title: Automated low-kilovoltage selection in pediatric computed tomography angiography: phantom study evaluating effects on radiation dose and image quality.
abstract: OBJECTIVE
  The purpose of this study was to compare the effects of combined automated tube voltage selection and automated tube current modulation on radiation dose and image quality in small-sized phantoms undergoing computed tomography angiography (CTA) with the use of automated current modulation alone.
  
  
  METHODS
  Three semianthropomorphic phantoms, corresponding to a neonate, a small child, and a small adult, underwent simulated abdominal CTA using an automated tube voltage selection technology, which simultaneously optimizes kilovoltage (in kilovolt [peak]) and tube-current/milliamperage (in milliampere-second) on the basis of the patient topogram and clinical task. The phantoms were scanned with 2 protocols: protocol A, using the combination of automated kilovoltage and milliamperage, and protocol B, using only automated milliamperage with the standard 120 kV(p). Radiation doses were measured for each phantom, and the measurements were then used to estimate volume computed tomography dose index. Image noise and iodine contrast, contrast-to-noise ratio, and the relative dose factor were assessed. Differences were tested using paired t tests, and percentage differences for various technical factors and the phantom sizes were calculated.
  
  
  RESULTS
  The computed tomography dose index was significantly lower in protocol A (mean, 3.3 mGy) compared with that in protocol B (mean, 7.7 mGy), representing a 56.0% dose reduction (P = 0.01). In protocol A, tube potential dropped from 120 to 70 kV(p) in the small and medium phantoms and to 80 kV(p) in the large phantom. For each phantom size, image noise and iodine contrast increased significantly in protocol A relative to those in protocol B (P = 0.03 and P < 0.01, respectively). Corresponding contrast-to-noise ratio values increased by 9.1% in protocol A relative to those in protocol B (P = 0.04). The relative dose factor values for protocol A relative to those for protocol B were 31%, 36%, and 44% for the small, medium, and large phantoms, respectively.
  
  
  CONCLUSIONS
  Combined use of automated kilovoltage selection and automated tube current modulation is more effective for reducing radiation dose and maintaining image quality during simulated pediatric CTA than is automated tube current modulation in isolation.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA. siegelm@mir.wustl.edu
authors.forename: Marilyn Joy
authors.initials: MJ
authors.lastname: Siegel
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ramirez-Giraldo
authors.forename: Charles
authors.initials: C
authors.lastname: Hildebolt
authors.forename: David
authors.initials: D
authors.lastname: Bradley
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schmidt
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D011874:Radiometry / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult