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01-11-2005 | Pediatric

CT dose reduction in children

Author: Peter Vock

Published in: European Radiology | Issue 11/2005

Abstract

World wide, the number of CT studies in children and the radiation exposure by CT increases. The same energy dose has a greater biological impact in children than in adults, and scan parameters have to be adapted to the smaller diameter of the juvenile body. Based on seven rules, a practical approach to paediatric CT is shown: Justification and patient preparation are important steps before scanning, and they differ from the preparation of adult patients. The subsequent choice of scan parameters aims at obtaining the minimal signal-to-noise ratio and volume coverage needed in a specific medical situation; exposure can be divided in two aspects: the CT dose index determining energy deposition per rotation and the dose-length product (DLP) determining the volume dose. DLP closely parallels the effective dose, the best parameter of the biological impact. Modern scanners offer dose modulation to locally minimise exposure while maintaining image quality. Beyond the selection of the physical parameters, the dose can be kept low by scanning the minimal length of the body and by avoiding any non-qualified repeated scanning of parts of the body. Following these rules, paediatric CT examinations of good quality can be obtained at a reasonable cost of radiation exposure.

Beaconsfield T, Nicholson R, Thornton A, Al-Kutoubi A (1998) Would thyroid and breast shielding be beneficial in CT of the head? Eur Radiol 8:664–667CrossRefPubMed

Boone JM, Geraghty EM, Seibert JA, Wootton-Gorges SL (2003) Dose reduction in pediatric CT: a rational approach. Radiology 228:352–360PubMed

Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. Am J Roentgenol 176:289–296

Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–231CrossRefPubMed

Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A 100:13761–13766CrossRefPubMed

Brenner DJ, Elliston CD (2004) Estimated radiation risk potentially associated with full-body CT screening. Radiology 232:735–738PubMed

Brnic Z, Vekic B, Hebrang A, Anic P (2003) Efficacy of breast shielding during CT of the head. Eur Radiol 13:2436–2440CrossRefPubMed

Chapple CL, Willis S, Frame J (2002) Effective dose in paediatric computed tomography. Phys Med Biol 47:107–115CrossRefPubMed

Cody DD, Moxley DM, Krugh KT, O’Daniel JC, Wagner LK, Eftekhari F (2004) Strategies for formulating appropriate MDCT techniques when imaging the chest, abdomen, and pelvis in pediatric patients. Am J Roentgenol 182:849–859

10.

Donnelly LF, Emery KH, Brody AS, Laor T, Gylys-Morin VM, Anton GA, Thomas SR, Frush DP (2001) Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large children’s hospital. Am J Roentgenol 176:303–306PubMed

11.

European Commission (2000) European guidelines on quality criteria for computed tomography, EUR 16262EN. Office for Official Publications of the European Communities, Luxembourg

12.

Fricke BL, Donnelly LF, Frush DP, Yoshizumi T, Varchena V, Poe SA, Lucaya J (2003) In-plane bismuth breast shields for pediatric CT: effects on radiation dose and image quality using experimental and clinical data. Am J Roentgenol 180:407–411

13.

Frush DP, Soden B, Frush KS, Lowry C (2002) Improved pediatric multidetector CT using a size-based color-coded format. Am J Roentgenol 178:721–726PubMed

14.

Frush DP (2002) Pediatric CT: practical approach to diminish the radiation dose. Pediatr Radiol 32:714–717CrossRefPubMed

15.

Frush DP, Donnelly LF, Rosen NS (2003) Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics 112:951–957CrossRefPubMed

16.

Golding SJ, Shrimpton PC (2002) Commentary. Radiation dose in CT: are we meeting the challenge? Br J Radiol 75:1–4PubMed

17.

Hidajat N, Schroder RJ, Vogl T, Schedel H, Felix R (1996) The efficacy of lead shielding in patient dosage reduction in computed tomography (German). Rofo 165:462–465PubMed

18.

Hohl C, Mahnken AH, Klotz E, Das M, Stargardt A, Mühlenbruch G, Schmidt T, Günther RW, Wildberger JE (2005) Radiation dose reduction to the male gonads during MDCT: the effectiveness of a lead shield. Am J Roentgenol 184:128–130

19.

Hopper KD, King SH, Lobell ME, TenHave TR, Weyver JS (1997) Rhe breast: in-plane x-ray protection during diagnostic thoracic CT-shielding with bismuth radioprotective garments. Radiology 205:853–858PubMed

20.

