Effect of low tube voltage and low iodine concentration abdominal CT on image quality and radiation dose in children: preliminary study
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To evaluate the image quality of a double-low protocol (low tube voltage and low iodine concentration) for abdominal CT in children.
Materials and methods
The double-low protocol was compared to the conventional protocol in pediatric patients weighing less than 40 kg from May 2016 to December 2016. Double-low protocol (Group A, n = 18): tube voltage, 70 kVp; and iodine concentration,: 250 mgI/mL versus Conventional protocol (Group B, n = 13): tube voltage, 80–100 kVp; and iodine concentration, 350 mgI/mL. Mean attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared between the two groups. Image contrast, noise, beam-hardening artifacts, and overall image quality were subjectively scored. Reader performance for correctly differentiating two groups by visual assessment was evaluated. Radiation dose and total iodine load were recorded.
The mean attenuations of the portal vein and liver and the mean image noise in Group A were higher than in Group B (p = 0.04, 0.03, 0.004, respectively). The mean SNR and CNR of the main portal vein and liver were lower in Group A without any statistically significant difference. There were no statistically significant differences between the two groups in qualitative analysis (image contrast, image noise, and overall image quality) with substantial agreement between the reviewers (weighted kappa values; 0.59–0.76). Significantly diminished radiation dose and iodine load were observed in Group A compared with Group B (25.0%, 36.8% reduction; p = 0.007, 0.006, respectively).
The double-low protocol was feasible for pediatric abdominal CT and reduced both radiation dose and iodine load, while maintaining image quality.
KeywordsChildren Computed tomography Low tube voltage Iodine concentration Dose reduction
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the institutional review board of our institution and was waived the requirement for informed consent.
- 9.Verghese PS (2014) Contrast nephropathy in children. Journal of Pediatric Intensive Care 3:045–052Google Scholar
- 13.Shen Y, Hu X, Zou X, Zhu D, Li Z, Hu D (2016) Did low tube voltage CT combined with low contrast media burden protocols accomplish the goal of “double low” for patients? An overview of applications in vessels and abdominal parenchymal organs over the past 5 years. International journal of clinical practice 70.Google Scholar
- 15.Nakagawa M, Ozawa Y, Sakurai K, Shimohira M, Ohashi K, Asano M, Yamaguchi S, Shibamoto Y (2015) Image quality at low tube voltage (70 kV) and sinogram-affirmed iterative reconstruction for computed tomography in infants with congenital heart disease. Pediatric Radiology 45:1472–1479CrossRefGoogle Scholar
- 17.Marin D, Nelson RC, Schindera ST, Richard S, Youngblood RS, Yoshizumi TT, Samei E (2009) Low-tube-voltage, high-tube-current multidetector abdominal ct: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm—initial clinical experience 1. Radiology 254:145–153CrossRefGoogle Scholar
- 18.Takahashi H, Okada M, Hyodo T, Hidaka S, Kagawa Y, Matsuki M, Tsurusaki M, Murakami T (2014) Can low-dose CT with iterative reconstruction reduce both the radiation dose and the amount of iodine contrast medium in a dynamic CT study of the liver? European Journal of Radiology 83:684–691CrossRefGoogle Scholar
- 19.Nakaura T, Nakamura S, Maruyama N, Funama Y, Awai K, Harada K, Uemura S, Yamashita Y (2012) Low contrast agent and radiation dose protocol for hepatic dynamic CT of thin adults at 256–detector row CT: effect of low tube voltage and hybrid iterative reconstruction algorithm on image quality. Radiology 264:445–454CrossRefGoogle Scholar
- 20.Namimoto T, Oda S, Utsunomiya D, Shimonobo T, Morita S, Nakaura T, Yamashita Y (2012) Improvement of image quality at low-radiation dose and low-contrast material dose abdominal CT in patients with cirrhosis: intraindividual comparison of low tube voltage with iterative reconstruction algorithm and standard tube voltage. Journal of Computer Assisted Tomography 36:495–501CrossRefGoogle Scholar
- 24.Kalra MK, Woisetschläger M, Dahlström N, Singh S, Lindblom M, Choy G, Quick P, Schmidt B, Sedlmair M, Blake MA (2012) Radiation dose reduction with Sinogram Affirmed Iterative Reconstruction technique for abdominal computed tomography. Journal of Computer Assisted Tomography 36:339–346CrossRefGoogle Scholar
- 25.Schabel C, Fenchel M, Schmidt B, Flohr TG, Wuerslin C, Thomas C, Korn A, Tsiflikas I, Claussen CD, Heuschmid M (2013) Clinical evaluation and potential radiation dose reduction of the novel sinogram-affirmed iterative reconstruction technique (SAFIRE) in abdominal computed tomography angiography. Academic Radiology 20:165–172CrossRefGoogle Scholar
- 26.NNakaura T, Awai K, Maruyama N, Takata N, Yoshinaka I, Harada K, Uemura S, Yamashita Y (2011) Abdominal dynamic CT in patients with renal dysfunction: contrast agent dose reduction with low tube voltage and high tube current–time product settings at 256–detector row CT. Radiology 261:467–476CrossRefGoogle Scholar
- 28.Wang W, Zhao YE, Qi L, Li X, Zhou CS, Zhang LJ, Lu GM (2017) Prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp with 30 mL contrast agent: an intraindividual comparison with sequential scanning at 120 kVp with 60 mL contrast agent. European Journal of Radiology 90:97–105CrossRefGoogle Scholar
- 32.Maliborski A, Żukowski P, Nowicki G, Bogusławska R (2011) Contrast-induced nephropathy–a review of current literature and guidelines. Medical science monitor: international medical journal of experimental and clinical research 17: RA199.Google Scholar
- 33.Saint-Laurent Q Consensus Guidelines for the Prevention of Contrast Induced Nephropathy.Google Scholar
- 34.Trout AT, Dillman JR, Ellis JH, Cohan RH, Strouse PJ (2011) Patterns of intravenous contrast material use and corticosteroid premedication in children—a survey of Society of Chairs of Radiology in Children’s Hospitals (SCORCH) member institutions. Pediatric Radiology 41:1272–1283CrossRefGoogle Scholar