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I just perform a scout/tomo on the 32 cm CTDI phantom and see what the scanner selects as a technique on the protocol you are testing for an adult abdomen. For Siemens and Philips, the reference effective mAs is usually spot on. For GE with</div>
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<div dir="auto">I just perform a scout/tomo on the 32 cm CTDI phantom and see what the scanner selects as a technique on the protocol you are testing for an adult abdomen. For Siemens and Philips, the reference effective mAs is usually spot on. For GE with the noise index, you have to have some baseline to what the 32 cm usually needs. </div><div dir="auto"><br></div><div dir="auto">Triston Dougall </div><div dir="auto"><br></div><div dir="auto"><br></div><div dir="auto"><br></div><div dir="auto"><br></div><div><br><div class="gmail_quote gmail_quote_container"><div dir="ltr" class="gmail_attr">On Thu, Sep 17, 2026 at 10:30 AM Szczykutowicz, Timothy P 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>> wrote:<br></div><blockquote class="gmail_quote" style="margin:0px 0px 0px 0.8ex;border-left:1px solid rgb(204,204,204);padding-left:1ex">
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Tyler, I respectfully disagree with is "In a time and resource-constrained system, using a representative number of patient exams to estimate an average technique is perfectly acceptable. " I think given the paper I shared in last</div>
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Tyler, I respectfully disagree with is "In a time and resource-constrained system, using a representative number of patient exams to estimate an average technique is perfectly acceptable. "</div>
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I think given the paper I shared in last email, doing this where we know the end result is possibly tens or hundreds of percent off makes the clinical correlation between phantom IQ and patient IQ weak at best.</div>
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I didn't know this. This justifies my frustration then with the point of all this ACR physics testing. What are we doing here folks...?</div>
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"One more thing I'll say about the ACR accreditation process, and this isn't a secret but isn't shouted from the rooftops: the clinical images that are submitted are not cross-checked against the phantom techniques. The ACR gives physicists the benefit of
the doubt that the techniques we list in the phantom data form are representative of the clinical protocols." </div>
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My issue with this ACR testing is it is time consuming for physics to discuss with local techs and rads the details needed to fill out the forms and conduct the phantom and dose scanning. And these scans have limited correlation with the real clinical image
quality or doses. The hours my teams and I spend having these physics to tech and rad discussions during acr accreditation would be much better spent having protocol optimization discussions. I would love to see a day where the clinical case submissions remained,
and the physics portion abandoned these phantom scanning and dose submission requirements, and replaced with a more robust documentation of physics-rad-tech review of CT protocols. This is where the magic happens and meaningful alterations to CT protocols
occur. I've had multiple techs crying on the phone asking questions about the phantom and dose paperwork. Every time I do it as well, it is so counterintuitive. I know many of you on here make your living knowing these forms inside and out, but I would encourage
you to ask how much value to the site's patients you believe this process is helping. We are highly trained individuals, being reduced to filling out complicated paperwork by this process. Imagine if the ACR process mandated review of AEC function over patient
size, we so could check for protocols running too slow for smaller folks, or too fast (under-dosing) larger folks. Or had us review reformat creation practices that used thick slices to create reformats... tons of IQ stuff we could be mandated to check with
direct effects on image quality. </div>
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This ACR process has permeated what defines us as clinical imaging physicists. I would love to see the day when we our ABR MOC questions don't ask questions about specifics of ACR accreditation...are we experts in compliance or experts in clinical imaging physics.
I don't think ACR accreditation testing details should define clinical imaging physics. </div>
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We at UW have been running our CT-POW workshop the last two years, we had 60 people this year, and will open to 100 next year. This conference is all about ct protocol optimization, if you like my bent on this ACR stuff, please consider attending next year.
