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Prospective Evaluation of Image Quality with Use of a Patient Image Gallery for Dose Reduction in Pediatric 16-MDCT

¹ Department of Diagnostic Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
² Siemens Medical Solutions, Forchheim, Germany.
³ Division of Pediatric Radiology, Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —6-year-old girl with suspected intraabdominal abscess. Example of image gallery images for 20-kg body weight with tube voltage of 100 kVp, B30f kernel, and 5-mm slice thickness. Original MDCT scan with effective tube current–time product of 60 mAs.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —6-year-old girl with suspected intraabdominal abscess. Example of image gallery images for 20-kg body weight with tube voltage of 100 kVp, B30f kernel, and 5-mm slice thickness. Computer-simulated images corresponding to A at same level with serial dose reductions to effective tube current–time products of 43 mAs (B), 30 mAs (C), and 21 mAs (D). Increased noise and reduced image quality with decreasing tube current in same patient are evident.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —6-year-old girl with suspected intraabdominal abscess. Example of image gallery images for 20-kg body weight with tube voltage of 100 kVp, B30f kernel, and 5-mm slice thickness. Computer-simulated images corresponding to A at same level with serial dose reductions to effective tube current–time products of 43 mAs (B), 30 mAs (C), and 21 mAs (D). Increased noise and reduced image quality with decreasing tube current in same patient are evident.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —6-year-old girl with suspected intraabdominal abscess. Example of image gallery images for 20-kg body weight with tube voltage of 100 kVp, B30f kernel, and 5-mm slice thickness. Computer-simulated images corresponding to A at same level with serial dose reductions to effective tube current–time products of 43 mAs (B), 30 mAs (C), and 21 mAs (D). Increased noise and reduced image quality with decreasing tube current in same patient are evident.

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —8-year-old boy with Hodgkin's disease. Chest CT scan shows regions of interest placed on autochthonous muscles for objective analysis of image quality.

View larger version (7K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Bland-Altman plots for objective analysis of examined body regions. Graph shows results for chest. All values are within lower and upper agreement limits (dotted lines). Concordance correlation coefficient is 0.6933. Mean value of differences between image gallery and CT is –0.2133 (black line apart from zero line).

View larger version (7K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Bland-Altman plots for objective analysis of examined body regions. Graph shows results for abdomen. Concordance correlation coefficient is 0.3300. Mean value of differences between image gallery and CT is 0.1500.

View larger version (7K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Bland-Altman plots for objective analysis of examined body regions. Graph shows results for pelvis. Concordance correlation coefficient is 0.5486. Mean value of differences between image gallery and CT is 1.8571.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —9-year-old 26-kg girl with mediastinal lymphoma and pleural effusion. All images were rated good diagnostic quality. Computer-simulated images (patient image gallery) for 30-kg body weight at 120 kVp and 28-mAs effective tube current–time setting in soft-tissue (A) and lung (B) windows with mean image noise of 10.5 H.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —9-year-old 26-kg girl with mediastinal lymphoma and pleural effusion. All images were rated good diagnostic quality. Computer-simulated images (patient image gallery) for 30-kg body weight at 120 kVp and 28-mAs effective tube current–time setting in soft-tissue (A) and lung (B) windows with mean image noise of 10.5 H.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —9-year-old 26-kg girl with mediastinal lymphoma and pleural effusion. All images were rated good diagnostic quality. Clinical chest MDCT scan corresponding to A and B obtained with true tube current at soft-tissue (C) and lung (D) windows. Mean image noise is 12.1 H; volume CT dose index, 3.7 mGy; effective dose, 1.9 mSv. Dose was not reduced in comparison with weight-adapted standard pediatric protocol.

View larger version (33K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —9-year-old 26-kg girl with mediastinal lymphoma and pleural effusion. All images were rated good diagnostic quality. Clinical chest MDCT scan corresponding to A and B obtained with true tube current at soft-tissue (C) and lung (D) windows. Mean image noise is 12.1 H; volume CT dose index, 3.7 mGy; effective dose, 1.9 mSv. Dose was not reduced in comparison with weight-adapted standard pediatric protocol.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —7-year-old 25-kg girl with splenic rupture. Both images were rated good diagnostic quality. Computer-simulated image (patient image gallery) for 30-kg body weight at 120 kVp and 41-mAs effective tube current–time setting with mean image noise of 8.8 H.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —7-year-old 25-kg girl with splenic rupture. Both images were rated good diagnostic quality. Clinical abdominal MDCT scan corresponding to A obtained with true tube current shows splenic rupture (arrow). Mean image noise, 9.2 H; volume CT dose index, 5.8 mGy; effective dose, 2.6 mSv; 37% dose reduction compared with previously recommended weight-adapted standard pediatric protocol.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —13-year-old 36-kg girl with right ovarian abscess. To avoid sedation, MRI was not performed. Both images were rated good diagnostic. Computer-simulated image (patient image gallery) for 40-kg body weight at 120 kVp and 57-mAs effective tube current–time setting with mean image noise of 11.9 H.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —13-year-old 36-kg girl with right ovarian abscess. To avoid sedation, MRI was not performed. Both images were rated good diagnostic. Clinical plelvic MDCT scan corresponding to A obtained with true tube current shows right ovarian abscess (arrow). Mean image noise is 11.1 H; volume CT dose index, 4.3 mGy; effective dose, 2.7 mSv; 37% dose reduction compared with standard pediatric protocol.

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