Clinical Radiology
Volume 62, Issue 6 , Pages 507-517 , June 2007

Dose reduction in paediatric MDCT: general principles

  • A. Paterson

      Affiliations

    • Radiology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
    • Corresponding Author InformationGuarantor and correspondent: A. Paterson, Radiology Department, Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast, Co Antrim BT12 6BE, UK. Tel.: +44 28 9063 2448; fax: +44 28 9031 3798.
  • ,
  • D.P. Frush

      Affiliations

    • Division of Paediatric Radiology, Department of Radiology, Duke University Health System, Durham, North Carolina, USA

Received 27 October 2005 ,Revised 11 December 2006 ,Accepted 18 December 2006.

References 

  1. Shrimpton PC, Edyrean S. CT scanner dosimetry. Br J Radiol. 1998;71:1–3
  2. Mettler FA, Wiest PW, Locken JA, et al. CT scanning: patterns of use and dose. J Radiol Prot. 2000;20:353–359
  3. Baker SR. Musings at the beginning of the hyper-CT era. Abdom Imaging. 2003;28:110–114
  4. Linton OW, Mettler FA. National conference on dose reduction in CT, with an emphasis on pediatric patients. AJR Am J Roentgenol. 2003;181:321–329
  5. Wiest PW, Locken JA, Heintz PH, et al. CT scanning: a major source of radiation exposure. Semin Ultrasound CT MR. 2002;23:402–410
  6. Coren ME, Ng V, Rubens M, et al. The value of ultrafast computed tomography in the investigation of pediatric chest disease. Pediatr Pulmonol. 1998;26:389–395
  7. Brenner DJ, Elliston CD, Hall EJ, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176:289–296
  8. Frush DP. Review of radiation issues for computed tomography. Semin Ultrasound CT MR. 2004;25:17–24
  9. Tack D, Gevenois PA. Radiation dose in computed tomography of the chest. JBR-BTR. 2004;87:281–288
  10. Huda W, Ravenel JG, Scalzetti EM. How do radiographic techniques affect image quality and patient doses in CT?. Semin Ultrasound CT MR. 2002;23:411–422
  11. Kalra MK, Mahe MM, Toth TL, et al. Strategies for CT radiation dose optimization. Radiology. 2004;230:619–628
  12. Huda W. Dose and image quality in CT. Pediatr Radiol. 2002;32:709–713
  13. International Commission on Radiological Protection . 1990 Recommendations of the International Commission on Radiological Protection. ICRP publication 60 Oxford: Pergamon; 1991;
  14. Ware DE, Huda W, Mergo PJ, et al. Radiation effective doses to patients undergoing abdominal CT examinations. Radiology. 1999;210:645–650
  15. Huda W, Scalzetti EM, Roskopf M. Effective doses to patients undergoing thoracic computed tomography examinations. Med Phys. 2000;27:838–844
  16. Huda W, Chamberlain CC, Rosenbaum AE, et al. Radiation doses to infants and adults undergoing head CT examinations. Med Phys. 2001;28:393–399
  17. Veit R, Zankl M. Influence of patient size on organ doses in diagnostic radiology. Radiat Prot Dosimetry. 1992;43:241–243
  18. Caon M, Bibbo G, Pattison J. Monte Carlo calculated effective dose to teenage girls from computed tomography examinations. Radiat Prot Dosimetry. 2000;90:445–448
  19. Chapple C-L, Willis S, Frame J. Effective dose in paediatric computed tomography. Phys Med Biol. 2002;47:107–115
  20. Khursheed A, Hillier MC, Shrimpton PC, et al. Influence of patient age on normalized effective doses calculated for CT examinations. Br J Radiol. 2002;75:819–830
  21. Shrimpton PC, Wall BF. Reference doses for paediatric computed tomography. Radiat Prot Dosimetry. 2000;90:249–252
