Advanced CT Techniques for Decreasing Radiation Dose, Reducing Sedation Requirements, and Optimizing Image Quality in Children.
Radiographics. 2019 May-Jun;39(3):709-726. doi: 10.1148/rg.2019180082. Epub 2019 Mar 29.
Gottumukkala RV1, Kalra MK1, Tabari A1, Otrakji A1, Gee MS1.
CT is an invaluable diagnostic tool for pediatric patients; however, concerns have arisen about the potential risks of ionizing radiation associated with diagnostic imaging in young patients, particularly for pediatric populations that may require serial CT examinations. Recent attention has also been focused on the immediate and long-term risks of administration of anesthetic medications to infants and young children who require sedation to undergo imaging examinations. These concerns can be mitigated with use of advanced CT techniques that can decrease scan time and radiation dose while preserving image quality. In this article, current state-of-the-art CT acquisition techniques are reviewed as part of a comprehensive strategy to reduce radiation dose, decrease sedation needs, and optimize image quality in infants and young children. Three imaging strategies are discussed, including (a) dual-energy CT (DECT), (b) imaging with a low tube potential, and (c) rapid scanning. Consolidating multiphase imaging protocols into a single phase with virtual nonenhanced imaging on DECT scanners, as well as use of low tube voltage, can reduce the radiation dose while increasing the conspicuity of contrast material-enhanced structures with a reduced volume of iodinated contrast material and a reduced rate of injection. Rapid scanning techniques with either ultrahigh pitch at dual-source CT or with wide-area detector single-source CT facilitate scanning without the need for sedation in many children. ©RSNA, 2019 See discussion on this article by Szczykutowicz .
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