title: Entrance skin dosimetry and size-specific dose estimate from pediatric chest CTA.
abstract: BACKGROUND
  Size-specific dose estimate (SSDE), which corrects CT dose index (CTDI) for body diameter and is a better measure of organ dose than is CTDI, has not yet been validated in vivo.
  
  
  OBJECTIVE
  The purpose was to determine the correlation between SSDE and measured breast entrance skin dose (ESD) for pediatric chest CT angiography across a variety of techniques, scanner models, and patient sizes.
  
  
  METHODS
  During 42 examinations done on 4 different scanners over 7 years, we measured mid-sternal ESD as an approximation of breast dose with skin dosimeters. We recorded age, weight, effective tube current, kilovoltage potential, console CTDI, and dose-length product, from which we calculated effective dose. We measured effective chest diameter to convert CTDI to SSDE, and we correlated SSDE with measured ESD, using linear regression. We evaluated image quality to answer the clinical question.
  
  
  RESULTS
  Patient mean (±SD) age was 8.4 ± 6.1 years (median, 7.9 years; range, 0.02-19.5 years); mean weight was 35 ± 27 kg (median, 26 kg; range, 3.5-115 kg); effective chest diameter was 20 ± 7 cm (median, 19 cm; range, 10-35 cm). Mean effective dose was 2.9 ± 2.8 mSv (median, 2.2 mSv; range, 0.1-14.4 mSv). We observed a linear correlation (R(2) = 0.98, P < .005) between SSDE (mean, 11 ± 11mGy; median, 7 mGy; range, 0.5-40 mGy) and breast ESD (mean, 12 ± 11 mGy; median, 7 mGy; range, 0.3-44 mGy). Our doses, which compared favorably with those previously reported, decreased significantly (P < .05) during the course of our study, because of the introduction of automatic exposure control, low kilovoltage, and high pitch techniques. All studies were of diagnostic quality.
  
  
  CONCLUSIONS
  SSDE is a valid dose measure in children undergoing chest CT angiography over a wide range of scanner platforms, techniques, and patient sizes, and it may be used to model breast dose and to document the results of dose reduction strategies.
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 246 A, Boston, MA 02114, USA. Electronic address: swestra@partners.org.
authors.forename: Sjirk J
authors.initials: SJ
authors.lastname: Westra
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 246 A, Boston, MA 02114, USA.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Li
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 246 A, Boston, MA 02114, USA.
authors.forename: Kavita
authors.initials: K
authors.lastname: Gulati
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 246 A, Boston, MA 02114, USA.
authors.forename: Sarabjeet
authors.initials: S
authors.lastname: Singh
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 246 A, Boston, MA 02114, USA.
authors.forename: Bob
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 246 A, Boston, MA 02114, USA.
authors.forename: Mannudeep K
authors.initials: MK
authors.lastname: Kalra
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 246 A, Boston, MA 02114, USA.
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D061330:Multidetector Computed Tomography / Q000009:adverse effects / Q000295:instrumentation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D013902:Radiography, Thoracic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012307:Risk Factors; D012867:Skin / Q000528:radiation effects*; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
keywords: Breast dose; CT image quality; Chest CT angiography; Effective dose; Pediatric; Radiation dose