt.Wait@kp.org><br>
<b>Cc:</b> 'DxMedPhys List' <intl_dxmedphys_wd_osu_list@lists.osu.edu><br>
<b>Subject:</b> [EXTERNAL] Re: [Intl_DxMedPhys] ACR CT test question<o:p></o:p></span></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">Just as the average BMI could be larger at a given facility, so can the amount of pediatrics patients in the targeted weight/age range. Many times, facilities might
only do a handful of these pediatric exam types/ages a year (and need to substitute<o:p></o:p></span></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">Just as the average BMI could be larger at a given facility, so can the amount of pediatrics patients in the targeted weight/age range. Many times, facilities might
only do a handful of these pediatric exam types/ages a year (and need to substitute<o:p></o:p></span></p>
</div>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">Just as the average BMI could be larger at a given facility, so can the amount of pediatrics patients in the targeted weight/age range. Many times, facilities might only do
a handful of these pediatric exam types/ages a year (and need to substitute another type of clinical exam or an older patient when the accreditation comes up). </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">Donna Davis-Urgo, One Physics</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> </span><o:p></o:p></p>
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<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+murgo571=verizon.net@lists.osu.edu">intl_dxmedphys_wd_osu_list-bounces+murgo571=verizon.net@lists.osu.edu</a>>
<b>On Behalf Of </b>Bob Kobistek via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Wednesday, September 16, 2026 10:23 AM<br>
<b>To:</b> Tyler Fisher <<a href="mailto:sdtyler@gmail.com">sdtyler@gmail.com</a>>; Matt Wait <<a href="mailto:Matt.Wait@kp.org">Matt.Wait@kp.org</a>><br>
<b>Cc:</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> Re: [Intl_DxMedPhys] ACR CT test question</span><o:p></o:p></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">The downside I see with basing the phantom scans on the “average” patient drawn from the institutions patient population is that if the average for the local population
does not align with whatever the ACR considers average, then pass / fail</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt">The downside I see with basing the phantom scans on the “average” patient drawn from the institutions patient population is that if the average for the local population does not align with whatever the ACR
considers average, then pass / fail criteria would not be appropriate for that institution. I used to consult in rural West Virginia where the average patient would be heavy when compared to most other definitions of average. So if a higher CTDIvol is needed
to produce acceptable image quality in this high-BMI population, the facility may fail if the CTDIvol is above the failure limit. The flip side to that is that the standard ACR image quality phantom was designed with a specific body model in mind. A high BMI
population would lead to the use of increased mAs or mAs and kV combination when scanning the phantom, which would result in image quality scores that do not represent the image quality of the clinical scans.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#A50021">Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#A50021">Medical Physicist</span><o:p></o:p></p>
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</span><span style="font-size:14.0pt;color:#A50021">Medical Physics, Inc.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:14.0pt;color:#A50021">440-463-7879</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></p>
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<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+bob=rjkmedphys.com@lists.osu.edu">intl_dxmedphys_wd_osu_list-bounces+bob=rjkmedphys.com@lists.osu.edu</a>>
<b>On Behalf Of </b>Tyler Fisher via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Tuesday, September 15, 2026 1:36 PM<br>
<b>To:</b> Matt Wait <<a href="mailto:Matt.Wait@kp.org">Matt.Wait@kp.org</a>><br>
<b>Cc:</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> Re: [Intl_DxMedPhys] ACR CT test question</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">Hi Everyone, This has been a very good discussion. I'll add my two cents but also state up-front that I am the current chair of the ACR CT Physics Accreditation
Sub-Committee, so there may be a pro-ACR bias coming through. In general, the</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Hi Everyone,</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">This has been a very good discussion. I'll add my two cents but also state up-front that I am the current chair of the ACR CT Physics Accreditation Sub-Committee, so there may be a pro-ACR bias coming through. </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">In general, the ACR technical standards, QC Manuals, and Accreditation program requirements are overlapping but independent. The QC manuals are assembled and maintained by ACR staff and committees of volunteer
members who represent the accreditation programs and other stakeholders. Slight variations in language or specifics like this are to be expected.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">The intent of the "average-sized" language in the accreditation program, as I interpret it, is site and scanner specific. When I test a CT system, I will look through the patients scanned recently for what
I think is their standard adult abdomen protocol. I check the scout first to make sure they're not tiny or bariatric, then I'll scroll through the primary axial images until I get to mid-liver and record the mA. I'll take an average of 6 or 8 patients.
