[Intl_DxMedPhys] [EXTERNAL] Re: ACR CT test question
Krebs, Jordan
jordankr at med.umich.edu
Thu Sep 17 14:13:18 EDT 2026
Hi Shane,
I've been working a lot with MRI lately and I had the same initial gut reaction. I think the problem though is that the MRI ACR T1 and T2 scans are designed to check the function of the different systems in the MR scanner and not the image quality of a given protocol (ignoring the site T1 and T2 scans, which are only used to assess low contrast detectability if the ACR T1 and T2 scans fail). CT ACR checks on the other hand are entirely protocol dependent for image quality, and I think part of the motivation is to prevent doses from being driven so low that image quality suffers. I think a better solution than a set technique (which would mostly determine how good of a scanner you have as new photon counting CT would easily outperform energy integrating CT on every image quality metric) is the same solution someone already proposed: scan some standard phantom (such as the CTDI body phantom) and let the AEC determine a technique based on how the protocol is setup. That technique could then be scaled by some factor determined by the ACR or used directly to scan the ACR IQ phantom. This would remove a lot of the argument and guess work behind picking a technique while still making it entirely dependent on how the site protocol is configured.
As to whether this is actually a test worth performing I leave to the CT experts here. But it does seem like a more elegant solution than assessing IQ in a standardized phantom depending on who was scanned recently or what is the scanned population in a region. If the question at hand is: "Does the protocol provide a minimum level of image quality for a benchmark patient?" then let the scanner determine what the technique should be from some object that mimics that benchmark patient. If the question is instead: "Does this protocol provide sufficient IQ to address clinical questions in this scanner's population?" then I don't think that is a question the ACR phantom can answer, and is likely a question best left to radiologists. Not to say we don't have a role in optimizing IQ in our protocols, but who am I to say to a radiologist that our images are too noisy or have too little contrast.
Best Regards,
Jordan
________________________________
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> on behalf of Shane McCotter via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Sent: Thursday, September 17, 2026 1:08 PM
To: Li, Baojun <baojunli at bu.edu>; Douglas Pfeiffer <xraydoug at me.com>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: ACR CT test question
Excuse my ignorance, but has there ever been any discussion to duplicate the MRI ACR process where we have a set technique in addition to the site protocols? Where the ACR would define techniques (kV, mAs, pitch, etc. ) in addition to submitting
ZjQcmQRYFpfptBannerStart
This Message Is From an External Sender
This message came from outside your organization.
ZjQcmQRYFpfptBannerEnd
Excuse my ignorance, but has there ever been any discussion to duplicate the MRI ACR process where we have a set technique in addition to the site protocols? Where the ACR would define techniques (kV, mAs, pitch, etc. ) in addition to submitting
Excuse my ignorance, but has there ever been any discussion to duplicate the MRI ACR process where we have a set technique in addition to the site protocols? Where the ACR would define techniques (kV, mAs, pitch, etc.) in addition to submitting phantom images based on patient population?
Shane
________________________________
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+shane=rpcphysics.com at lists.osu.edu> on behalf of Douglas Pfeiffer via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Sent: Thursday, September 17, 2026 11:52 AM
To: Li, Baojun <baojunli at bu.edu>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: ACR CT test question
I’m sorry, Baojun, but I respectfully disagree with that. We do this very often with phantoms: given a clinically reasonable exposure, what do we see in the phantom. The only way to have any standardization at all is to define the conditions
I’m sorry, Baojun, but I respectfully disagree with that. We do this very often with phantoms: given a clinically reasonable exposure, what do we see in the phantom. The only way to have any standardization at all is to define the conditions of that exposure. Even if the “average” patient is bigger than 70 kg, it at least verifies that the protocol will give appropriate image quality. If image quality suffers for that defined patient size, then it likely suffers at other sizes. From an accreditation standpoint, there is no way to provide P/F criteria for all patient sizes. We have to pick one and extrapolate.
