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Balancing radiation dose and image quality in infants on photon-counting CT for pediatric cardiac imaging: comparing
Nolan H Dang1, Wei Zhou1, Gladys M Arguello Fletes2,3
1University of Colorado Anschutz Medical Campus, Aurora, United States.
Insights
A 70 kV protocol on photon-counting CT (PCCT) significantly lowers radiation dose in infants compared to 120 kV, maintaining similar diagnostic image quality for congenital heart disease evaluation.
Area of Science:
- Medical Imaging
- Pediatric Cardiology
- Radiology
Background:
- Photon-counting CT (PCCT) offers potential for enhanced diagnosis and reduced radiation in pediatric congenital heart disease.
- Current advanced PCCT techniques often require high kilovolt (kV) protocols.
Purpose of the Study:
- To compare image quality and radiation dose between low kV (70) and high kV (120) protocols in pediatric patients under 10 kg.
- To assess the feasibility of lower kV settings for pediatric cardiac CT.
Main Methods:
- Retrospective review of ultra-high pitch cardiac CT scans in patients under 10 kg using PCCT.
- Evaluation of 70 kV and 120 kV protocols, comparing contrast-to-noise ratios, subjective image quality (Likert scale), and radiation dose (CTDI).
Main Results:
- Fifty-eight scans were analyzed (28 in 70 kV, 30 in 120 kV).
- Similar contrast-to-noise ratios and subjective image quality scores were observed between the 70 kV and 120 kV groups.
- Radiation dose (CTDI) was significantly lower in the 70 kV group (0.13 mGy) compared to the 120 kV group (0.25 mGy).
Conclusions:
- A 70 kV protocol demonstrates potential for reducing radiation dose in infants undergoing CT for congenital heart disease.
- Image quality is comparable between 70 kV and 120 kV protocols, though advanced spectral reconstructions are limited at lower kV.
- Lower kV settings may be a viable option for dose reduction in pediatric PCCT.
Background:
Photon-counting CT (PCCT) has the potential to improve diagnosis and reduce radiation exposure in pediatric congenital heart disease. Early data in pediatric patients has shown advantages of advanced post-processing techniques that are currently only available with high kilovolt (kV) protocols.
Objective:
The purpose of our study was to compare image quality and radiation dose for low kV (70) and high kV (120) protocols in patients weighing under 10 kg.
Methods:
In this IRB-approved retrospective review of ultra-high pitch cardiac CT scans in patients under 10 kg, we evaluated two protocols on a PCCT scanner: low kV (70) and high kV (120). Patient demographics, contrast-to-noise ratio in aorta and pulmonary artery, and subjective image quality scores using a 5-point Likert scale were evaluated by two readers in addition to radiation dose comparison.
Results:
Fifty-eight scans were included, 28 in the 70 kV cohort and 30 in the 120 kV cohort. Median age was 0.17 years for 70 kV and 0.33 years for 120 kV and weight was 4.5 kg for 70 kV and 5.4 kg for 120 kV. Contrast-to-noise ratios (aorta 14.8 vs 17.8, P=0.6) and Likert scores for aorta (median 5 for both groups, P=0.2) were similar for both protocols. Radiation dose was significantly lower in the 70 kV group with CTDI of 0.13 mGy vs 0.25 mGy for 120 kV (P<0.001).
Conclusion:
A 70 kV protocol shows promise for reducing radiation dose in infants with similar image quality compared to the 120 kV protocol, although advanced spectral reconstructions would not be available.
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