I don't look at patient sex or age. If a site has additional data (ACR DIR or dose-tracking software) that will give me techniques for an average-sized patient, I'll use that, but more often than not, the sites that I visit do not. This method would be more
accurate than my average of 6 or 8 scans, but I think we have to remember that the majority of scanners in the country aren't being monitored like this. The ACR would love for everyone to participate in the ACR DIR, but this is not a requirement for accreditation.
Also, we're measuring and reporting a single CTDI value for a protocol whose standard deviation of CTDI values is huge. </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">For new scanners, Scott's suggested methods all seem reasonable. I tend to take my knowledge of similar (or exactly the same make/model) scanners, the site's standard protocols for other scanners if available,
default protocols, and my own personal expertise to come up with an average technique. I will note in my report that the protocols tested may not match the clinical protocols established during applications training and the next time I lay hands on that scanner,
I'm going to closely review what they're actually doing. Also, I'll make sure at acceptance testing that the reported CTDI values match what I measure, so that if the protocols are different than what I tested, at least they'll know that the doses are accurate. </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">The discussion about finding a "21 or 23 cm effective diameter patient" to set as the "average-patient" is wrong. The "DFOV close to 21 cm" is strictly based on the size of the image quality phantom - it
has nothing to do with an average patient. If the image quality phantom was 30 cm diameter, we'd tell you to scan with a DFOV close to 31 cm.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Last thing I'll say is this: The ACR believes that qualified diagnostic medical physicists have the expertise and integrity to perform quality medical physics testing on scanners. Can someone iteratively
increase dose to get CNR to pass? Of course. Can we cheat the average technique down to make sure that we're within the dose thresholds? Sure. The accreditation programs work on the assumption that we're all doing our best. The programs try to balance
being overly prescriptive on how to do every single test vs. allowing physicists free-reign to do whatever we want. Over 25 years of the CT accreditation program, I think we've gotten pretty close to the right balance, but as the chair, I'm open to suggestions
of how we can improve.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Thanks.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Tyler Fisher</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Therapy Physics, Inc.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">On Mon, Sep 14, 2026 at 1:53</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif"> </span><span style="font-size:12.0pt">PM Matt Wait via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>>
wrote:</span><o:p></o:p></p>
<blockquote style="border:none;border-left:solid #CCCCCC 1.0pt;padding:0in 0in 0in 6.0pt;margin-left:4.8pt;margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt">
<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">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</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black">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.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black">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.</span><o:p></o:p></p>
<div id="m_-5737958591266385675m_2428996515185521996Signature">
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black"> </span><o:p></o:p></p>
<p style="margin:0in;background:white"><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#0078B3">Matt Wait, MS, DABR, DABSNM, MRSE</span></b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><br>
Senior Diagnostic Physicist</span><o:p></o:p></p>
<p style="margin:0in;background:white"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black">Associate Radiation Safety Officer</span><o:p></o:p></p>
<p style="margin:0in;background:white"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black">Assistant Residency Director</span><o:p></o:p></p>
<p style="margin:0in;line-height:12.0pt;background:white"><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#0084B9">Kaiser Permanente</span></b><o:p></o:p></p>
<p style="margin:0in;line-height:12.0pt;background:white"><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#0084B9">Southern Permanente Medical Group</span></b><o:p></o:p></p>
<p style="margin:0in;line-height:12.0pt;background:white"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black">Medical Imaging Technology and Informatics<br>
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Sunset Blvd</a></span><o:p></o:p></p>
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Angeles, CA 90027</a></span><o:p></o:p></p>
<p style="margin:0in;line-height:12.0pt;background:white"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$" target="_blank">x5347
(office</a>)</span><o:p></o:p></p>
