Retrospective review of CT brain image quality, diagnostic adequacy and radiation dose in a paediatric population imaged at a non‐paediatric tertiary hospital

Abstract

Introduction: Minimising radiation exposure in paediatric imaging examinations whilst maintaining acceptable diagnostic quality continues to present a challenge. The aims of this study were to assess institutional compliance of paediatric CT brain (CTB) examinations performed in an adult hospital with ARPANSA radiation dose recommendations and to compare qualitative CTB diagnostic acceptability with objective imaging parameters and radiation dose. Methods: A retrospective review of 115 consecutive paediatric CTB examinations was undertaken at an adult tertiary referral centre in Australia over a 2year period. Dose length product (DLP) was compared with the ARPANSA standards. CTB image quality was subjectively classified by two neuroradiologists independently, with discordant results resolved by consensus. Objective assessment of image quality included measurements of signal-to-noise (SNR) and contrast-to-noise ratios (CNR) of grey and white matter. Results: All patient scans complied with ARPANSA DLP recommendations; however, 10 out of 115 scans were classified as being of diagnostically suboptimal image quality. These scans had significantly lower mean DLP values compared with diagnostically adequate examinations (105.1 vs 379.2 mGy.cm; P < 0.0001). CTB scans of adequate diagnostic quality, when compared to suboptimal scans, had significantly higher CNR (1.8 vs 1.1; P < 0.0001) and SNR in grey (7.1 vs 4.6; P < 0.0001) and white matter (5.6 vs 3.8; P < 0.0001). Conclusion: All CTB examinations in this series complied with the ARPANSA DLP recommendations; however, 9% were of suboptimal diagnostic image quality. While it is important to minimize unnecessary radiation exposure, our results suggest that excessively low DLP values can lead to suboptimal diagnostic image quality.

Lowering head computed tomography radiation dose for craniosynostosis: An institutional change and review of literature

“…CTDIvol (mGy) (mean ± SD) DLP (mGy-cm) (mean ± SD) CED (mSv) (mean ± SD) Literature published using modern CT methods since the advent of rapid multi-detector image acquisition, revealed seventeen studies that investigated cumulative ionizing radiation doses from head CT scans in pediatric patients (Figure 1) [1,12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] . These studies included numerous pediatric patients ranging in age from newborn to 17 years old, with the seventeen studies reporting calculated effective doses ranging from 0.015 mSv to 8.91 mSv [1,12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] . Of the seventeen studies included, five were found to specifically investigate ionizing radiation exposure from CT scans in pediatric patients with CS, with these studies also emphasizing the utilization of low-dose CT protocols that yielded effective doses of less than 1 mSv [17][18][19][20]26] .…”

Should Radiation Exposure be an Issue of Concern in Children With Multiple Trauma?

“…11 As all the doses of radiation were converted to mSv, which represent the effective dose received by the patient already taking into account the tissue sensitivity, which enables inter-patient comparison and the calculation of carcinogenesis risk. 12 Where there were absent figures, 2 strategies were adopted: first, to use doses from studies that assessed children and effective dose (mSv) of various radiological and CT investigations 13 (''Literature dose''); secondly, published radiological doses were used as a broad estimate of doses that would have been used locally, a recognized technique 14 (''Local dose''). To test the validity of both, the Literature and Local technique of estimated doses, for the examinations in which an actual dose was present (n ¼ 3049), a comparison was made with the predicted dose.…”