In more elaborate approaches, the tube output is modifi ed according to the patient geometry in the transverse direction to maintain adequate dose when moving to different body regions, e.g. from thorax to abdomen (automatic exposure control). In the special case of ECG-gated spiral scanning for cardiac applications, dose can be reduced by 30–50% using ECG-controlled dose modulation (Jakobset al. 2002). During the spiral scan, the output of the X-ray tube is modulated according to the patient’s ECG. It is kept at its nominal value during a user-defined phase of the cardiac cycle, in general the mid- to end-diastolic phase. During the rest of the cardiac cycle, the tube output is reduced to 20% of its nominal value. The tube current is not switched off but kept at 20% of its nominal value to allow for image reconstruction throughout the entire cardiac cycle. Even though their signal-to-noise ratio is decreased, the low-dose images are sufficient for functional evaluation
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