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<div class="MsoNormal" align="center" style="text-align:center"><span style="font-size:12.0pt">
<hr size="2" width="98%" align="center">
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:black">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:black"> Douglas Pfeiffer <<a href="mailto:xraydoug@me.com" target="_blank">xraydoug@me.com</a>><br>
<b>Sent:</b> Monday, September 14, 2026 1:47 PM<br>
<b>To:</b> Matt Wait <<a href="mailto:Matt.Wait@kp.org" target="_blank">Matt.Wait@kp.org</a>><br>
<b>Cc:</b> DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>>; Bob Kobistek <<a href="mailto:bob@rjkmedphys.com" target="_blank">bob@rjkmedphys.com</a>><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</span><span style="font-size:12.0pt">
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">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. </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<div id="m_-5737958591266385675m_2428996515185521996x_signature">
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Best regards,</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Doug</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Medical Physicist, Radiation Safety Officer</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Boulder Community Health</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"><a href="mailto:xraydoug@me.com" target="_blank">xraydoug@me.com</a></span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"><a href="tel:(303)%20415-7515" target="_blank">303.415.7515</a></span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">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.</span><o:p></o:p></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<blockquote style="margin-top:5.0pt;margin-bottom:5.0pt">
<p class="MsoNormal"><span style="font-size:12.0pt">On Sep 14, 2026, at 2:42</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif"> </span><span style="font-size:12.0pt">PM, Matt Wait <<a href="mailto:Matt.Wait@kp.org" target="_blank">Matt.Wait@kp.org</a>>
wrote:</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">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.</span><o:p></o:p></p>
<div id="m_-5737958591266385675m_2428996515185521996x_Signature">
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="background:white"><b><span style="font-family:"Arial",sans-serif;color:#0078B3">Matt Wait, MS, DABR, DABSNM, MRSE</span></b><span style="font-family:"Arial",sans-serif;color:black"><br>
Senior Diagnostic Physicist</span><o:p></o:p></p>
<p class="MsoNormal" style="background:white"><span style="font-family:"Arial",sans-serif;color:black">Associate Radiation Safety Officer</span><o:p></o:p></p>
<p class="MsoNormal" style="background:white"><span style="font-family:"Arial",sans-serif;color:black">Assistant Residency Director</span><o:p></o:p></p>
<p class="MsoNormal" style="line-height:12.0pt;background:white"><b><span style="font-family:"Arial",sans-serif;color:#0084B9">Kaiser Permanente</span></b><o:p></o:p></p>
<p class="MsoNormal" style="line-height:12.0pt;background:white"><b><span style="font-family:"Arial",sans-serif;color:#0084B9">Southern Permanente Medical Group</span></b><o:p></o:p></p>
<p class="MsoNormal" style="line-height:12.0pt;background:white"><span style="font-family:"Arial",sans-serif;color:black">Medical Imaging Technology and Informatics<br>
<a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$" target="_blank">4867
Sunset Blvd</a></span><o:p></o:p></p>
<p class="MsoNormal" style="line-height:12.0pt;background:white"><span style="font-family:"Arial",sans-serif;color:black"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$" target="_blank">Los
Angeles, CA 90027</a></span><o:p></o:p></p>
<p class="MsoNormal" style="line-height:12.0pt;background:white"><span style="font-family:"Arial",sans-serif;color:black"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$" target="_blank">x5347
(office</a>)</span><o:p></o:p></p>
<p class="MsoNormal" style="line-height:12.0pt;background:white"><span style="font-family:"Arial",sans-serif;color:black"><a href="tel:(818)%20232-2427" target="_blank">(818) 232-2427</a> (mobile phone)</span><o:p></o:p></p>
<p style="margin:0in"><span style="font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
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<hr size="2" width="749" style="width:561.55pt" align="center">
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<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"> Douglas Pfeiffer <<a href="mailto:xraydoug@me.com" target="_blank">xraydoug@me.com</a>><br>
<b>Sent:</b> Monday, September 14, 2026 1:35 PM<br>
<b>To:</b> Matt Wait <<a href="mailto:Matt.Wait@kp.org" target="_blank">Matt.Wait@kp.org</a>><br>
<b>Cc:</b> DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>>; Bob Kobistek <<a href="mailto:bob@rjkmedphys.com" target="_blank">bob@rjkmedphys.com</a>><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</span><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"> </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">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).
