title: Pilot study of radiation dose reduction for pediatric head CT in evaluation of ventricular size.
abstract: OBJECTIVE
  CT is a ubiquitous, efficient, and cost-effective method to evaluate pediatric ventricular size, particularly in patients with CSF shunt diversion who often need emergent imaging. We therefore sought to determine the minimum dose output or CT dose index required to produce clinically acceptable examinations.
  
  
  METHODS
  Using a validated noise insertion method and CT projection data from 22 patients, standard pediatric head CT images were reconstructed with weighted filtered back-projection and sinogram-affirmed iterative reconstruction corresponding to routine, 25%, and 10% dose. Reconstructed images were then evaluated by 3 neuroradiologists (blinded to dose and reconstruction method) for ventricular size, diagnostic confidence, image quality, evidence of hemorrhage, and shunt tip location, and compared with the reference standard.
  
  
  RESULTS
  There was no significant difference in the ventricular size ranking, and the sensitivity for moderate to severe hydrocephalus was 100%. There was no significant difference between the full-dose level and the ventricular size rankings at the 25% or the 10% dose level for either reconstruction kernel (P > .979). Diagnostic confidence was maintained across doses and kernel. Hemorrhage was more difficult to identify as image quality degraded as dose decreased but was still seen in a majority of cases. Shunts were identified by all readers across all doses and reconstruction methods.
  
  
  CONCLUSIONS
  CT images having dose reductions of 90% relative to routine head CT examinations provide acceptable image quality to address the specific clinical task of evaluating ventricular size.
authors.affiliation: From the Department of Radiology (S.G.), University of California Los Angeles, Los Angeles, California.
authors.forename: S
authors.initials: S
authors.lastname: Gabriel
authors.affiliation: Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota. eckel.laurence@mayo.edu.
authors.forename: L J
authors.initials: LJ
authors.lastname: Eckel
authors.affiliation: Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota.
authors.forename: D R
authors.initials: DR
authors.lastname: DeLone
authors.affiliation: Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota.
authors.forename: K N
authors.initials: KN
authors.lastname: Krecke
authors.affiliation: Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota.
authors.forename: P H
authors.initials: PH
authors.lastname: Luetmer
authors.affiliation: Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota.
authors.forename: C H
authors.initials: CH
authors.lastname: McCollough
authors.affiliation: Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota.
authors.forename: J G
authors.initials: JG
authors.lastname: Fletcher
authors.affiliation: Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota.
authors.forename: L
authors.initials: L
authors.lastname: Yu
mesh_terms: D000465:Algorithms; D014695:Cerebral Ventriculography / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging*; D008297:Male; D010865:Pilot Projects; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*
references.citation: J Neurosurg. 2001 Jul;95(1):145-7
references.pmid: 11453388
references.citation: World Neurosurg. 2013 Dec;80(6):e307-12
references.pmid: 23111234
references.citation: J Neurosurg Pediatr. 2013 Jan;11(1):15-9
references.pmid: 23101557
references.citation: AJR Am J Roentgenol. 2001 Feb;176(2):289-96
references.pmid: 11159059
references.citation: Invest Radiol. 2010 Apr;45(4):202-10
references.pmid: 20177389
references.citation: Pediatr Emerg Care. 2006 Jan;22(1):28-34
references.pmid: 16418609
references.citation: Surg Neurol Int. 2012;3:103
references.pmid: 23087819
references.citation: J Comput Assist Tomogr. 2013 Jul-Aug;37(4):551-9
references.pmid: 23863531
references.citation: J Comput Assist Tomogr. 2012 Jul-Aug;36(4):477-87
references.pmid: 22805680
references.citation: Health Phys. 2011 Mar;100(3):318-21
references.pmid: 21595081
references.citation: AJR Am J Roentgenol. 2001 Jul;177(1):27-30
references.pmid: 11418392
references.citation: Pediatr Ann. 1997 Oct;26(1O):613-20
references.pmid: 9339462
references.citation: J Magn Reson Imaging. 2013 Mar;37(3):501-30
references.pmid: 23345200
references.citation: J Comput Assist Tomogr. 2012 Sep-Oct;36(5):560-9
references.pmid: 22992607
references.citation: Surg Forum. 1951;:399-403
references.pmid: 14931257
references.citation: J Neurosurg. 2005 Aug;103(2 Suppl):124-30
references.pmid: 16370277