  22. Brenner DJ, Elliston CD, Hall EJ, et al. Estimates of cancer risks from pediatric CT radiation are not merely theoretical: comment on “Point/counterpoint: in x-ray computed tomography, technique factors should be selected appropriate to patient size. Against the proposition” (Med Phys 2001;28:1543–1545). Med Phys. 2001;28:2387–2388
  23. Keat N. Real-time CT and CT fluoroscopy. Br J Radiol. 2001;74:1088–1099
  24. Imanishi Y, Fukui A, Niimi H, et al. Radiation-induced temporary hair loss as a radiation damage only occurring in patients who had the combination of MDCT and DSA. Eur Radiol. 2005;15:41–46
  25. Cohen BL. Cancer risks from low-level radiation. AJR Am J Roentgenol. 2002;179:1137–1143
  26. Pierce DA, Shimizu Y, Preston DL, et al. Studies of the mortality of A-bomb survivors. Report 12, part 1. Cancer: 1950–1990. Radiat Res. 1996;146:1–27
  27. Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res. 2000;154:178–186
  28. Preston DL, Shimizu Y, Pierce DA, et al. Studies of mortality of atomic bomb survivors. Report 13: solid cancer and non-cancer disease mortality: 1950–1997. Radiat Res. 2003;160:381–407
  29. The National Academies . Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Available at: http://www.nap.edu2005;(Accessed 2 September 2005)
  30. National Cancer Institute. Radiation risks and pediatric computed tomography (CT): a guide for health care providers. http://www.cancer.gov/cancerinfo/causes/radiation-risks-pediatric-CT (Accessed 27 October, 2005).
  31. Jacob K, Vivian G, Steel JR. X-ray dose training: are we exposed to enough?. Clin Radiol. 2004;59:928–934
  32. Lee CI, Haims AH, Monico EP, et al. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004;231:393–398
  33. Slovis TL. The ALARA concept in pediatric CT: myth or reality?. Radiology. 2002;223:5–6
  34. Paterson A, Frush DP, Donnelly LF. Helical CT of the body: are settings adjusted for pediatric patients?. AJR Am J Roentgenol. 2001;176:297–301
  35. Kalra MD, Maher MM, Toth TL, et al. Radiation from “extra” images acquired with abdominal and/or pelvic CT: effect of automatic tube current modulation. Radiology. 2004;232:409–414
  36. Hopper KD, King SH, Lobell ME, et al. The breast: in-plane x-ray protection during diagnostic thoracic CT – shielding with bismuth radioprotective garments. Radiology. 1997;205:853–858
  37. Colombo P, Pedroli G, Nicoloso M, et al. Valutazione dell'efficacia di una protezione in Bismuto durante esami TC. La Radiol Med. 2004;108:560–568
  38. Brnić Z, Vekić B, Hebrang A, et al. Efficacy of breast shielding during CT of the head. Eur Radiol. 2003;13:2436–2440
  39. Fricke BL, Donnelly LF, Frush DP, et al. In-plane bismuth breast shields for pediatric CT: effects on radiation dose and image quality using experimental and clinical data. AJR Am J Roentgenol. 2003;180:407–411
  40. Hohl C, Mahnken AH, Klotz E, et al. Radiation dose reduction to the male gonads during MDCT: the effectiveness of a lead shield. AJR Am J Roentgenol. 2005;184:128–130
  41. Price R, Wood C. Radiosensitive tissues can be shielded during CT scanning. BMJ. 2000;321:49–50
  42. Hollingsworth C, Frush DP, Cross M, et al. Helical CT of the body: survey of pediatric techniques. AJR Am J Roentgenol. 2003;180:401–406
  43. Pages J, Buls N, Osteaux M. CT doses in children: a multicentre study. Br J Radiol. 2003;76:803–811
  44. Frush DP, Soden B, Frush KS, et al. Improved pediatric multidetector body CT using a size-based color-coded format. AJR Am J Roentgenol. 2002;178:721–726
