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Radiation Dose Optimization in Adult Head CT: A Comprehensive Review from Phantom-Based Evaluation to Clinical Implementation

*Inganatul Islamiyah orcid scopus  -  Department of Physics, Brawijaya University, Malang, Jawa Timur, Indonesia, Indonesia
Yuyun Yueniwati orcid scopus  -  Department of Physics, Brawijaya University, Malang, Jawa Timur, Indonesia, Indonesia
Chomsin Sulistya Widodo orcid scopus  -  Department of Physics, Brawijaya University, Malang, Jawa Timur, Indonesia, Indonesia
Zaenal Arifin orcid scopus  -  Department of Physics, Diponegoro University, Semarang, Central Java, Indonesia, Indonesia
Received: 14 Feb 2026; Revised: 18 May 2026; Accepted: 22 May 2026; Available online: 30 May 2026; Published: 30 May 2026.

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Abstract

The widespread use of head computed tomography (CT) has led to a significant increase in patient radiation dose. Although modern CT systems include dose-saving technologies, further optimization is necessary to balance radiation dose and image quality. This study aims to review dose optimization strategies in head computed tomography (CT), focusing on the impact of acquisition parameter modifications across different phantom types and their translation into clinical applications. Variations in radiation dose and image quality are quantitatively assesed using multiple phantoms. PMMA phantoms validates dose measurements, image quality phantoms enable comprehensive assessment of image metrics, and anthropomorphic phantoms ensure clinical relevance. In clinical applications, image quality is qualitatively evaluated by radiologists. Results show that tube voltage and tube current are the main strategies of dose optimization, supported by automatic exposure control, pitch adjustment, and reconstruction algorithms. Iterative reconstruction techniques effectively mitigate noise amplification due to the adjustments. Radiation dose reduction ranges from approximately 15% to 80%, depending on the applied parameter modifications. Since dose reductions often lead to increased image noise and variations in image quality, this review identifies the optimal range of parameter adjustments that maintain diagnostically acceptable image quality. Combining quantitative assessments with phantoms and qualitative evaluations by radiologists enables a more comprehensive understanding of optimization results that can greatly benefit clinical practice by serving as a long-term guideline for safe and effective head CT dose optimization.

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Keywords: Head Computed Tomography (CT), Radiation Dose Optimization, Phantom, Clinical Implementation
Funding: Universitas Brawijaya, Universitas Diponegoro