On the testing and support side, that is where the medical physicist can use their training and experience - to investigate what the clinical impact of that finding is. Does it hold across all patient sizes? The QC Manual is not intended to limit what a physicist does; we can, and should, do more depending on what we see.
Best regards,
Doug
Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)
Medical Physicist, Radiation Safety Officer
Boulder Community Health
xraydoug at me.com
303.415.7515
+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-
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.
On Sep 17, 2026, at 9:52 AM, Li, Baojun via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu> wrote:
I respectfully disagree. If the purpose of the phantom testing is to corroborate the clinical image submission, it doesn’t make sense to test a 70 kg phantom when the typical patient population is closer to 90 kg.
I understand that the ACR CNR pass/fail criteria were established based on a 70 kg patient. However, I believe there is an important distinction between using a standardized 70 kg reference for establishing the acceptance criterion and selecting the phantom size/protocol parameters that best represent the clinical patient population.
The phantom images should, in my view, be reasonably representative of the clinical images being submitted for evaluation.
Thanks,
Baojun
From: Bob Kobistek <bob at rjkmedphys.com<mailto:bob at rjkmedphys.com>>
Sent: Thursday, September 17, 2026 11:35 AM
To: Li, Baojun <baojunli at bu.edu<mailto:baojunli at bu.edu>>; intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: RE: [Intl_DxMedPhys] [EXTERNAL] Re: ACR CT test question
You don't often get email from bob at rjkmedphys.com<mailto:bob at rjkmedphys.com>. Learn why this is important<https://urldefense.com/v3/__https://aka.ms/LearnAboutSenderIdentification__;!!KGKeukY!0mS4-b3MzWpcDjcCQJO6WI3SMnTOpmrLjxb4NIiFFwJYGgo6ZzCNmZrgcjCpFuZHgqythzF9LrEkmca1qnFzk_k4C_OuYJiewW216WY$>
I go back to my statement that the local patient population should not be used to define “average.” This was supported by Doug Pfeiffer’s subsequent comments. The ACR committee based the CNR pass/fail criteria on a 70 kg patient.
Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)
Medical Physicist
RJK Medical Physics, Inc.
440-463-7879
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+bob=rjkmedphys.com at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+bob=rjkmedphys.com at lists.osu.edu>> On Behalf Of Li, Baojun via Intl_dxmedphys_wd_osu_list
Sent: Thursday, September 17, 2026 11:29 AM
To: intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: ACR CT test question
The issue to me is how to find the representative CTDIvol among your patient population. The issue is complicated by the fact that almost all scanners use ATCM for clinical abd/pelv exams. If you have ACR CT Dose Index Registry or an enterprise
The issue to me is how to find the representative CTDIvol among your patient population. The issue is complicated by the fact that almost all scanners use ATCM for clinical abd/pelv exams.
If you have ACR CT Dose Index Registry or an enterprise dose tracking software (Radmetrics, DoseWatch, Imalogix, Sectra, …), it gives you the average and median CTDIvol among your patient population. You can then work it out the mAs necessary to achieve this CTDIvol. To me, this is easier than trying to figure out the average-sized patient by hand.
Thanks,
Baojun
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu>> On Behalf Of Triston Dougall via Intl_dxmedphys_wd_osu_list
Sent: Thursday, September 17, 2026 10:53 AM
To: Szczykutowicz, Timothy P <TSzczykutowicz at uwhealth.org<mailto:TSzczykutowicz at uwhealth.org>>
Cc: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: ACR CT test question
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
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.
Triston Dougall
On Thu, Sep 17, 2026 at 10:30 AM Szczykutowicz, Timothy P via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
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
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 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.
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...?
"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."
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.
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.