Sign up isn't started yet, but dates are August 9-11 2027. We charged $35 this year, and next year's price should be similarly nominal. <a href="https://urldefense.com/v3/__https://ctecc.radiology.wisc.edu/ct-pow/__;!!KGKeukY!1LY_DGnGwMew5D6cor5aBz1CgPuBoq6J7Q60vMbL0zquzbLQHB0RNm-v_7vn3LRldqZLOUi3t_eHa0wp1mC2vG9u8B_lQBT5EHHy6xUPDr3M0hHxNw$" target="_blank" style="font-family:Aptos,Aptos_EmbeddedFont,Aptos_MSFontService,Calibri,Helvetica,sans-serif">https://ctecc.radiology.wisc.edu/ct-pow/</a> You also get CME/CE/CAMPEP
credits is you are MD/tech/physicist. </div>
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To the OP and others new to the testing, for GE and canon GUIs, my team made this guide on filing out parts of the ACR paperwork, see below link
<a href="https://urldefense.com/v3/__https://uwgect.wiscweb.wisc.edu/general-resources/__;!!KGKeukY!1LY_DGnGwMew5D6cor5aBz1CgPuBoq6J7Q60vMbL0zquzbLQHB0RNm-v_7vn3LRldqZLOUi3t_eHa0wp1mC2vG9u8B_lQBT5EHHy6xUPDr1Lr8o14Q$" id="m_4670361824211774971OWA5bd42386-65cc-df25-8c42-617eddac0f54" target="_blank" style="font-family:Aptos,Aptos_EmbeddedFont,Aptos_MSFontService,Calibri,Helvetica,sans-serif">
https://uwgect.wiscweb.wisc.edu/general-resources/</a> </div>
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Tyler, we should do a medical physics point counterpoint on this ;) </div>
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<span style="font-family:Tahoma,sans-serif;font-size:10pt;color:black">Timothy P. Szczykutowicz, Ph.D., DABR<br>
Professor<br>
Departments of Radiology, Medical Physics and BME<br>
University of Wisconsin Madison<br>
Cell# </span><span style="font-family:Tahoma,sans-serif;font-size:10pt;color:blue"><a href="tel:(716)%20560-7751" id="m_4670361824211774971OWA28d850cc-472c-68a0-85dd-d3ef7e15b54f" style="margin-top:0px;margin-bottom:0px;font-family:Tahoma,sans-serif;color:blue" target="_blank"><u style="font-family:Tahoma,sans-serif">1-716-560-7751</u></a></span><span style="font-family:Tahoma,sans-serif;font-size:10pt;color:black"><br>
Office# 1-608-263-5729<br>
he/him/his</span></p>
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<b style="font-family:Calibri,Arial,Helvetica,sans-serif">From:</b> Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+tszczykutowicz=<a href="mailto:uwhealth.org@lists.osu.edu" target="_blank" style="font-family:Calibri,Arial,Helvetica,sans-serif">uwhealth.org@lists.osu.edu</a>> on behalf of Tyler Fisher via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank" style="font-family:Calibri,Arial,Helvetica,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b style="font-family:Calibri,Arial,Helvetica,sans-serif">Sent:</b> Wednesday, September 16, 2026 4:04 PM<br>
<b style="font-family:Calibri,Arial,Helvetica,sans-serif">To:</b> Douglas Pfeiffer <<a href="mailto:xraydoug@me.com" target="_blank" style="font-family:Calibri,Arial,Helvetica,sans-serif">xraydoug@me.com</a>><br>
<b style="font-family:Calibri,Arial,Helvetica,sans-serif">Cc:</b> DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank" style="font-family:Calibri,Arial,Helvetica,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b style="font-family:Calibri,Arial,Helvetica,sans-serif">Subject:</b> Re: [Intl_DxMedPhys] [EXTERNAL] Re: ACR CT test question </div>
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Hi Everyone, I will humbly state that I think some folks are overthinking this. As has been pointed out, the range of WED in the abdominal area is huge; output is exponentially related to patient size; and the ACR is asking for a single CTDI</div>
<div style="direction:ltr">Hi Everyone,</div>
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<div style="direction:ltr">I will humbly state that I think some folks are overthinking this. As has been pointed out, the range of WED in the abdominal area is huge; output is exponentially related to patient size; and the ACR is asking for a single CTDI
number that will never represent the full range of CTDI values that could be used in a protocol. In a time and resource-constrained system, using a representative number of patient exams to estimate an average technique is perfectly acceptable. If a facility
has additional resources and access to better data, great! The accreditation program doesn't require that level of detailed analysis to get to an average technique, but if you want to do that, by all means, do it. I don't want the ACR saying that there's
one right way to find an average technique. We should use whatever tools are available to us and our professional judgement</div>
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<div style="direction:ltr">The question of what to do for new systems is a good one. Particularly for new technology (new recon methods, photon counting, dual energy, etc.), this obviously presents challenges to figuring out average techniques when you're
