Low Radiation Dose Implications in Obese Abdominal Computed Tomography Imaging
, Khalid M. Alshamrani 3,4, Abdelmoneim Sulieman 5, Walaa M. Alsharif 1, Sultan A. Alshoabi 1, Moawia B. Gameraddin 1, Khalid M. Aloufi 1, Shrooq T. Aldahery 6 and Shane J. Foley 2Round 1
Reviewer 1 Report
My main concerns of this study lie in the following aspects: first, virtually nothing new is found from this study as it is widely studied in terms of relationship between mAs, kVp and dose values in body organs including abdominal CT. Further, with modern CT scanners, automatic tube current modulation is the preferred method while adjusting kVp as manual adjusting mA is not recommended. To this point, I do not think this study was well designed. Second, authors only reported image noise in terms of SD while they did not report SNR and CNR. This is another drawback of the study design. Without showing objective assessment of image quality, reduction of radiation dose is questionable as we cannot be sure that images are diagnostic, even in the presence of lower radiation dose.
There are no figures showing the comparison of image quality acquired with different protocols.
Author Response
Comment 1: My main concerns of this study lie in the following aspects: first, virtually nothing new is found from this study as it is widely studied in terms of the relationship between mAs, kVp, and dose values in body organs including abdominal CT. Further, with modern CT scanners, automatic tube current modulation is the preferred method while adjusting kVp as manual adjusting mA is not recommended. To this point, I do not think this study was well designed.
Response: As you know sir, patient radiation risk for a specific organs depends on the accurate estimation of organs and effective doses. Most of the conversion factors used are based on old data for the standard man (70 kg, 170 cm), or old simulated CT machines. Therefore, assessment of organ dose of obese patients is crucial. TCM is the best method for dose reduction while maintaining image quality, however, as you know TCM can reduce dose to smaller patients and may also increase the dose to large patients.
Comment 2: Second, authors only reported image noise in terms of SD while they did not report SNR and CNR. This is another drawback of the study design. Without showing objective assessment of image quality, reduction of radiation dose is questionable as we cannot be sure that images are diagnostic, even in the presence of lower radiation dose. There are no figures showing the comparison of image quality acquired with different protocols.
Response: Further details regarding SNR were added in the text and highlighted in yellow to provide an objective assessment of the image quality
Comment: English language and style are fine/minor spell check required
Response: now the English language carefully revised and edited.
Author Response File: 
Author Response.doc
Reviewer 2 Report
The manuscript from Abdulaziz A. Q et al. focuses on a scientifically important field. In contrast to Bariatric Imaging, the CT scan became more prevalent for obese patients. Authors evaluated the low radiation dose implications in abdominal CT using relatively low tube voltage technique. This manuscript fits in the scope of Applied Sciences journal. The data presented in this current manuscript is very convincing and accepted as publication in Applied Sciences journal.
Author Response
-Reviewer 2
Comment The manuscript from Abdulaziz A. Q et al. focuses on a scientifically important field. In contrast to Bariatric Imaging, the CT scan became more prevalent for obese patients. Authors evaluated the low radiation dose implications in abdominal CT using relatively low tube voltage technique. This manuscript fits in the scope of Applied Sciences journal. The data presented in this current manuscript is very convincing and accepted as publication in Applied Sciences journal.
Response: Thank you very much for your careful revision and positive remarks. This study will help to protect patients from unnecessary radiation and projected cancer risk from CT procedures.
Author Response File: Author Response.doc
Round 2
Reviewer 1 Report
Thank you for your effort in revising the manuscript which is significantly improved compared to the previous version. Just one comment which can be fixed when checking the proof:
Page 9, last para before Discussion, Figure 5 &6-Figures 5 &6.
