title: Successful Dose Reduction Using Reduced Tube Voltage With Hybrid Iterative Reconstruction in Pediatric Abdominal CT.
abstract: OBJECTIVE
  The purpose of this article is to assess radiation dose reduction, image quality, and diagnostic confidence using low tube voltage in combination with hybrid iterative reconstruction in contrast-enhanced pediatric abdominal CT.
  
  
  METHODS
  CT examinations of 133 patients (median age, 10 years) were performed at sequentially reduced doses. The first group (group 1) was scanned using dimension-based protocols at 120 kV for all patient sizes. The optimized group (group 5) was scanned at 80 kV for less than 18 cm in the lateral dimension and 100 kV in the 19-30 cm lateral dimension. CT examinations reconstructed with filtered back projection (FBP) and four levels of hybrid iterative reconstruction were reviewed by four blinded readers for subjective image quality and diagnostic confidence. Objective noise, volume CT dose index (CTDIvol), and size-specific dose estimate (SSDE) were recorded. Data were analyzed using t tests, one and two-way ANOVA, and the intraclass correlation coefficient.
  
  
  RESULTS
  Compared with group 1, the radiation dose was reduced for group 5 by 63% measured by SSDE (4.69 vs 10.00 mGy; p < 0.001). Subjective image noise was increased for FBP images (p < 0.001) but not was statistically significantly different for all levels of hybrid iterative reconstruction; artifacts were reduced and visibility of small structures was improved (both p < 0.001). Diagnostic confidence was improved for solid organ injury and metastatic disease (both p < 0.001) and was not statistically significantly different for appendicitis (p = 0.306).
  
  
  CONCLUSIONS
  Use of hybrid iterative reconstruction with low-tube-voltage protocols enables substantial radiation dose reduction for pediatric abdominal CT with equivalent to improved subjective image quality and diagnostic confidence.
authors.affiliation: 1 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106.
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Berlin
authors.affiliation: 1 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106.
authors.forename: Dayna M
authors.initials: DM
authors.lastname: Weinert
authors.affiliation: 1 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106.
authors.forename: Pauravi S
authors.initials: PS
authors.lastname: Vasavada
authors.affiliation: 1 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106.|2 Present address: Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Martinez-Rios
authors.affiliation: 1 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106.
authors.forename: Roshni A
authors.initials: RA
authors.lastname: Parikh
authors.affiliation: 1 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106.|3 Present address: Children's National Medical Center, Washington, DC.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Wien
authors.affiliation: 1 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106.
authors.forename: David W
authors.initials: DW
authors.lastname: Jordan
authors.affiliation: 1 Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Novak
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D011860:Radiography, Abdominal / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: ALARA; dose reduction; iterative reconstruction; low tube voltage; pediatric body CT