title: Dose optimization in pediatric cardiac x-ray imaging.
abstract: OBJECTIVE
  The aim of this research was to explore x-ray beam parameters with intent to optimize pediatric x-ray settings in the cardiac catheterization laboratory. This study examined the effects of peak x-ray tube voltage (kVp) and of copper (Cu) x-ray beam filtration independently on the image quality to dose balance for pediatric patient sizes. The impact of antiscatter grid removal on the image quality to dose balance was also investigated.
  
  
  METHODS
  Image sequences of polymethyl methacrylate phantoms approximating chest sizes typical of pediatric patients were captured using a modern flat-panel receptor based x-ray imaging system. Tin was used to simulate iodine-based contrast medium used in clinical procedures. Measurements of tin detail contrast and flat field image noise provided the contrast to noise ratio. Entrance surface dose (ESD) and effective dose (E) measurements were obtained to calculate the figure of merit (FOM), CNR2/dose, which evaluated the dose efficiency of the x-ray parameters investigated. The kVp, tube current (mA), and pulse duration were set manually by overriding the system's automatic dose control mechanisms. Images were captured with 0, 0.1, 0.25, 0.4, and 0.9 mm added Cu filtration, for 50, 55, 60, 65, and 70 kVp with the antiscatter grid in place, and then with it removed.
  
  
  RESULTS
  For a given phantom thickness, as the Cu filter thickness was increased, lower kVp was favored. Examining kVp alone, lower values were generally favored, more so for thinner phantoms. Considering ESD, the 8.5 cm phantom had the highest FOM at 50 kVp using 0.4 mm of Cu filtration. The 12 cm phantom had the highest FOM at 55 kVp using 0.9 mm Cu, and the 16 cm phantom had highest FOM at 55 kVp using 0.4 mm Cu. With regard to E, the 8.5 and 12 cm phantoms had the highest FOM at 50 kVp using 0.4 mm of Cu filtration, and the 16 cm phantom had the highest FOM at 50 kVp using 0.25 mm Cu. Antiscatter grid removal improved the FOM for a given set of x-ray conditions. Under aforesaid optimal settings, the 8.5 cm phantom FOM improved by 24% and 33% for ESD and E, respectively. Corresponding improvements were 26% and 24% for the 12 cm phantom and 6% and 15% for the 16 cm phantom.
  
  
  CONCLUSIONS
  For pediatric patients, using 0.25-0.9 mm Cu filtration in the x-ray beam while maintaining 50-55 kVp, depending on patient size, provided optimal x-ray image quality to dose ratios. These settings, adjusted for x-ray tube loading limits and clinically acceptable image quality, should provide a useful strategy for optimizing iodine contrast agent based cardiac x-ray imaging. Removing the antiscatter grid improved the FOM for the 8.5 and 12 cm phantoms, therefore grid removal is recommended for younger children. Improvement for the 16 cm phantom declined into the estimated margin of error for the FOM; the need for grid removal for older children would depend on practical feasibility in the clinical environment.
authors.affiliation: LXi Research, Division of Medical Physics, University of Leeds, Worsley Building, Clarendon Way, Leeds LS2 9JT, United Kingdom. a.j.gislason@leeds.ac.uk
authors.forename: Amber J
authors.initials: AJ
authors.lastname: Gislason
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Davies
authors.forename: Arnold R
authors.initials: AR
authors.lastname: Cowen
mesh_terms: D055592:Biophysical Phenomena; D006328:Cardiac Catheterization; D002648:Child; D005471:Fluoroscopy / Q000706:statistics & numerical data; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D009010:Monte Carlo Method; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D012542:Scattering, Radiation