doing an acceptance test. This is where I think this listserv should be and is a very helpful resource. Except for a very few sites that are research centers for the major vendors, there's almost always someone who reads this listserv who already has that
scanner and has implemented successful protocols. Reach out and figure out their protocols. Acceptance testing, by definition, should be more thorough than annual testing, so maybe testing various protocols to find the techniques that will achieve acceptable
CNR would be a good idea. If we're able to verify that the reported CTDI is accurate, then we could spend more time figuring out how changes in technique factors impact image quality on any particular scanner and then review clinical exams to make sure that
the dose ranges and image quality are acceptable.</div>
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<div style="direction:ltr">One more thing I'll say about the ACR accreditation process, and this isn't a secret but isn't shouted from the rooftops: the clinical images that are submitted are not cross-checked against the phantom techniques. The ACR gives
physicists the benefit of the doubt that the techniques we list in the phantom data form are representative of the clinical protocols. </div>
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<div style="direction:ltr">Tyler Fisher</div>
<div style="direction:ltr">Therapy Physics, Inc.</div>
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<div style="direction:ltr">On Wed, Sep 16, 2026 at 9:43 AM Douglas Pfeiffer <<a href="mailto:xraydoug@me.com" id="m_4670361824211774971OWA3389a017-23db-b27e-4983-23274b4affcb" target="_blank">xraydoug@me.com</a>> wrote:</div>
<blockquote style="margin:0px 0px 0px 0.8ex;padding-left:1ex;border-left:1px solid rgb(204,204,204)">
<div>The CNR values in the manual were developed using clinical techniques on the phantom, 70 kg-ish adult abdomen and 20 kg-ish ped abdomen. The phantom was predetermined, so the CNR values came from scanning that fixed phantom with cllnical techniques. So,
no, you don’t want to scale the mAs down.</div>
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Best regards,</div>
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Doug</div>
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Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</div>
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Medical Physicist, Radiation Safety Officer</div>
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Boulder Community Health</div>
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<a href="mailto:xraydoug@me.com" id="m_4670361824211774971OWAc1008e5c-db0d-0918-a629-d2a72a51903a" target="_blank">xraydoug@me.com</a></div>
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<a href="tel:(303)%20415-7515" id="m_4670361824211774971OWAcd9842de-d538-9e80-5d5b-738b8533f4cc" target="_blank">303.415.7515</a></div>
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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 16, 2026, at 10:35 AM, Januseski, Daniel via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWA88015474-74e0-ea85-2505-ad4e174a7bbd" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>> wrote:</div>
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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.</div>
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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.</div>
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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?</div>
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Dan</div>
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<b style="font-family:Calibri,sans-serif"><i style="font-family:Calibri,sans-serif">Daniel J. Januseski, M.S., DABR</i></b></div>
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<i style="font-family:Calibri,sans-serif">Director, Department of Diagnostic Imaging Physics</i></div>
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<b style="font-family:Calibri,sans-serif">From:</b> Intl_dxmedphys_wd_osu_list <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list-bounces+djanuseski=virtua.org@lists.osu.edu" id="m_4670361824211774971OWAd12ed261-e294-63de-8d78-6bfe1de70c4e" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list-bounces+djanuseski=virtua.org@lists.osu.edu</u></a></span>>
<b style="font-family:Calibri,sans-serif">On Behalf Of </b>Donna Davis-Urgo via Intl_dxmedphys_wd_osu_list<br>
<b style="font-family:Calibri,sans-serif">Sent:</b> Wednesday, September 16, 2026 12:06 PM<br>
