Paediatric cardiac computed tomography: a review of imaging techniques and radiation dose consideration

Abstract

The significant challenges involved in imaging the heart in small children (<15 kg) have been addressed by, and partially resolved with improvement in temporal and spatial resolution secondary to the advent of new multidetector CT technology. This has enabled both retrospective and prospective ECG-gated imaging in children even at high heart rates (over 100 bpm) without the need for beta blockers. Recent studies have highlighted that the radiation burden associated with cardiac CT can be reduced using prospective ECG-gating. Our experience shows that the resultant dose reduction can be optimised to a level equivalent to that of a non-gated study. This article reviews the different aspects of ECG-gating and the preferred technique for cardiac imaging in the young child (<15 kg). We summarize our evidenced based recommendations for readers, referencing recent articles and using our in house data, protocols and dose measurements discussing the various methods available for dose calculations and their inherent bias.

Impact of Sinogram Affirmed Iterative Reconstruction (SAFIRE) Algorithm on Image Quality with 70 kVp-Tube-Voltage Dual-Source CT Angiography in Children with Congenital Heart Disease

“…The “ALARA” (as low as reasonable achievable) principle has to be considered thoroughly before each examination for children. Several dose reduction strategies, such as reduced tube voltage, automated tube current modulation, weight-adjusted tube current, minimization of z-axis coverage as well as use of the prospective ECG-triggering sequential mode and high-pitch mode, have been successfully implemented into paediatric cardiac CT angiography and have been shown to effectively lower the radiation dose [1]–[3], [4]–[8].…”

Application of prospective ECG-triggered dual-source CT coronary angiography for infants and children with coronary artery aneurysms due to Kawasaki disease

“…Electrocardiogram (ECG)-gated scans, especially retrospective ECG-gated scans, have been used to evaluate coronary artery lesions in children with KD [2,9]. The high radiation dose required remains the main concern [10]; even though dose-saving methods including low tube potential, tube current modulation and body sizeadapted CT protocols have been adopted, the effective radiation dose is still high at up to 2.17-3.14 mSv [11][12][13].…”

Ionizing Radiation in Medical Imaging and Efforts in Dose Optimization

“…Adjustment of kV to 80kv is not an unreasonable approach as well as changing mAs values by employing weight-based specific protocols (Ben Saad et al, 2009, Lee et al, 2006, Young et al 2011.…”