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  1. C.-C. Huang, F. F. Effendi, R. O. Kosik, W.-J. Lee, L.-J. Wang, C.-J. Juan, and W. P. Chan, “Utilization of CT and MRI scanning in Taiwan, 2000–2017,” Insights Imaging 14, 23 (2023)
  2. G. Verfaillie, C. Franck, A. De Crop, L. Beels, Y. D’Asseler, and K. Bacher, “A systematic review and meta-analysis on the radiation dose of computed tomography in hybrid nuclear medicine imaging,” EJNMMI Phys. 10, 32 (2023)
  3. Y. Bouchareb, M. Al Kharusi, A. Al Maqbali, A. Al Maimani, H. Al Maskari, S. R. Sirasanagandla, A. Al Jabri, et al., “Establishing diagnostic reference levels for paediatric CT imaging: a multi-centre study,” Healthcare 13, (2025)
  4. United Nations Scientific Committee on the Effects of Ionizing Radiation (UNSCEAR), Sources, Effects and Risks of Ionizing Radiation, UNSCEAR Report (2022)
  5. T. Kubo, Y. Ohno, H. U. Kauczor, and H. Hatabu, “Radiation dose reduction in chest CT—review of available options,” Eur. J. Radiol. 83, 1953–1961 (2014)
  6. D. Bos, N. Guberina, S. Zensen, M. Opitz, M. Forsting, and A. Wetter, “Radiation dose management in CT,” Dtsch. Arztebl. Int. 120, 135–141 (2023)
  7. Y.-H. Shao, K. Tsai, S. Kim, Y.-J. Wu, and K. Demissie, “Exposure to tomographic scans and cancer risks,” JNCI Cancer Spectr. 4(1), (2020)
  8. H. Omer, S. Alameen, W. E. Mahmoud, A. Sulieman, and F. Abolaban, “Eye lens and thyroid radiation exposure in brain CT,” Saudi J. Biol. Sci. 27, 342–346 (2020)
  9. S. Modlinska, M. Rojek, M. Bielowka, and J. Kufel, “Establishing local diagnostic reference levels for head CT,” Biomedicines 12, 2446 (2024)
  10. International Commission on Radiological Protection (ICRP), “Diagnostic reference levels in medical imaging,” ICRP Publication 135, Ann. ICRP 46(1) (2017)
  11. Y. Inoue, “Radiation dose management in computed tomography,” Tomography 9, 955–966 (2023)
  12. M. Dieckmeyer, N. Sollmann, K. Kupfer, M. T. Löffler, K. J. Paprottka, J. S. Kirschke, and T. Baum, “CT of the head: techniques to reduce radiation dose,” Clin. Neuroradiol. 33, 591–610 (2023)
  13. C. Anam, R. Amilia, A. Naufal, H. Sutanto, W. S. Budi, and G. Dougherty, “Automatic CNR measurement using ACR phantom,” J. Imaging 11, 175 (2025)
  14. C. Picone, A. Porto, R. Fusco, C. Granata, M. C. Brunese, V. Granata, et al., “Optimization and image quality in CT studies based on DRLs,” Discover Appl. Sci. 7, 523 (2025)
  15. M. K. Aloufi, F. H. Alhazmi, F. A. Alrehily, N. S. Alraddadi, A. S. Alharbi, A. M. Alamin, et al., “Assessing effective doses and proposing DRLs for pediatric CT,” Appl. Sci. 14, (2024)
  16. S. T. Mekonin and T. T. Deressu, “Computed dose index on a 16-slice CT scanner,” Dose-Response 20, 1–6 (2022)
  17. J. Holm, L. Loizou, N. Albiin, N. Kartalis, B. Leidner, and A. Sundin, “Low tube voltage CT for improved lesion detection,” BMC Med. Imaging 12, 20 (2012)
  18. C. H. McCollough, A. N. Primak, N. Braun, J. Kofler, L. Yu, and J. Christner, “Strategies for reducing radiation dose in CT,” Radiol. Clin. North Am. 47(1), 27–40 (2009)
  19. Mannudeep K. Kalra, Michael M. Maher, Thomas L. Toth, Lawrence M. Hamberg, Michael A. Blake, Judy A. Shepard, Sanjay Saini, “Strategies for CT radiation dose optimization”, Radiology, 230(3):619–628, 2004
  20. L. C. Fernandes, P. C. Santana, C. E. Velasquez, and A. P. Mourão, “CT scan optimization using head phantom,” Proc. Int. Nucl. Atl. Conf., 22–27 (2017)
  21. M. L. Gomez and A. P. Mourão, “Dosimetry in CT using head phantom,” Braz. J. Radiat. Sci., 1–10 (2019)
  22. F. S. Santos and A. P. Mourão, “Dose evaluation of head CT scans using phantom,” Int. J. Radiol. Imaging Technol. 8, 099 (2022)
  23. F. S. Santos, F. A. Oliveira, and A. P. Mourão, “CT acquisition protocols using head phantoms,” Rev. Bras. Fis. Med. 17, 706 (2023)
  24. M. A. Elmahdy, A. M. El-Sayed, and H. M. Hassan, “Dose delivery accuracy in CT,” J. Radiat. Res. Appl. Sci. 8(3), 367–371 (2015)
  25. T. Prabsattroo, K. Wachirasirikul, P. Tansangworn, P. Punikhom, and W. Sudchai, “Dose optimization and image quality in adult brain CT,” J. Imaging 9, 264 (2023)
  26. K.-P. Chang, T.-K. Hsu, W.-T. Lin, and W.-L. Hsu, “Optimization of dose and image quality in CT,” Radiat. Phys. Chem. 140, 260–265 (2017)
  27. Korn, M. Fenchel, B. Bender, et al., “Iterative reconstruction in head CT,” AJNR Am. J. Neuroradiol. 33, 218 (2012)
  28. O. Rapalino, S. Kamalian, S. Payabvash, et al., “Cranial CT with adaptive statistical iterative reconstruction,” AJNR Am. J. Neuroradiol. 33, 609 (2012)
  29. J. Greffier, J. Frandon, A. Larbi, J.-P. Beregi, and F. Pereira, “CT iterative reconstruction algorithms,” Eur. Radiol. 30, 487–500 (2020)
  30. E. Lāce, R. Mohammadian, A. Āboltiņš, D. Sosārs, and I. Apine, “Trade-off between radiation parameters and image quality,” Acta Radiol. 64(9), (2023)
  31. S. Singh, M. K. Kalra, M. D. Gilman, et al., “Adoption of CT dose reduction techniques,”

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