<b style="font-family:Calibri,sans-serif">To:</b> 'Bob Kobistek' <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:bob@rjkmedphys.com" id="m_4670361824211774971OWA62a7c5f4-c643-8b4a-2f6a-7dba9443f581" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">bob@rjkmedphys.com</u></a></span>>; 'Tyler Fisher' <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:sdtyler@gmail.com" id="m_4670361824211774971OWAc294dcbd-4f38-f322-5758-8f38e11532a3" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">sdtyler@gmail.com</u></a></span>>;
'Matt Wait' <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:Matt.Wait@kp.org" id="m_4670361824211774971OWAf3f5d487-c1b4-4570-f01a-6cf80edd0c9c" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">Matt.Wait@kp.org</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Cc:</b> 'DxMedPhys List' <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWA774d58f8-4b0d-b89d-c877-5c479eb00f69" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Subject:</b> [EXTERNAL] Re: [Intl_DxMedPhys] ACR CT test question</div>
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STOP</b> and <b style="font-family:Tahoma,sans-serif">ANALYZE</b> before opening attachments, clicking on links, or providing any information.</span></div>
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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</div>
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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</div>
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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). </div>
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Donna Davis-Urgo, One Physics</div>
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<b style="font-family:Calibri,sans-serif">From:</b> Intl_dxmedphys_wd_osu_list <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list-bounces+murgo571=verizon.net@lists.osu.edu" id="m_4670361824211774971OWA9063e875-3c07-04ac-ab19-c54704a5a689" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list-bounces+murgo571=verizon.net@lists.osu.edu</u></a></span>>
<b style="font-family:Calibri,sans-serif">On Behalf Of </b>Bob Kobistek via Intl_dxmedphys_wd_osu_list<br>
<b style="font-family:Calibri,sans-serif">Sent:</b> Wednesday, September 16, 2026 10:23 AM<br>
<b style="font-family:Calibri,sans-serif">To:</b> Tyler Fisher <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:sdtyler@gmail.com" id="m_4670361824211774971OWA3b85899c-8d98-fbd3-0261-bd44756f1c24" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">sdtyler@gmail.com</u></a></span>>; Matt Wait <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:Matt.Wait@kp.org" id="m_4670361824211774971OWA8b79a171-1b40-9271-36bc-b5a889551e85" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">Matt.Wait@kp.org</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Cc:</b> DxMedPhys List <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWA8fbbad38-824a-65e2-f960-17441a8e285b" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</div>
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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</div>
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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.</div>
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Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)</div>
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Medical Physicist</div>
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<span style="font-family:Castellar,serif;font-size:22pt">RJK</span><span style="font-family:"Colonna MT";font-size:22pt"> </span><span style="font-size:14pt;font-family:Aptos,sans-serif">Medical Physics, Inc.</span></div>
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<b style="font-family:Calibri,sans-serif">From:</b> Intl_dxmedphys_wd_osu_list <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list-bounces+bob=rjkmedphys.com@lists.osu.edu" id="m_4670361824211774971OWAd3ebad9b-1972-6b2c-b57f-5856a3ceb02b" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list-bounces+bob=rjkmedphys.com@lists.osu.edu</u></a></span>>
<b style="font-family:Calibri,sans-serif">On Behalf Of </b>Tyler Fisher via Intl_dxmedphys_wd_osu_list<br>
<b style="font-family:Calibri,sans-serif">Sent:</b> Tuesday, September 15, 2026 1:36 PM<br>
<b style="font-family:Calibri,sans-serif">To:</b> Matt Wait <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:Matt.Wait@kp.org" id="m_4670361824211774971OWA1e2ba585-2c7f-ed70-d2ee-16bcd07acb22" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">Matt.Wait@kp.org</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Cc:</b> DxMedPhys List <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWAb87bfbee-f868-d807-bc0d-d0479b208ffb" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</div>
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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</div>
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Hi Everyone,</div>
