Effect of low tube voltage and low iodine concentration abdominal CT on image quality and radiation dose in children: preliminary study

  • Sun Kyoung You
  • Young Hun ChoiEmail author
  • Jung-Eun Cheon
  • Woo Sun Kim
  • In-One Kim
  • So Mi Lee
  • Hyun-Hae Cho



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.


Children 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.

Ethical approval

This study was approved by the institutional review board of our institution and was waived the requirement for informed consent.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sun Kyoung You
    • 1
    • 2
  • Young Hun Choi
    • 3
    • 4
    Email author
  • Jung-Eun Cheon
    • 3
    • 4
    • 5
  • Woo Sun Kim
    • 3
    • 4
    • 5
  • In-One Kim
    • 3
    • 4
    • 5
  • So Mi Lee
    • 6
  • Hyun-Hae Cho
    • 7
  1. 1.Department of RadiologyChungnam National University College of MedicineDaejeonRepublic of Korea
  2. 2.Department of RadiologyChungnam National University HospitalDaejeonRepublic of Korea
  3. 3.Department of RadiologySeoul National University Children’s HospitalSeoulRepublic of Korea
  4. 4.Department of RadiologySeoul National University College of MedicineSeoulRepublic of Korea
  5. 5.Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulRepublic of Korea
  6. 6.Department of RadiologySchool of Medicine, Kyungpook National University, Kyungpook National University HospitalDaeguRepublic of Korea
  7. 7.Department of RadiologyEwha Womans University Mokdong HospitalSeoulRepublic of Korea

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