Huda W, Gkanatsios NA (1997) Effective dose and energy imparted in diagnostic radiology. Med Phys 24:1311–1318CrossRefPubMed

21.

Huda W, Scalzetti EM, Levin G (2000) Technique factors and image quality as functions of patient weight at abdominal CT. Radiology 217:430–435PubMed

22.

Huda W (2002) Effective dose to adult and pediatric patients. Pediatr Radiol 32:272–279CrossRefPubMed

23.

International Commission on Radiological Protection (1990) 1990 recommendations of the international commission on radiological protection. ICRP publication 60. Pergamon Press, Oxford

24.

Kalender WA, SeisslerW, Klotz E, Vock P (1990) Spiral volumetric CT with single breath-hold technique, continuous transport, and continuous scanner rotation. Radiology 176:181–183PubMed

25.

Lee CI, Haims AH, Monico EP, Brink JA, Forman HP (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231:393–398PubMed

26.

Mettler FA, Wiest PW, Locken JA, Kelsey CA (2000) CT scanning: patterns of use and dose. J Radiol Prot 20:353–359CrossRefPubMed

27.

Mini RL, Vock P, Mury R, Schneeberger PP (1995) Radiation exposure of patients who undergo CT of the trunk. Radiology 195:557–562PubMed

28.

Nickoloff EL, Alderson PO (2001) Radiation exposures to patients from CT. Reality, public perception, and policy. Am J Roentgenol 177:285–287

29.

Nickoloff E (2002) Current adult and pediatric CT doses. Pediatr Radiol 32:250–260CrossRefPubMed

30.

Pages J, Buls N, Osteaux M (2003) CT doses in children: a multicentre study. Br J Radiol 76:803–811CrossRefPubMed

31.

Paterson A, Frush DP, Donnelly LF (2001) Helical CT of the body: are settings adjusted for pediatric patients? Am J Roentgenol 176:297–301

32.

Pierce DA, Preston DL (2000) Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 154:178–186PubMed

33.

Price R, Halson P, Sampson M (1999) Dose reduction during CT scanning in an anthropomorphic phantom by the use of a male gonad shield. Br J Radiol 72:489–494PubMed

34.

Ravenel JG, Scalzetti EM, Huda W, Garrisi W (2001) Radiation exposure and image quality in chest CT examinations. Am J Roentgenol 177:279–284

35.

Semelka R (2005) Radiation risk from CT scans: a call for patient-focused imaging. Medscape Radiol 6(01) 1/26/2005

36.

Shrimpton PC, Edyvean S (1998) CT scanner dosimetry. Br J Radiol 71:1–3

37.

Shrimpton PC, Wall BF (2000) Reference doses for paediatric computed tomography. Radiat Prot Dosim 90:249–252

38.

Shrimpton PC, Hillier MC, Lewis MA, Dunn M (2005) Doses from computed tomography (CT) examinations in the UK-2003 review. UK Health protection agency, NRPB-W67

39.

Slovis TL (2003) Children, computed tomography radiation dose, and the as low as reasonably achievable (ALARA) concept. Pediatrics 112:971–972CrossRefPubMed

40.

Suess C, Chen X (2002) Dose optimization in pediatric CT: current technology and future innovations. Pediatr Radiol 32:729–734CrossRefPubMed

41.

United Nations Scientific Committee on the Effects of Atomic Radiation (2000) UNSCEAR 2000 report to the general assembly, vol I: sources. United Nations, New York

42.

Verdun FR, Lepori D, Monnin P, Valley JF, Schnyder P, Gudinchet F (2004) Management of patient dose and image noise in routine pediatric CT abdominal examinations. Eur Radiol 14:835–841CrossRefPubMed

43.

Vock P (2002) CT radiation exposure in children: consequences of the American discussion for Europe (German). Radiologe 42:697–702CrossRefPubMed

44.

Wall BF (2001) Diagnostic reference levels-the way forward. Commentary. Br J Radiol 74:785–788PubMed

45.

Ware DE, Huda W, Mergo PJ, Litwiller AL (1999) Radiation effective doses to patients undergoing abdominal CT examinations. 210:645–650

Title: CT dose reduction in children
Author: Peter Vock
Publication date: 01-11-2005
Publisher: Springer-Verlag
Published in: European Radiology / Issue 11/2005
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-005-2856-0

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CT dose reduction in children

Abstract

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