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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. </div>
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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.</div>
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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. </div>
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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. </div>
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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.</div>
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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.</div>
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Thanks.</div>
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Tyler Fisher</div>
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Therapy Physics, Inc.</div>
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On Mon, Sep 14, 2026 at 1:53<span style="font-family:Arial,sans-serif"> </span>PM Matt Wait via Intl_dxmedphys_wd_osu_list <<span style="font-family:Aptos,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWAb2db34ca-afcf-73f7-626b-8a5446eb40fd" style="font-family:Aptos,sans-serif;color:blue" target="_blank"><u style="font-family:Aptos,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>>
wrote:</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. 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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<b style="font-family:Calibri,sans-serif">From:</b> Douglas Pfeiffer <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:xraydoug@me.com" id="m_4670361824211774971OWAf5ec791b-a597-5265-8e46-96d98655f8bc" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">xraydoug@me.com</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Sent:</b> Monday, September 14, 2026 1:47 PM<br>
<b style="font-family:Calibri,sans-serif">To:</b> Matt Wait <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:Matt.Wait@kp.org" id="m_4670361824211774971OWAe72ef02a-7cff-2b47-4f45-434bcb643bd3" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">Matt.Wait@kp.org</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Cc:</b> DxMedPhys List <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWA5079f9c1-afd1-a01b-f963-bb410a2c797f" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>>;
Bob Kobistek <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:bob@rjkmedphys.com" id="m_4670361824211774971OWAb173f2c2-6c93-8125-163c-e4f00ff907a6" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">bob@rjkmedphys.com</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</div>
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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. </div>
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Best regards,</div>
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Doug</div>
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Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</div>
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Medical Physicist, Radiation Safety Officer</div>
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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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On Sep 14, 2026, at 2:42<span style="font-family:Arial,sans-serif"> </span>PM, Matt Wait <<span style="font-family:Aptos,sans-serif;color:blue"><a href="mailto:Matt.Wait@kp.org" id="m_4670361824211774971OWAb87bdea2-42b4-fed9-2f20-63a1536ae983" style="font-family:Aptos,sans-serif;color:blue" target="_blank"><u style="font-family:Aptos,sans-serif">Matt.Wait@kp.org</u></a></span>>
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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<span style="font-family:Arial,sans-serif;color:rgb(0,120,179)"><b style="font-family:Arial,sans-serif">Matt Wait, MS, DABR, DABSNM, MRSE</b></span><br>
Senior Diagnostic Physicist</div>
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<b style="font-family:Arial,sans-serif">Kaiser Permanente</b></div><a href="https://urldefense.com/v3/__https://www.google.com/maps/search/4867*0D*0A*Sunset*Blvd**A0D*0A**A0D*0A*Los*0D*0A*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*0D*0A*(office?entry=gmail&source=g__;JSUrKyslJSslJSslJSsrKyslJSslJSslJSs!!KGKeukY!18d6TMrildy00aySXY8eAC9kfvM--ERMluis0RpK_2H6TQW8WrZJCRvqcaBnDyjluhLoIbkq3C1-Eoj_gSvdFTf7XAdwv4lA6WSgCG4$">
</a><div style="text-align:left;text-indent:0px;line-height:12pt;margin:0in;font-family:Arial,sans-serif;font-size:10pt;background-color:white;color:rgb(0,132,185)"><a href="https://urldefense.com/v3/__https://www.google.com/maps/search/4867*0D*0A*Sunset*Blvd**A0D*0A**A0D*0A*Los*0D*0A*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*0D*0A*(office?entry=gmail&source=g__;JSUrKyslJSslJSslJSsrKyslJSslJSslJSs!!KGKeukY!18d6TMrildy00aySXY8eAC9kfvM--ERMluis0RpK_2H6TQW8WrZJCRvqcaBnDyjluhLoIbkq3C1-Eoj_gSvdFTf7XAdwv4lA6WSgCG4$" style="font-family:Arial,sans-serif">
