Bismuth shielding, organ-based tube current modulation, and global reduction of tube current for dose reduction to the eye at head CT

Radiology. 2012 Jan;262(1):191-8. doi: 10.1148/radiol.11110470.


Purpose: To compare the dose and image quality of three methods for reducing the radiation dose to the eye at head computed tomography (CT): bismuth shielding, organ-based tube current modulation (TCM), and global reduction of the tube current.

Materials and methods: An anthropomorphic head phantom was scanned under six conditions: (a) without any dose reduction techniques (reference scanning); (b) with one bismuth eye shield; (c) with organ-based TCM; (d) with reduced tube current to yield the same dose reduction as one bismuth shield; (e) with two layers of bismuth shields; and (f) with organ-based TCM and one bismuth shield. Dose to the eye, image noise, and CT numbers in the brain region were measured and compared. The effect of increasing distance between the bismuth shield and eye lens was also investigated.

Results: Relative to the reference scan, the dose to the eye was reduced by 26.4% with one bismuth shield, 30.4% with organ-based TCM, and 30.2% with a global reduction in tube current. A combination of organ-based TCM with one bismuth shield reduced the dose by 47.0%. Image noise in the brain region was slightly increased for all dose reduction methods. CT numbers were increased whenever the bismuth shield was used. Increasing the distance between the bismuth shield and the eye lens helped reduce CT number errors, but the increase in noise remained.

Conclusion: Organ-based TCM provided superior image quality to that with bismuth shielding while similarly reducing dose to the eye. Simply reducing tube current globally by about 30% provides the same dose reduction to the eye as bismuth shielding; however, CT number accuracy is maintained and dose is reduced to all parts of the head.

MeSH terms

  • Artifacts
  • Bismuth
  • Eye / radiation effects*
  • Humans
  • Phantoms, Imaging
  • Radiation Dosage
  • Radiation Injuries / prevention & control*
  • Radiation Protection / instrumentation
  • Radiation Protection / methods*
  • Thermoluminescent Dosimetry
  • Tomography, X-Ray Computed / instrumentation*


  • Bismuth