Automatic Tube Current Modulation and Tube Voltage Selection in Pediatric Computed Tomography: A Phantom Study on Radiation Dose and Image Quality

Objectives The aim of this study was to investigate the effects of a modern automatic tube current modulation (ATCM) and automatic tube voltage selection (ATVS) system on radiation dose and image quality in pediatric head, and torso computed tomography (CT) examinations for various clinical indications. Materials and Methods Four physical anthropomorphic phantoms that represent the average individual as neonate, 1-year-old, 5-year-old, and 10-year-old child were used. Standard head, thorax, and abdomen/pelvis acquisitions were performed with (1) fixed tube current, (2) ATCM, and (3) ATVS. Acquisitions were performed at various radiation dose levels to generate images at different levels of quality. Reference volume CT dose index (CTDIvol), reference image noise, and reference contrast-to-noise ratios were determined. The potential dose reductions with ATCM and ATVS were assessed. Results The percent reduction of CTDIvol with ATCM ranged from 8% to 24% for head, 16% to 39% for thorax, and 25% to 41% for abdomen/pelvis. The percent reduction of CTDIvol with ATVS varied on the clinical indication. In CT angiography, ATVS resulted to the highest dose reduction, which was up to 70% for head, 77% for thorax, and 34% for abdomen/pelvis. In noncontrast examinations, ATVS increased dose by up to 21% for head, whereas reduced dose by up to 34% for thorax and 48% for abdomen/pelvis. Conclusions In pediatric CT, the use of ATCM significantly reduces radiation dose and maintains image noise. The additional use of ATVS reduces further the radiation dose for thorax and abdomen/pelvis, and maintains contrast-to-noise ratio for the specified clinical diagnostic task. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication September 14, 2018; and accepted for publication, after revision, October 26, 2018. Conflicts of interest and sources of funding: This project has received funding from the Euratom research and training program 2014–2018 under grant agreement No. 755523 (MEDIRAD). The funding source had no role in study design, in the collection, analysis, and interpretation of data, nor in the writing or submission of the report. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2kq7jVD). Correspondence to: Antonios E. Papadakis, PhD, Medical Physics Department, University Hospital of Heraklion, Stavrakia, 71110, Crete, Greece. E-mail: apapadak@pagni.gr. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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