</a><b style="font-family:Arial,sans-serif">Southern Permanente Medical Group</b></div>
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Medical Imaging Technology and Informatics<br>
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Sunset Blvd</u></a></span></div>
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<a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$" id="m_4670361824211774971OWA616e0aea-b888-919b-41b0-7e607dac75fb" style="font-family:Arial,sans-serif;color:blue" target="_blank"><u style="font-family:Arial,sans-serif">Los
Angeles, CA 90027</u></a></div>
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<span style="font-family:Arial,sans-serif;color:blue"><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$" id="m_4670361824211774971OWA83f71d96-ccde-ec19-62d2-7e33b9c11fc4" style="font-family:Arial,sans-serif;color:blue" target="_blank"><u style="font-family:Arial,sans-serif">x5347
(office</u></a></span>)</div>
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<span style="font-family:Arial,sans-serif;color:blue"><a href="tel:(818)%20232-2427" id="m_4670361824211774971OWA287b9569-fe6e-3b76-10e9-2e0f60aceffa" style="font-family:Arial,sans-serif;color:blue" target="_blank"><u style="font-family:Arial,sans-serif">(818) 232-2427</u></a></span> (mobile phone)</div>
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<b style="font-family:Calibri,sans-serif">From:</b> Douglas Pfeiffer <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:xraydoug@me.com" id="m_4670361824211774971OWA85875daf-74e8-f888-f9d0-45c2a20ede05" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">xraydoug@me.com</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Sent:</b> Monday, September 14, 2026 1:35 PM<br>
<b style="font-family:Calibri,sans-serif">To:</b> Matt Wait <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:Matt.Wait@kp.org" id="m_4670361824211774971OWAe43b0dcc-0457-5406-3db1-f3f6d9b3756d" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">Matt.Wait@kp.org</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Cc:</b> DxMedPhys List <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWA32abdbdb-3c14-a34a-a041-f0c8b48eda3b" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>>;
Bob Kobistek <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:bob@rjkmedphys.com" id="m_4670361824211774971OWAcef39bc8-fbb0-d5a2-ee52-a7c1f2402d2f" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">bob@rjkmedphys.com</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</div>
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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).</div>
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Best regards,</div>
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Doug</div>
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Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</div>
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Medical Physicist, Radiation Safety Officer</div>
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Boulder Community Health</div>
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<a href="mailto:xraydoug@me.com" id="m_4670361824211774971OWA6ddc0d61-a07a-0401-617c-acc4dbf5d6f8" style="font-family:Helvetica,sans-serif;color:blue" target="_blank"><u style="font-family:Helvetica,sans-serif">xraydoug@me.com</u></a></div>
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<a href="tel:(303)%20415-7515" id="m_4670361824211774971OWA30cc2569-21c7-5285-eca6-44e3bb5ba53e" style="font-family:Helvetica,sans-serif;color:blue" target="_blank"><u style="font-family:Helvetica,sans-serif">303.415.7515</u></a></div>
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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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On Sep 14, 2026, at 2:16 PM, Matt Wait <<span style="font-family:Helvetica,sans-serif;color:blue"><a href="mailto:Matt.Wait@kp.org" id="m_4670361824211774971OWAe1f86226-1e44-ca04-4249-8d48f4f301cb" style="font-family:Helvetica,sans-serif;color:blue" target="_blank"><u style="font-family:Helvetica,sans-serif">Matt.Wait@kp.org</u></a></span>> wrote:</div>
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Doug, how did you envision determining the automatic tube current selection for Standard Man?</div>
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<span style="font-family:Arial,sans-serif;color:rgb(0,120,179)"><b style="font-family:Arial,sans-serif">Matt Wait, MS, DABR, DABSNM, MRSE</b></span><br>
Senior Diagnostic Physicist</div>
<div style="text-align:left;text-indent:0px;margin:0in;font-family:Arial,sans-serif;font-size:10pt;background-color:white">
