Form Rx14 - Computerized Tomography Page 3

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MARYLAND DEPARTMENT OF THE ENVIRONMENT
●
1800 Washington Boulevard
Baltimore Maryland 21230
●
●
(410) 537-3193
1-800-633-6101
CALCULATION OF MSAD using the mathematical expression: MSAD = (E x F x K x L)/T where:
E = average exposure in (C/kg) coulombs per kilogram or in milliroentgens (mR)
f = factor to convert exposure in air to absorbed dose in tissue or attenuating matter in grays per C/kg, or in RAD
per mR)
K = calibration factor to account for the radiation measuring device response and volume
L = effective length of the radiation measuring device in millimeters
T= thickness in millimeters of the tomographic section selected
Typical HEAD Technique Factors, (C) Contrast, (NC) Without Contrast, (B) Both with & without contrast: _____
_____ kVp
_____ mA
_____ Scan Time (sec.)
_____ Scan Thickness (mm)
No. Scans/Exam _____
MSAD measured (HEAD) = _____RAD/mSv
Comments:
Manufactured rated MSAD or CTDI available:
Yes
No = _____RAD/mSv
CTDI
MSAD (check one)
If Yes, state techniques used: _____ kVp
_____ mA
_____ Scan Time (sec.)
_____ Scan Width (mm)
Form Number
MDE/ARMA/COM.010
(MDE
Page 3 of 3
RX14) Revision Date 6/15/16
Recycled Paper
TTY Users 1-800-735-2258

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