  45. Donnelly LF, Emery KH, Brody AS, et al. Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large children's hospital. AJR Am J Roentgenol. 2001;176:303–306
  46. Zhu X, Yu J, Huang Z. Low-dose chest CT: optimizing radiation protection for patients. AJR Am J Roentgenol. 2004;183:809–816
  47. Shah R, Gupta AK, Rehani MM, et al. Effect of reduction in tube current on reader confidence in paediatric computed tomography. Clin Radiol. 2005;60:224–231
  48. Mayo JR, Kim K, MacDonald SLS, et al. Reduced radiation dose helical chest CT: effect on reader evaluation of structures and lungs findings. Radiology. 2004;232:749–756
  49. Boiselle PM, Dippolito G, Copeland J, et al. Multiplanar and 3D imaging of the central airways: comparison of image quality and radiation dose of single-detector row CT and multi-detector row CT at differing tube currents in dogs. Radiology. 2003;228:107–111
  50. Lucaya J, Piqueras J, García-Peña P, et al. Low-dose high-resolution CT of the chest in children and young adults: dose, cooperation, artefact incidence, and image quality. AJR Am J Roentgenol. 2000;175:985–992
  51. Prasad SR, Wittram C, Shepard J, et al. Standard-dose and 50%-reduced-dose chest CT: comparing the effect on image quality. AJR Am J Roentgenol. 2002;179:461–465
  52. Wildberger JE, Mahnken AH, Schmitz-Rode T, et al. Individually adapted examination protocols for reduction of radiation exposure in chest CT. Invest Radiol. 2001;36:604–611
  53. Pacharn P, Poe SA, Donnelly LF. Low-tube-current multidetector CT for children with suspected extrinsic airway compression. AJR Am J Roentgenol. 2002;179:1523–1527
  54. Ravenel JG, Scalzetti EM, Huda W, et al. Radiation exposure and image quality in chest CT examinations. AJR Am J Roentgenol. 2001;177:279–284
  55. Robinson AE, Hill EP, Harpen MD. Radiation dose reduction in pediatric CT. Pediatr Radiol. 1986;16:53–54
  56. Ratcliffe J, Swanson CE, Hafiz N, et al. Assessment of image quality of a standard and two dose-reducing protocols in paediatric pelvic CT. Pediatr Radiol. 2003;33:177–182
  57. Kalra MK, Prasad S, Saini S, et al. Clinical comparison of standard-dose and 50% reduced-dose abdominal CT: effect on image quality. AJR Am J Roentgenol. 2002;179:1101–1106
  58. Wormanns D, Diederich S, Lenzen H, et al. Abdominal spiral CT in children: which radiation exposure is required?. Eur Radiol. 2001;11:2262–2266
  59. Cohnen M, Fischer H, Hamacher J, et al. CT of the head by reduced current and kilovoltage: relationship between image quality and dose reduction. AJNR Am J Neuroradiol. 2000;21:1654–1660
  60. Hein E, Rogalla P, Klingebiel R, et al. Low-dose CT of the paranasal sinuses with eye lens protection: effect on image quality and radiation dose. Eur Radiol. 2002;12:1693–1696
  61. Mulkens TH, Broers C, Fieuws S, et al. Comparison of effective doses for low-dose MDCT and radiographic examination of sinuses in children. AJR Am J Roentgenol. 2005;184:1611–1618
  62. Ertl-Wagner BB, Hoffmann R-T, Bruning R. Multi-detector row CT angiography of the brain at various kilovoltage settings. Radiology. 2004;231:528–535
  63. Rustemeyer P, Streubühr U, Suttmoeller J. Low-dose dental computed tomography: significant dose reduction without loss of image quality. Acta Radiol. 2004;8:847–853
  64. Frush DP, Donnelly LF, Rosen NS. Computed tomography and radiation risks: what pediatric health care providers should know. Pediatr. 2003;112:951–957
