title: Pediatric CT: implementation of ASIR for substantial radiation dose reduction while maintaining pre-ASIR image noise.
abstract: OBJECTIVE
  To determine a comprehensive method for the implementation of adaptive statistical iterative reconstruction (ASIR) for maximal radiation dose reduction in pediatric computed tomography (CT) without changing the magnitude of noise in the reconstructed image or the contrast-to-noise ratio (CNR) in the patient.
  
  
  METHODS
  The institutional review board waived the need to obtain informed consent for this HIPAA-compliant quality analysis. Chest and abdominopelvic CT images obtained before ASIR implementation (183 patient examinations; mean patient age, 8.8 years ± 6.2 [standard deviation]; range, 1 month to 27 years) were analyzed for image noise and CNR. These measurements were used in conjunction with noise models derived from anthropomorphic phantoms to establish new beam current-modulated CT parameters to implement 40% ASIR at 120 and 100 kVp without changing noise texture or magnitude. Image noise was assessed in images obtained after ASIR implementation (492 patient examinations; mean patient age, 7.6 years ± 5.4; range, 2 months to 28 years) the same way it was assessed in the pre-ASIR analysis. Dose reduction was determined by comparing size-specific dose estimates in the pre- and post-ASIR patient cohorts. Data were analyzed with paired t tests.
  
  
  RESULTS
  With 40% ASIR implementation, the average relative dose reduction for chest CT was 39% (2.7/4.4 mGy), with a maximum reduction of 72% (5.3/18.8 mGy). The average relative dose reduction for abdominopelvic CT was 29% (4.8/6.8 mGy), with a maximum reduction of 64% (7.6/20.9 mGy). Beam current modulation was unnecessary for patients weighing 40 kg or less. The difference between 0% and 40% ASIR noise magnitude was less than 1 HU, with statistically nonsignificant increases in patient CNR at 100 kVp of 8% (15.3/14.2; P = .41) for chest CT and 13% (7.8/6.8; P = .40) for abdominopelvic CT.
  
  
  CONCLUSIONS
  Radiation dose reduction at pediatric CT was achieved when 40% ASIR was implemented as a dose reduction tool only; no net change to the magnitude of noise in the reconstructed image or the patient CNR occurred.
authors.affiliation: From the Department of Radiological Sciences, St Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38139.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Brady
authors.forename: Bria M
authors.initials: BM
authors.lastname: Moore
authors.forename: Brian S
authors.initials: BS
authors.lastname: Yee
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kaufman
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000592:standards*; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000592:standards*
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