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Perspective |
1
Department of Radiology, Children's Hospital Medical Center, 3333 Burnet Ave.,
Cincinnati, OH 45229-3039.
2
University of Cincinnati, College of Medicine, Cincinnati, OH
45219-2316.
3
Department of Radiology, Duke University Medical Center, Durham, NC
27710.
Received March 30, 2000;
accepted after revision August 2, 2000.
Address correspondence to L. F. Donnelly.
Introduction
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Despite these publications, other data suggest that adjustment of the tube current setting from standard adult doses for pediatric patients is largely overlooked [15, 16]. For example, in a recent study [17] that evaluated the effective dose to pediatric patients undergoing abdominal CT, the tube current setting used to calculate the dose for the pediatric patients was 220 mA. This value is much higher than the tube current setting suggested in the pediatric radiology literature [12,13,14,15]. In addition, in a review of techniques for helical CT examinations of pediatric patients performed elsewhere and submitted for a second interpretation, the average tube current setting used exceeded that typically suggested for an adult and had no relationship to patient age or size [17]. Another factor that may contribute to this lack of mA adjustment is that many of the available helical CT units are equipped with software that automatically chooses the tube current setting based on optimal image quality calculated for adults. Efforts must be made to override these automatic parameter settings when imaging children.
At our institution, a large children's hospital with a busy body CT section, we have adjusted CT protocols so that the tube current setting is chosen based on patient weight (Table 1). This table was created for use on a single-slice helical CT scanner (CT/i; General Electric Medical Systems, Milwaukee, WI). The chosen tube current setting is significantly lower than those we have used in the past. In some instances in which very small lesions may be present, such as in the evaluation of an immunocompromised child for fungal liver disease, we consider increasing the values in Table 1 by 50 mA to decrease noise. However, this increase is rarely necessary.
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The major disadvantage of decreasing the mA is an increase in noise and the associated potential for degradation of image quality [1]. We have taken several steps to ensure that the potential increase in noise does not compromise the diagnostic information provided using a lower mA that is chosen based on patient weight. First, it is the consensus of our group, which consists of six pediatric body imagers, that the images are of high quality with no loss of diagnostic information (Fig. 1A,1B,1C). We are not aware of any cases in which a diagnosis that was not detected on our reduced-dose CT examination has become evident at a later time. In addition, we have not repeated studies at an increased mA because of poor technical quality. Second, we have used phantoms to evaluate differences in noise using the techniques that we use in children of various sizes. Noise is related to the number of photons detected and is inversely proportional to the square root of the mAs. However, smaller patients attenuate the X-ray beam less, resulting in more photons reaching the detector and, therefore, less noise. Thus, the potential for increased noise caused by decreasing the tube current in younger patients is counterbalanced by the smaller size of the younger patients.
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We used a 32-cm phantom made of Lucite (Ineos Acrylics, Southampton, UK) to simulate the abdomen of a larger child. The standard deviation for Hounsfield units, a measure of image noise [10], was 10.66 H using the appropriate technique for a child of this size (100 mA). In contrast, when we evaluated a 16-cm phantom to simulate the abdomen of an infant with the appropriate technique (50 mA), the standard deviation was 10.78 H. Therefore, the amount of noise was similar in the images of the larger child and the infant phantoms despite using half the tube current for the infant phantom. We used our infant-sized phantom (16 cm) to document the relationship between tube current and radiation dose. Keeping other technical parameters constant (120 kVp, 24-cm field of view, 1-sec exposure, 10-mm collimation), we compared the exposure produced with a tube current of 100 mA with that produced with a tube current of 50 mA. The skin exposure was 1.59 R (0.410 mC/kg) using a tube current of 100 mA and 0.79 R (0.204 mC/kg) using a tube current of 50 mA. Therefore, reducing the mA by half resulted in a decreased radiation dose by half (0.499 ratio). Finally, measurements of standard deviation of Hounsfield units performed in our clinical studies have not shown increased noise in images of small children compared with those of larger children when using weight-based reduced mA and appropriate child size-adjusted collimation. For example, the standard deviation within a 26-mm2 area within the abdominal aorta, at the level of the superior pole of the right kidney, on unenhanced CT images measured 11.59 H for a 17-year-old boy (140 mA, 10-mm collimation, 120 kVp) and 9.06 H for a 2-year-old boy (140 mA, 5-mm collimation, 120 kVp). Despite the smaller collimation and lower mA, the noise (standard deviation) was actually less in the small child.
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Other Adjustments to Reduce Radiation Dose of Helical CT
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One CT parameter that has a much less profound effect on dose than tube current setting or pitch is collimation. Small changes in collimation do not largely affect radiation dose, assuming that tube current is not increased with a smaller collimation to compensate for increased noise. We typically decrease the collimation in young children because of their smaller size.
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E. Smergel, D. Benson, D. P. Frush, and L. F. Donnelly Radiation Dose on Pediatric CT: Losing Track of Time Am. J. Roentgenol., February 1, 2002; 178 (2): 507 - 508. [Full Text] [PDF] |
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R A Allan Imaging in inflammatory bowel disease Imaging, December 1, 2001; 13(4): 272 - 284. [Abstract] [Full Text] [PDF] |
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M. Mahesh, J. C. Scatarige, J. Cooper, and E. K. Fishman Dose and Pitch Relationship for a Particular Multislice CT Scanner Am. J. Roentgenol., December 1, 2001; 177(6): 1273 - 1275. [Abstract] [Full Text] [PDF] |
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E. M. Lautin CT As a Cause of Cancer: What's Old Is New Again Am. J. Roentgenol., September 1, 2001; 177(3): 717 - 717. [Full Text] [PDF] |
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N. S. Rosen, D. J. Brenner, C. D. Elliston, E. J. Hall, and W. E. Berdon Taking Care of Children Am. J. Roentgenol., September 1, 2001; 177 (3): 715 - 717. [Full Text] [PDF] |
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L. F. Rogers Radiation Exposure in CT: Why So High? Am. J. Roentgenol., August 1, 2001; 177(2): 277 - 277. [Full Text] [PDF] |
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E. L. Nickoloff and P. O. Alderson Radiation Exposures to Patients from CT: Reality, Public Perception, and Policy Am. J. Roentgenol., August 1, 2001; 177(2): 285 - 287. [Full Text] [PDF] |
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J. R. Haaga Radiation Dose Management: Weighing Risk Versus Benefit Am. J. Roentgenol., August 1, 2001; 177(2): 289 - 291. [Full Text] [PDF] |
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L. F. Donnelly Use of Three-Dimensional Reconstructed Helical CT Images in Recognition and Communication of Chest Wall Anomalies in Children Am. J. Roentgenol., August 1, 2001; 177(2): 441 - 445. [Full Text] [PDF] |
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L. F. Rogers Taking Care of Children: Check Out the Parameters Used for Helical CT Am. J. Roentgenol., February 1, 2001; 176(2): 287 - 287. [Full Text] [PDF] |
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