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 $35 this year, and next year's price should be similarly nominal. https://urldefense.com/v3/__https://ctecc.radiology.wisc.edu/ct-pow/__;!!KGKeukY!wKWhpGPssg9RZXf9DnyoWZ7hbyLVSe2kpqpWicZ_tWhbN3Lmg9Ze1dA7_gUzti5JObEPCGmk6lxE0ik4Qo61vpEjstT3uEgLB-LhX83LimEh$ <https://urldefense.com/v3/__https:/ctecc.radiology.wisc.edu/ct-pow/__;!!KGKeukY!1LY_DGnGwMew5D6cor5aBz1CgPuBoq6J7Q60vMbL0zquzbLQHB0RNm-v_7vn3LRldqZLOUi3t_eHa0wp1mC2vG9u8B_lQBT5EHHy6xUPDr3M0hHxNw$> You also get CME/CE/CAMPEP credits is you are MD/tech/physicist.
To the OP and others new to the testing, for GE and canon GUIs, my team made this guide on filing out parts of the ACR paperwork, see below linkhttps://uwgect.wiscweb.wisc.edu/general-resources/<https://urldefense.com/v3/__https:/uwgect.wiscweb.wisc.edu/general-resources/__;!!KGKeukY!1LY_DGnGwMew5D6cor5aBz1CgPuBoq6J7Q60vMbL0zquzbLQHB0RNm-v_7vn3LRldqZLOUi3t_eHa0wp1mC2vG9u8B_lQBT5EHHy6xUPDr1Lr8o14Q$>
Tyler, we should do a medical physics point counterpoint on this ;)
Timothy P. Szczykutowicz, Ph.D., DABR
Professor
Departments of Radiology, Medical Physics and BME
University of Wisconsin Madison
Cell# 1-716-560-7751<tel:(716)%20560-7751>
Office# 1-608-263-5729
he/him/his
________________________________
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+tszczykutowicz=uwhealth.org at lists.osu.edu<mailto:uwhealth.org at lists.osu.edu>> on behalf of Tyler Fisher via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Sent: Wednesday, September 16, 2026 4:04 PM
To: Douglas Pfeiffer <xraydoug at me.com<mailto:xraydoug at me.com>>
Cc: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: ACR CT test question
WARNING: This email appears to have originated outside of the UW Health email system.
DO NOT CLICK on links or attachments unless you recognize the sender and know the content is safe.
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
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 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
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.
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.
Tyler Fisher
Therapy Physics, Inc.
On Wed, Sep 16, 2026 at 9:43 AM Douglas Pfeiffer <xraydoug at me.com<mailto:xraydoug at me.com>> wrote:
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.
Best regards,
Doug
Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)
Medical Physicist, Radiation Safety Officer
Boulder Community Health
xraydoug at me.com<mailto:xraydoug at me.com>
303.415.7515<tel:(303)%20415-7515>
+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-
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.
On Sep 16, 2026, at 10:35 AM, Januseski, Daniel via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
This message was sent securely using <https://urldefense.com/v3/__http:/www.zixcorp.com/get-started/__;!!KGKeukY!3eV4_Vje7O0HZNPqkqWjIZEZwMWKVJwuTcUqKKARAM-q00Xn7ume1fSiahNDdFV1r2ze3zZX930Irql6Qj1QrDEeo7tUxbl02L7_VIiMMs8$> Zix<https://urldefense.com/v3/__http:/www.zixcorp.com/get-started/__;!!KGKeukY!3eV4_Vje7O0HZNPqkqWjIZEZwMWKVJwuTcUqKKARAM-q00Xn7ume1fSiahNDdFV1r2ze3zZX930Irql6Qj1QrDEeo7tUxbl02L7_VIiMMs8$>®<https://urldefense.com/v3/__http:/www.zixcorp.com/get-started/__;!!KGKeukY!3eV4_Vje7O0HZNPqkqWjIZEZwMWKVJwuTcUqKKARAM-q00Xn7ume1fSiahNDdFV1r2ze3zZX930Irql6Qj1QrDEeo7tUxbl02L7_VIiMMs8$>
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.
