Innovative Protocol Optimization for Radiation Dose Reduction in Pediatric Head CT Scan

Given children's heightened radiosensitivity and long-life expectancy, pediatric computed tomography (CT) requires minimizing ionizing radiation while preserving diagnostic performance, using as low as reasonably achievable (ALARA)-driven protocol optimization.

To implement and validate a structured, physics-driven optimization method for non-contrast pediatric head CT that reduces radiation dose while preserving reader rated diagnostic acceptability.

(1) Feasibility check: retrospective re-reconstruction using half slice thickness to increase apparent image noise by ∼50%; (2) anthropomorphic pediatric phantom scans to derive 17% and 30% dose reduction protocol variants; (3) quantitative Catphan testing; and (4) phased clinical roll out with predefined quality checks. Two board-certified radiologists, blinded to protocol, scored image quality of 133 head CT scans, before and after intervention. Dose endpoints were CT dose index volume and dose length product.

Reader rated image quality(IQ) scores were high under both standard- and lower-dose protocols, most rated good-excellent, with no clinically meaningful difference between protocols across predefined criteria (p > 0.10). Clinically implemented optimized protocol achieved ∼17% dose reduction relative to baseline, with an average DLP of ≈255 mGy·cm, while maintaining reader-rated diagnostic acceptability. These values are well below European pediatric Diagnostic Reference Levels for head CT. Conclusions Our stepwise, physics-anchored optimization method can reduce pediatric head CT dose while maintaining reader-rated diagnostically acceptable image quality. Further prospective validation is warranted before broader implementation and extension to additional protocols.