involving both adults and children (18–
20). With angular modulation, the
effective tube current–time product is the
key difference. Scanners with the angular
modulation technique offer users the option
of scanning with angular modulation
or fixed tube current (Fig 1b). After
selecting other scanning parameters such
as peak voltage, table feed, and detector
configuration, the user enters a value for
the effective tube current–time product
for the scan. The effective tube current–
time product (mAseff) is defined as follows:
mAseff (TC GR)/PF, where TC is
the tube current (in milliamperes), GR is
the gantry rotation time (in seconds),
and PF is the CT pitch factor.
The scanner maintains a constant effective
tube current–time product irrespective
of pitch value so that radiation
dose does not vary as pitch is changed.
This helps to maintain a constant image
quality as the pitch factor (table feed)
changes. Consequently, an increase in
pitch leads to an increase in tube current,
and a decrease in pitch leads to a reduction
in tube current. After selection of the
effective tube current–time product, the
scanner performs real-time modulation
of tube current in the x-y plane. The selected
effective tube current–time product
represents the maximum effective
value that will be used for scanning. The
angular-modulation technique reduces
the effective tube current–time product
to a value less than that selected for projection
angles with a lower attenuation
profile. The final displayed effective tube
current–time product represents an average
of various effective values used in
different projections (Fig 5).
Real-time online selection of the effective
tube current–time product with angular
modulation enhances the radiation
dose efficiency of the CT scanner. The
user must remember that, like z-axis
modulation, accurate centering of patients
in the scanning field of view is
critical with angular modulation, since
shifts from the center can lead to erroneous
estimation of the projection angle
area and tube current modulation, resulting
in noisier images. The scanning protocol
used at our institution for routine
abdominal and pelvic CT with angular
modulation is summarized in Table 2.