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.
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?
Dan
Daniel J. Januseski, M.S., DABR
Director, Department of Diagnostic Imaging Physics
Radiation Safety Officer
(856) 247-4436<tel:(856)%20247-4436> | f (856) 247-2819<tel:(856)%20247-2819>
djanuseski at virtua.org<mailto:djanuseski at virtua.org>
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+djanuseski=virtua.org at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+djanuseski=virtua.org at lists.osu.edu>> On Behalf Of Donna Davis-Urgo via Intl_dxmedphys_wd_osu_list
Sent: Wednesday, September 16, 2026 12:06 PM
To: 'Bob Kobistek' <bob at rjkmedphys.com<mailto:bob at rjkmedphys.com>>; 'Tyler Fisher' <sdtyler at gmail.com<mailto:sdtyler at gmail.com>>; 'Matt Wait' <Matt.Wait at kp.org<mailto:Matt.Wait at kp.org>>
Cc: 'DxMedPhys List' <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: [EXTERNAL] Re: [Intl_DxMedPhys] ACR CT test question
**WARNING** This email did NOT originate from inside Virtua.
Please STOP and ANALYZE before opening attachments, clicking on links, or providing any information.
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
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
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).
Donna Davis-Urgo, One Physics
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+murgo571=verizon.net at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+murgo571=verizon.net at lists.osu.edu>> On Behalf Of Bob Kobistek via Intl_dxmedphys_wd_osu_list
Sent: Wednesday, September 16, 2026 10:23 AM
To: Tyler Fisher <sdtyler at gmail.com<mailto:sdtyler at gmail.com>>; Matt Wait <Matt.Wait at kp.org<mailto:Matt.Wait at kp.org>>
Cc: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: Re: [Intl_DxMedPhys] ACR CT test question
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
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.
Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)
Medical Physicist
RJK Medical Physics, Inc.
440-463-7879<tel:(440)%20463-7879>
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+bob=rjkmedphys.com at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+bob=rjkmedphys.com at lists.osu.edu>> On Behalf Of Tyler Fisher via Intl_dxmedphys_wd_osu_list
Sent: Tuesday, September 15, 2026 1:36 PM
To: Matt Wait <Matt.Wait at kp.org<mailto:Matt.Wait at kp.org>>
Cc: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: Re: [Intl_DxMedPhys] ACR CT test question
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
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 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.
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.
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.
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.
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.
Thanks.
Tyler Fisher
Therapy Physics, Inc.
On Mon, Sep 14, 2026 at 1:53 PM Matt Wait via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
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
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 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.
Matt Wait, MS, DABR, DABSNM, MRSE
Senior Diagnostic Physicist
Associate Radiation Safety Officer
Assistant Residency Director
Kaiser Permanente
Southern Permanente Medical Group
Medical Imaging Technology and Informatics
4867 Sunset Blvd<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$>
Los Angeles, CA 90027<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$>
x5347 (office<https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$>)
(818) 232-2427<tel:(818)%20232-2427> (mobile phone)
________________________________
From: Douglas Pfeiffer <xraydoug at me.com<mailto:xraydoug at me.com>>
Sent: Monday, September 14, 2026 1:47 PM
To: Matt Wait <Matt.Wait at kp.org<mailto:Matt.Wait at kp.org>>
Cc: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>; Bob Kobistek <bob at rjkmedphys.com<mailto:bob at rjkmedphys.com>>
Subject: Re: [Intl_DxMedPhys] ACR CT test question
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.
Best regards,
Doug
Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)
Medical Physicist, Radiation Safety Officer
Boulder Community Health
xraydoug at me.com<mailto:xraydoug at me.com>
303.415.7515<tel:(303)%20415-7515>
+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-
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.
On Sep 14, 2026, at 2:42 PM, Matt Wait <Matt.Wait at kp.org<mailto:Matt.Wait at kp.org>> wrote:
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.
