 Tipnis Sameer |
 Maria Vittoria Spampinato |
Pediatric CT poses unique challenges in terms of achieving diagnostic-quality images using the least amount of radiation. Our purpose for this project was to implement standardized pediatric CT protocols, which yield high-quality diagnostic images at the lowest patient dose across different scanners at our institution. Another objective of this quality improvement project was to teach our trainees the basics of how to improve safe and effective imaging in pediatric CT.
When we evaluated our “baseline” protocols, we found that neuroradiologists at our institution deemed the image quality of neck CT studies across a wide range of CT dose levels and techniques to be diagnostically acceptable. In light of these findings, we reduced the amount of radiation used to perform neck CTs and implemented novel, age-specific, low-dose protocols across all scanners at our institution, while making sure that the diagnostic image quality was not compromised. The reductions in the median CT dose index volume (CTDIvol) and effective dose for the follow-up cohort were substantial, ranging from 40–65% and 21–55%, respectively. Our results show that neuroradiologists found the image quality of these lower-dose scans to be clinically acceptable for making a confident diagnosis. A practical lesson learned is that while the use of automatic dose modulation will decrease the amount of radiation used for a study to some extent, radiation dose in pediatric neck CT could be further decreased by choosing an appropriate reference mAs and target CTDIvol.
Advances in CT technology have made several approaches to dose reduction available. Since the beginning of this project, iterative reconstruction algorithms have been game changers in pediatric CT.