Can a revised paediatric radiation dose reduction CT protocol be applied and still maintain anatomical delineation, diagnostic confidence and overall imaging quality?

OBJECTIVE: To compare multidetector CT (MDCT) radiation doses between default settings and a revised dose reduction protocol and to determine whether the diagnostic confidence can be maintained with imaging quality made under the revised protocol in paediatric head, chest and abdominal CT studies.
METHODS: The study retrospectively reviewed head, chest, abdominal and thoracoabdominal MDCT studies, comparing 231 CT studies taken before (Phase 1) and 195 CT studies taken after (Phase 2) the implemented revised protocol. Image quality was assessed using a five-point grading scale based on anatomical criteria, diagnostic confidence and overall quality. Image noise and dose-length product (DLP) were collected and compared.
RESULTS: The relative dose reductions between Phase 1 and Phase 2 were statistically significant in 35%, 51% and 54% (p < 0.001) of head, chest and abdominal CT studies, respectively. There were no statistically significant differences in overall image quality score comparisons in the head (p = 0.3), chest (p = 0.7), abdominal (p = 0.7) and contiguous thoracic (p = 0.1) and abdominal (p = 0.2) CT studies, with the exception of anatomical quality in definition of bronchial walls and delineation of intrahepatic portal branches in thoracoabdominal CTs, and diagnostic confidence in mass lesion in head CTs, liver lesion (>1 cm), splanchnic venous thrombosis, pancreatitis in abdominal CTs, and emphysema and aortic dissection in thoracoabdominal CTs.
CONCLUSION: Paediatric CT radiation doses can be significantly reduced from manufacturer's default protocol while still maintaining anatomical delineation, diagnostic confidence and overall imaging quality. ADVANCES IN KNOWLEDGE: Revised paediatric CT protocol can provide a half DLP reduction while preserving overall imaging quality.