Technical strategies for radiation dose optimisation in paediatric pelvic radiography: a systematic review

Paediatric pelvic radiography is a frequently performed diagnostic procedure that exposes radiosensitive organs to ionising radiation. Optimisation of imaging parameters is essential to minimise radiation dose while preserving diagnostic image quality. This systematic review aimed to evaluate technical strategies for radiation dose optimisation in paediatric pelvic radiography and assess their impact on radiation dose and image quality. A systematic search of PubMed, Scopus, Embase, and Web of Science was conducted for studies published between 2004 and 2025. Experimental and clinical studies assessing radiation dose and image quality in paediatric pelvic radiography were included. Data on exposure parameters, dose metrics, and image quality assessment methods were extracted and synthesised narratively. Nine studies met the inclusion criteria, predominantly comprising phantom-based experimental designs. Increasing tube potential (kVp), extending source-to-image distance (SID), and applying additional aluminium or copper filtration consistently reduced radiation dose. Dose reductions of up to 60-70% were reported without clinically significant loss of image quality. Although objective image quality metrics (e.g., CNR, SNR) occasionally declined, subjective assessments confirmed that images remained diagnostically acceptable. Optimisation of technical parameters in paediatric pelvic radiography can achieve substantial radiation dose reduction while maintaining clinically acceptable image quality. However, the predominance of phantom-based evidence highlights the need for further patient-based clinical studies to support routine implementation.