title: Cardiovascular CT angiography in neonates and children: image quality and potential for radiation dose reduction with iterative image reconstruction techniques.
abstract: OBJECTIVE
  To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CTA), comparing iterative reconstruction in image space (IRIS) and sinogram-affirmed iterative reconstruction (SAFIRE) with filtered back-projection (FBP) and estimate the potential for further dose reductions.
  
  
  METHODS
  Forty neonates and children underwent low radiation CTA with or without ECG synchronisation. Data were reconstructed with FBP, IRIS and SAFIRE. For ECG-synchronised studies, half-dose image acquisitions were simulated. Signal noise was measured and IQ graded. Effective dose (ED) was estimated.
  
  
  RESULTS
  Mean absolute and relative image noise with IRIS and full-dose SAFIRE was lower than with FBP (P < 0.001), while SNR and CNR were higher (P < 0.001). Image noise was also lower and SNR and CNR higher in half-dose SAFIRE studies compared with full-and half-dose FBP studies (P < 0.001). IQ scores were higher for IRIS, full-dose SAFIRE and half-dose SAFIRE than for full-dose FBP and higher for half-dose SAFIRE than for half-dose FBP (P < 0.05). Median weight-specific ED was 0.3 mSv without and 1.36 mSv with ECG synchronisation. The estimated ED of half-dose SAFIRE studies was 0.68 mSv.
  
  
  CONCLUSIONS
  IR improves image noise, SNR, CNR and subjective IQ compared with FBP in low-radiation-dose paediatric CTA and allows further dose reductions without compromising diagnostic IQ.
  
  
  CONCLUSIONS
  • Iterative reconstruction techniques significantly improve non-invasive cardiovascular CT in children. • Using half traditional radiation dose image quality is higher with iterative reconstruction. • Iterative reconstruction techniques may allow further radiation reductions in paediatric cardiovascular CT.
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC 29401, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tricarico
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Hlavacek
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.forename: Ullrich
authors.initials: U
authors.lastname: Ebersberger
authors.forename: John W
authors.initials: JW
authors.lastname: Nance
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Cho
authors.forename: J Reid
authors.initials: JR
authors.lastname: Spears
authors.forename: Francesco
authors.initials: F
authors.lastname: Secchi
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Savino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marano
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
authors.forename: Paul
authors.initials: P
authors.lastname: Apfaltrer
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000151:congenital* / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*