Matt Wait, MS, DABR, DABSNM, MRSE
Senior Diagnostic Physicist
Associate Radiation Safety Officer
Assistant Residency Director
Kaiser Permanente
Southern Permanente Medical Group
Medical Imaging Technology and Informatics
4867 Sunset Blvd<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$>
Los Angeles, CA 90027<https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$>
x5347 (office<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$>)
(818) 232-2427<tel:(818)%20232-2427> (mobile phone)
________________________________
From: Douglas Pfeiffer <xraydoug at me.com<mailto:xraydoug at me.com>>
Sent: Monday, September 14, 2026 1:35 PM
To: Matt Wait <Matt.Wait at kp.org<mailto:Matt.Wait at kp.org>>
Cc: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>; Bob Kobistek <bob at rjkmedphys.com<mailto:bob at rjkmedphys.com>>
Subject: Re: [Intl_DxMedPhys] ACR CT test question
Going through the list of scanned patients on the scanner and looking for abdomens that look about the right size, and looking at the mA at mid-liver (belly button-ish).
Best regards,
Doug
Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)
Medical Physicist, Radiation Safety Officer
Boulder Community Health
xraydoug at me.com<mailto:xraydoug at me.com>
303.415.7515<tel:(303)%20415-7515>
+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-
The opinions expressed in this message are the product of the gray and white matter loitering in my cranium. I speak for myself and no one else, unless I say otherwise.
On Sep 14, 2026, at 2:16 PM, Matt Wait <Matt.Wait at kp.org<mailto:Matt.Wait at kp.org>> wrote:
Doug, how did you envision determining the automatic tube current selection for Standard Man?
Matt Wait, MS, DABR, DABSNM, MRSE
Senior Diagnostic Physicist
Associate Radiation Safety Officer
Assistant Residency Director
Kaiser Permanente
Southern Permanente Medical Group
Medical Imaging Technology and Informatics
4867 Sunset Blvd<https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$>
Los Angeles, CA 90027<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$>
x5347 (office<https://urldefense.com/v3/__https:/www.google.com/maps/search/4867*Sunset*Blvd**A0D*0A**A0D*0A*Los*Angeles,*CA*90027**A0D*0A**A0D*0A*x5347*(office?entry=gmail&source=g__;KysrJSUrJSUrKysrKyUlKyUlKys!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNp2uhMtA$>)
(818) 232-2427<tel:(818)%20232-2427> (mobile phone)
________________________________
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+matt.wait=kp.org at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+matt.wait=kp.org at lists.osu.edu>> on behalf of Douglas Pfeiffer via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Sent: Monday, September 14, 2026 1:12 PM
To: Bob Kobistek <bob at rjkmedphys.com<mailto:bob at rjkmedphys.com>>
Cc: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: Re: [Intl_DxMedPhys] ACR CT test question
Caution: This email came from outside Kaiser Permanente. Do not open attachments or click on links if you do not recognize the sender.
________________________________
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.
Best regards,
Doug
Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)
Medical Physicist, Radiation Safety Officer
Boulder Community Health
xraydoug at me.com<mailto:xraydoug at me.com>
303.415.7515<tel:(303)%20415-7515>
+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-
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.
On Sep 9, 2026, at 1:45 PM, Bob Kobistek via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
Hi.
I also beat my head against a wall searching for answers to these questions when the ACR CT accreditation program was started. I stopped overthinking it, and now I pretty much wing it.
For average size patient, I look through patient scans 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.
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.
There is very little guidance on how to chose mAs (and kVp when applicable) for automated technique selection. So we use out best judgment.
Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)
Medical Physicist
RJK Medical Physics, Inc.