  65. Perisinakis K, Damilakis J, Voloudaki A, et al. Patient dose reduction in CT examinations by optimizing scanogram acquisition. Radiat Prot Dosimetry. 2001;93:173–178
  66. O'Daniel JC, Stevens DM, Cody DD. Reducing radiation exposure from survey CT scans. AJR Am J Roentgenol. 2005;509–515
  67. Frush DP, Slack CC, Hollingsworth CL, et al. Computer-simulated radiation dose reduction for abdominal multidetector CT of pediatric patients. AJR Am J Roentgenol. 2002;179:1107–1113
  68. Hoe CL, Samei E, Frush DP, et al. Simulation of liver lesions for pediatric CT. Radiology. 2006;238:699–705
  69. Huda W, Scalzetti EM, Levin G. Technique factors and image quality as functions of patient weight at abdominal CT. Radiology. 2000;217:430–435
  70. Dawson P. Patient dose in multislice CT: why is it increasing and does it matter?. Br J Radiol. 2004;77:S10–S13
  71. Fox SH, Toth T. Dose reduction on GE CT scanners. Pediatr Radiol. 2002;32:718–723
  72. Morgan HT. Dose reduction for CT pediatric imaging. Pediatr Radiol. 2002;32:724–728
  73. Suess C, Chen X. Dose optimization in pediatric CT: current technology and future innovations. Pediatr Radiol. 2002;32:729–734
  74. Westerman BR. Radiation dose from Toshiba CT scanners. Pediatr Radiol. 2002;32:735–737
  75. Kalra MK, Maher MM, Kamath RS, et al. Sixteen-detector row CT of abdomen and pelvis: study for optimization of z-axis modulation technique performed in 153 patients. Radiology. 2004;233:241–249
  76. Kalra MK, Maher MM, Toth TL, et al. Comparison of z-axis automatic tube current modulation technique with fixed tube current CT scanning of abdomen and pelvis. Radiology. 2004;232:347–353
  77. Greess H, Wolf H, Baum U, et al. Dose reduction in computed tomography by attenuation-based on-line modulation of tube current: evaluation of six anatomical regions. Eur Radiol. 2000;10:391–394
  78. Mastora I, Remy-Jardin M, Delannoy V, et al. Multi-detector row spiral CT angiography of the thoracic outlet: dose reduction with anatomically adapted online tube current modulation and preset dose savings. Radiology. 2004;230:116–124
  79. Hundt W, Rust F, Stäbler A, et al. Dose reduction in multislice computed tomography. J Comput Assist Tomogr. 2005;29:140–146
  80. Greess H, Nömayr A, Wolf H, et al. Dose reduction in CT examination of children by an attenuation-based on-line modulation of tube current (CARE dose). Eur Radiol. 2002;12:1571–1576
  81. Kojima M, Itoh S, Ikeda M, et al. Usefulness of a method for changing tube current during helical scanning in multislice CT. Radiat Med. 2003;21:193–204
  82. Greess H, Lutze J, Nömayr A, et al. Dose reduction in subsecond multislice spiral CT examination of children by online tube current modulation. Eur Radiol. 2004;14:995–999
  83. Kalra MK, Wittram C, Maher MM. Can noise reduction filters improve low-radiation-dose chest CT images? Pilot study. Radiology. 2003;228:257–264
  84. Mayo JR, Whittall KP, Leung AN, et al. Simulated dose reduction in conventional chest CT: validation study. Radiology. 1997;202:453–457
  85. Ron E. Ionizing radiation and cancer risks: evidence from epidemiology. Pediatr Radiol. 2002;32:232–237
  86. Ionising Radiation (Medical Exposure) Regulations 2000 (Statutory Instrument 2000 No. 1059). London: HMSO; 2000;

PII: S0009-9260(07)00014-1

doi: 10.1016/j.crad.2006.12.004

Clinical Radiology
Volume 62, Issue 6 , Pages 507-517 , June 2007