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"> </span><o:p></o:p></p>
<div id="m_-5737958591266385675m_2428996515185521996x_x_signature">
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Best regards,</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Doug</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Medical Physicist, Radiation Safety Officer</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Boulder Community Health</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">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.</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">On Sep 14, 2026, at 2:16 PM, Matt Wait <<a href="mailto:Matt.Wait@kp.org" target="_blank">Matt.Wait@kp.org</a>> wrote:</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Doug, how did you envision determining the automatic tube current selection for Standard Man?</span><o:p></o:p></p>
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<p class="MsoNormal" style="background:white"><b><span style="font-family:"Arial",sans-serif;color:#0078B3">Matt Wait, MS, DABR, DABSNM, MRSE</span></b><span style="font-family:"Arial",sans-serif;color:black"><br>
Senior Diagnostic Physicist</span><o:p></o:p></p>
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<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+matt.wait=kp.org@lists.osu.edu" target="_blank">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" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Sent:</b> Monday, September 14, 2026 1:12 PM<br>
<b>To:</b> Bob Kobistek <<a href="mailto:bob@rjkmedphys.com" target="_blank">bob@rjkmedphys.com</a>><br>
<b>Cc:</b> DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</span><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">
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<p class="MsoNormal"><strong><span style="font-size:13.5pt;font-family:"Helvetica",sans-serif;color:red">Caution: </span></strong><span style="font-size:13.5pt;font-family:"Helvetica",sans-serif;color:red">This email came from outside Kaiser Permanente. Do
not open attachments or click on links if you do not recognize the sender.</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">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.
</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Best regards,</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Doug</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Medical Physicist, Radiation Safety Officer</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">Boulder Community Health</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"><a href="mailto:xraydoug@me.com" target="_blank">xraydoug@me.com</a></span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"><a href="tel:(303)%20415-7515" target="_blank">303.415.7515</a></span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">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.</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif">On Sep 9, 2026, at 1:45 PM, Bob Kobistek via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>>
wrote:</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Helvetica",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Hi.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></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.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></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.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></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.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></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.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#A50021">Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#A50021">Medical Physicist</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:22.0pt;font-family:"Castellar",serif;color:#A50021">RJK</span><span style="font-size:22.0pt;font-family:"Colonna MT";color:#A50021"> </span><span style="font-size:14.0pt;color:#A50021">Medical Physics, Inc.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:14.0pt;color:#A50021"><a href="tel:(440)%20463-7879" target="_blank">440-463-7879</a></span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><o:p></o:p></p>
<div style="border:none;border-top:solid windowtext 1.0pt;padding:3.0pt 0in 0in 0in;border-color:currentcolor currentcolor">
<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" target="_blank"><span style="color:#467886">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</span></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" target="_blank"><span style="color:#467886">intl_dxmedphys_wd_osu_list@lists.osu.edu</span></a>><br>
<b>Subject:</b> [Intl_DxMedPhys] ACR CT test question</span><o:p></o:p></p>
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<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal"><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</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">All,</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">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><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">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><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">“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><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">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><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">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><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Sincerely,</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Scott</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> </span><o:p></o:p></p>
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<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:"Trebuchet MS",sans-serif;color:#00A19C">D. SCOTT WINTER</span></b><o:p></o:p></p>
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<p class="MsoNormal"><b><span style="font-family:"Trebuchet MS",sans-serif;color:#6F767E">CHIEF DIAGNOSTIC MEDICAL PHYSICIST</span></b><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Trebuchet MS",sans-serif;color:#6E757D"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$" target="_blank">4500</a> <a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$" target="_blank">13th</a> <a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$" target="_blank">St</a></span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Trebuchet MS",sans-serif;color:#6E757D"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$" target="_blank">Gulfport</a></span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Trebuchet MS",sans-serif;color:#6E757D"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$" target="_blank">,</a> </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Trebuchet MS",sans-serif;color:#6E757D"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$" target="_blank">MS</a></span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Trebuchet MS",sans-serif;color:#6E757D"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$" target="_blank">39501</a></span><o:p></o:p></p>
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<p class="MsoNormal"><a href="https://urldefense.com/v3/__https:/www.wearememorial.com/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFYF5vxZV$" target="_blank"><span style="font-size:1.0pt;text-decoration:none"><image001.gif></span></a><o:p></o:p></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><o:p></o:p></p>
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