Associate Radiation Safety Officer</div>
<div style="text-align:left;text-indent:0px;margin:0in;font-family:Arial,sans-serif;font-size:10pt;background-color:white">
Assistant Residency Director</div>
<div style="text-align:left;text-indent:0px;line-height:12pt;margin:0in;font-family:Arial,sans-serif;font-size:10pt;background-color:white;color:rgb(0,132,185)">
<b style="font-family:Arial,sans-serif">Kaiser Permanente</b></div><a href="https://urldefense.com/v3/__https://www.google.com/maps/search/4867*0D*0A*Sunset*Blvd**A0D*0A**A0D*0A*Los*0D*0A*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*0D*0A*(office?entry=gmail&source=g__;JSUrKyslJSslJSslJSsrKyslJSslJSslJSs!!KGKeukY!18d6TMrildy00aySXY8eAC9kfvM--ERMluis0RpK_2H6TQW8WrZJCRvqcaBnDyjluhLoIbkq3C1-Eoj_gSvdFTf7XAdwv4lA6WSgCG4$">
</a><div style="text-align:left;text-indent:0px;line-height:12pt;margin:0in;font-family:Arial,sans-serif;font-size:10pt;background-color:white;color:rgb(0,132,185)"><a href="https://urldefense.com/v3/__https://www.google.com/maps/search/4867*0D*0A*Sunset*Blvd**A0D*0A**A0D*0A*Los*0D*0A*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*0D*0A*(office?entry=gmail&source=g__;JSUrKyslJSslJSslJSsrKyslJSslJSslJSs!!KGKeukY!18d6TMrildy00aySXY8eAC9kfvM--ERMluis0RpK_2H6TQW8WrZJCRvqcaBnDyjluhLoIbkq3C1-Eoj_gSvdFTf7XAdwv4lA6WSgCG4$" style="font-family:Arial,sans-serif">
</a><b style="font-family:Arial,sans-serif">Southern Permanente Medical Group</b></div>
<div style="text-align:left;text-indent:0px;line-height:12pt;margin:0in;font-family:Arial,sans-serif;font-size:10pt;background-color:white"><a href="https://urldefense.com/v3/__https://www.google.com/maps/search/4867*0D*0A*Sunset*Blvd**A0D*0A**A0D*0A*Los*0D*0A*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*0D*0A*(office?entry=gmail&source=g__;JSUrKyslJSslJSslJSsrKyslJSslJSslJSs!!KGKeukY!18d6TMrildy00aySXY8eAC9kfvM--ERMluis0RpK_2H6TQW8WrZJCRvqcaBnDyjluhLoIbkq3C1-Eoj_gSvdFTf7XAdwv4lA6WSgCG4$" style="font-family:Arial,sans-serif">
</a>Medical Imaging Technology and Informatics<br><a href="https://urldefense.com/v3/__https://www.google.com/maps/search/4867*0D*0A*Sunset*Blvd**A0D*0A**A0D*0A*Los*0D*0A*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*0D*0A*(office?entry=gmail&source=g__;JSUrKyslJSslJSslJSsrKyslJSslJSslJSs!!KGKeukY!18d6TMrildy00aySXY8eAC9kfvM--ERMluis0RpK_2H6TQW8WrZJCRvqcaBnDyjluhLoIbkq3C1-Eoj_gSvdFTf7XAdwv4lA6WSgCG4$" style="font-family:Arial,sans-serif">
</a><span style="font-family:Arial,sans-serif;color:blue"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$" id="m_4670361824211774971OWA261376f7-8e59-021e-433e-b1a8b95d0b5a" style="font-family:Arial,sans-serif;color:blue" target="_blank"><u style="font-family:Arial,sans-serif">4867
Sunset Blvd</u></a></span></div>
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<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$" id="m_4670361824211774971OWAfc7b482e-778c-0e4b-3baf-137a762af55f" style="font-family:Arial,sans-serif;color:blue" target="_blank"><u style="font-family:Arial,sans-serif">Los
Angeles, CA 90027</u></a></div>
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<span style="font-family:Arial,sans-serif;color:blue"><a href="https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$" id="m_4670361824211774971OWAf07d69ab-8c0a-9f24-46c2-a538474960c4" style="font-family:Arial,sans-serif;color:blue" target="_blank"><u style="font-family:Arial,sans-serif">x5347
(office</u></a></span>)</div>
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<span style="font-family:Arial,sans-serif;color:blue"><a href="tel:(818)%20232-2427" id="m_4670361824211774971OWA82e6959f-4d78-5dce-2afa-7ad8ced84fbb" style="font-family:Arial,sans-serif;color:blue" target="_blank"><u style="font-family:Arial,sans-serif">(818) 232-2427</u></a></span> (mobile phone)</div>
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<b style="font-family:Calibri,sans-serif">From:</b> Intl_dxmedphys_wd_osu_list <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list-bounces+matt.wait=kp.org@lists.osu.edu" id="m_4670361824211774971OWA481b8e20-114e-f5a2-934a-3a46074eadb9" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list-bounces+matt.wait=kp.org@lists.osu.edu</u></a></span>>
on behalf of Douglas Pfeiffer via Intl_dxmedphys_wd_osu_list <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWA59f90f59-f80c-5d16-7af7-daa708c1f448" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Sent:</b> Monday, September 14, 2026 1:12 PM<br>
<b style="font-family:Calibri,sans-serif">To:</b> Bob Kobistek <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:bob@rjkmedphys.com" id="m_4670361824211774971OWAbf632fad-89be-6210-a1d4-e78a4d01be9c" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">bob@rjkmedphys.com</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Cc:</b> DxMedPhys List <<span style="font-family:Calibri,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWAcecf4e94-3d07-bfc8-4be7-d5add05ed5a2" style="font-family:Calibri,sans-serif;color:blue" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Subject:</b> Re: [Intl_DxMedPhys] ACR CT test question</div>
