title: Ultralow dose computed tomography attenuation correction for pediatric PET CT using adaptive statistical iterative reconstruction.
abstract: OBJECTIVE
  To develop ultralow dose computed tomography (CT) attenuation correction (CTAC) acquisition protocols for pediatric positron emission tomography CT (PET CT).
  
  
  METHODS
  A GE Discovery 690 PET CT hybrid scanner was used to investigate the change to quantitative PET and CT measurements when operated at ultralow doses (10-35 mA s). CT quantitation: noise, low-contrast resolution, and CT numbers for 11 tissue substitutes were analyzed in-phantom. CT quantitation was analyzed to a reduction of 90% volume computed tomography dose index (0.39/3.64; mGy) from baseline. To minimize noise infiltration, 100% adaptive statistical iterative reconstruction (ASiR) was used for CT reconstruction. PET images were reconstructed with the lower-dose CTAC iterations and analyzed for: maximum body weight standardized uptake value (SUVbw) of various diameter targets (range 8-37 mm), background uniformity, and spatial resolution. Radiation dose and CTAC noise magnitude were compared for 140 patient examinations (76 post-ASiR implementation) to determine relative dose reduction and noise control.
  
  
  RESULTS
  CT numbers were constant to within 10% from the nondose reduced CTAC image for 90% dose reduction. No change in SUVbw, background percent uniformity, or spatial resolution for PET images reconstructed with CTAC protocols was found down to 90% dose reduction. Patient population effective dose analysis demonstrated relative CTAC dose reductions between 62% and 86% (3.2/8.3-0.9/6.2). Noise magnitude in dose-reduced patient images increased but was not statistically different from predose-reduced patient images.
  
  
  CONCLUSIONS
  Using ASiR allowed for aggressive reduction in CT dose with no change in PET reconstructed images while maintaining sufficient image quality for colocalization of hybrid CT anatomy and PET radioisotope uptake.
authors: Division of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee 38105.
authors: Samuel L
authors: SL
authors: Brady
authors: Nuclear Medicine and Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105.
authors: Barry L
authors: BL
authors: Shulkin
mesh_terms: D000293:Adolescent; D001692:Biological Transport; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007223:Infant; D008297:Male; D019047:Phantoms, Imaging; D049268:Positron-Emission Tomography; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18