440-463-7879<tel:(440)%20463-7879>
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu>> On Behalf Of David S. Winter via Intl_dxmedphys_wd_osu_list
Sent: Monday, September 7, 2026 4:02 PM
To: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: [Intl_DxMedPhys] ACR CT test question
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
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 only part 1 would be good to ask the ACR directly.)
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.
“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.
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?
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.
Sincerely,
Scott
D. SCOTT WINTER
CHIEF DIAGNOSTIC MEDICAL PHYSICIST
O:
228-865-3475<tel:228-865-3475>
4500<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$> 13th<https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$> St<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$>
,
Gulfport<https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$>
,<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$>
MS<https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$>
,<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$>
39501<https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$>
<image001.gif><https://urldefense.com/v3/__https:/www.wearememorial.com/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFYF5vxZV$>
WeAreMemorial.com<https://urldefense.com/v3/__https:/www.wearememorial.com/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFYF5vxZV$>
|
Facebook<https://urldefense.com/v3/__https:/www.facebook.com/MemorialHospitalMS/__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFdPd1EsI$>
|
YouTube<https://urldefense.com/v3/__https:/www.youtube.com/user/gulfportmemorial__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFUp5zZIl$>
|
LinkedIn<https://urldefense.com/v3/__https:/www.linkedin.com/company/memorial-hospital-at-gulfport__;!!KGKeukY!2MSmyveKKzGn4EYDtlECE0uHMzo9qICIABIb_AilEMGb_zQ1uA7SIMU5B_TVMuEa8DaUCdbH70xPaPjVYos6Dt0dayhOFbsk9WzQ$>
This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments,<https://urldefense.com/v3/__https:/www.google.com/maps/search/4500*13th*St**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*Gulfport**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*MS**A0D*0A**A0D*0A**A0D*0A*,**A0D*0A**A0D*0A**A0D*0A*39501?entry=gmail&source=g__;KysrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSsrJSUrJSUrJSUrKyUlKyUlKyUlKyslJSslJSslJSs!!KGKeukY!x0papCM_iTVWnSTQkMc_SHwci_FgU-ejRnjPVU_cgUbJqe-P2hx_f5xsdNZb_QTzWtxmZZ6JO-vfe_fkP6jHa56k6UJ_NeNUWk_9Hg$> please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email or contact the sender at the number listed.
NOTICE TO RECIPIENT: If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents. If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them. v.173.295 Thank you.
This email message is intended only for the use of the individual(s) or entity, to which it is addressed, and may contain information that is privileged, confidential and protected from disclosure under applicable law. If you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately by telephone or return email, delete the message from your computer system, and return any hard copies to us at the following address 303 Lippincott Drive, Marlton, NJ 08053<https://urldefense.com/v3/__https:/www.google.com/maps/search/303*Lippincott*Drive,*Marlton,*NJ*08053?entry=gmail&source=g__;KysrKys!!KGKeukY!xEx2tbR91l4zqtDFgjrWzXMm7pTJFzYklMJ3MZSnKZcN68ZFHZ1QF8cY9SPNiEfGkZ7fHkGA7qPNgzDtcLQE1SLSw5cQDcTDQr-YdA$>. Thank you.
This message was secured by Zix<https://urldefense.com/v3/__http:/www.zixcorp.com__;!!KGKeukY!3eV4_Vje7O0HZNPqkqWjIZEZwMWKVJwuTcUqKKARAM-q00Xn7ume1fSiahNDdFV1r2ze3zZX930Irql6Qj1QrDEeo7tUxbl02L7_DCVw_DQ$>®.
**********************************************************
The contents of this message and any attachments may be confidential and privileged. Please do not share contents without the permission of the author. If you believe this message has been received in error, please inform the sender, and then delete the message. Your receipt of this message is not intended to waive any applicable privilege.
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lists.osu.edu/pipermail/intl_dxmedphys_wd_osu_list/attachments/20260917/9fcfa1c9/attachment.html>
More information about the Intl_dxmedphys_wd_osu_list
mailing list