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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.</div>
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Best regards,</div>
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Doug</div>
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Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</div>
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Medical Physicist, Radiation Safety Officer</div>
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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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On Sep 9, 2026, at 1:45 PM, Bob Kobistek via Intl_dxmedphys_wd_osu_list <<span style="font-family:Helvetica,sans-serif;color:blue"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWA31c1375f-bd8a-d73c-b2da-1f9e0f19aba7" style="font-family:Helvetica,sans-serif;color:blue" target="_blank"><u style="font-family:Helvetica,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>>
wrote:</div>
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Hi.</div>
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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.</div>
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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.</div>
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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.</div>
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There is very little guidance on how to chose mAs (and kVp when applicable) for automated technique selection. So we use out best judgment.</div>
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Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)</div>
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Medical Physicist</div>
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<span style="font-family:Castellar,serif;font-size:22pt">RJK</span><span style="font-family:"Colonna MT";font-size:22pt"> </span><span style="font-size:14pt;font-family:Aptos,sans-serif">Medical Physics, Inc.</span></div>
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<b style="font-family:Calibri,sans-serif">From:</b> Intl_dxmedphys_wd_osu_list <<span style="font-family:Calibri,sans-serif;color:rgb(70,120,134)"><a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu" id="m_4670361824211774971OWA5b81920a-2bc4-db88-1d77-18c325ff9fdc" style="font-family:Calibri,sans-serif;color:rgb(70,120,134)" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</u></a></span>>
<b style="font-family:Calibri,sans-serif">On Behalf Of </b>David S. Winter via Intl_dxmedphys_wd_osu_list<br>
<b style="font-family:Calibri,sans-serif">Sent:</b> Monday, September 7, 2026 4:02 PM<br>
<b style="font-family:Calibri,sans-serif">To:</b> DxMedPhys List <<span style="font-family:Calibri,sans-serif;color:rgb(70,120,134)"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" id="m_4670361824211774971OWA63c89f2b-fda1-5bc9-27d9-95d256668173" style="font-family:Calibri,sans-serif;color:rgb(70,120,134)" target="_blank"><u style="font-family:Calibri,sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span>><br>
<b style="font-family:Calibri,sans-serif">Subject:</b> [Intl_DxMedPhys] ACR CT test question</div>
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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</div>
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All,</div>
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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.)</div>
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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. </div>
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“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. </div>
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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?</div>
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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. </div>
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Sincerely,</div>
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Scott</div>
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<b style="font-family:"Trebuchet MS",sans-serif">D. SCOTT WINTER</b></div>
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<b style="font-family:"Trebuchet MS",sans-serif">CHIEF DIAGNOSTIC MEDICAL PHYSICIST</b></div>
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303 Lippincott Drive, Marlton, NJ 08053</a>. Thank you.</span><br>
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