Revisiting the need for radiation output measurements after X-ray tube replacement in computed tomography

Purpose: State regulations require that CT radiation output be measured using a dosimeter after major service. The most common major service is tube replacement. We hypothesized that historical QC data could be used instead to determine if output measurements are necessary, potentially reducing the need for output measurements that require an on-site visit by a qualified medical physicist. Methods: Records of 65 original equipment manufacturer (OEM) tube replacements were reviewed to determine with what frequency output was outside the manufacturer's specifications. The previous 7 days of historical quality control (QC) data prior to a tube change was used to establish a baseline mean noise level and 95% inferential confidence intervals (ICIs) about the mean. This was compared to an ICI constructed using 7 days of QC data post-tube change and the region of indifference. Different methods for acquiring samples of image noise were compared using a single factor analysis of variance (ANOVA). Results: None of the 65 tube replacements reviewed in this study resulted in an output change that exceeded the manufacturer's specifications. In all but one case, the results of the ICI analysis matched the measured output results. In the single case where results were discordant, the mean image noise was slightly higher after the tube change, which may have indicated the need for a larger sample size or service unrelated to the X-ray tube, for example, system calibration. The method used to sample image noise did not significantly affect the calculated mean noise. Conclusions: This review of historical OEM tube replacement data indicated the likelihood of output falling outside manufacturer specifications is low. Considering this, it is likely that using QC data from programs required by regulation and the American College of Radiology (ACR), medical physicists can reliably verify radiation output stability remotely instead of making measurements using a dosimeter.