In this study, we applied and optimized a fast non-local means (FNLM) algorithm to reduce noise in pediatric abdominal virtual monoenergetic images (VMIs). To analyze various contrast agent concentrations, we produced contrast agent concentration samples (20, 40, 60, 80, and 100%) and inserted them into a phantom model of a one-year-old pediatric patient. Single-energy computed tomography (SECT) and dual-energy computed tomography (DECT) images were acquired from the phantom, and 40 kilo-electron-volt (keV) VMI was acquired based on the DECT images. For the 40 keV VMI, the smoothing factor of the FNLM algorithm was applied from 0.01 to 1.00 in increments of 0.01. We derived the optimized value of the FNLM algorithm based on quantitative evaluation and performed a comparative assessment with SECT, DECT, and a total variation (TV) algorithm. As a result of the analysis, we found that the average contrast to noise ratio (CNR) and coefficient of variation (COV) of each concentration were most improved at a smoothing factor of 0.02. Based on these results, we derived the optimized smoothing factor value of 0.02. Comparative evaluation shows that the optimized FNLM algorithm improves the CNR and COV results by approximately 3.14 and 2.45 times, respectively, compared with the DECT image, and the normalized noise power spectrum result shows a 10−1 mm2 improvement. The main contribution of this study is to demonstrate the effectiveness of an optimized FNLM algorithm in reducing noise in pediatric abdominal VMI, allowing high-quality images to be acquired while reducing contrast dose. This advancement has significant implications for minimizing the risk of contrast-induced toxicity, especially in pediatric patients. Our approach addresses the problem of limited datasets in pediatric imaging by providing a computationally efficient noise reduction technique and highlights the clinical applicability of the FNLM algorithm. In addition, effective noise reduction enables high-contrast imaging with minimal radiation and contrast exposure, which is expected to be suitable for repeat CT examinations of pediatric liver cancer patients and other abdominal diseases.
