title: Pediatric thoracic CT angiography at 70 kV: a phantom study to investigate the effects on image quality and radiation dose.
abstract: BACKGROUND
  Studies have demonstrated that 70-kilovolt (kV) imaging enhances the contrast of iodine, potentially affording a reduction in radiation dose while maintaining the contrast-to-noise ratio (CNR). There is a maximum amount of image noise beyond which increased contrast does not improve structure visualization. Thus, noise should be constrained during protocol optimization.
  
  
  OBJECTIVE
  This phantom study investigated the effect of 70-kV imaging for pediatric thoracic CT angiography on image quality and radiation dose in a pediatric population when a noise constraint was considered.
  
  
  METHODS
  We measured contrast and noise using anthropomorphic thoracic phantoms ranging in size from newborn age equivalent to 10-year-old age equivalent. We inserted contrast rods into the phantoms to simulate injected contrast material used in a CT angiography study. The image-quality metric "iodine CNR with a noise constraint" was used to determine the relative dose factor for each phantom size, kV setting (70-140 kV) and noise constraint (1.00-1.20). A noise constraint of 1.20 indicates that noise should not increase by more than 20% of the noise level in images performed at the reference kV, selected to be 80 kV in this study. The relative dose factor can be applied to the original dose obtained at 80 kV in order to maintain iodine CNR with the noise constraint. A relative dose factor <1.0 indicates potential for dose reduction while a relative dose factor >1.0 indicates a dose penalty.
  
  
  RESULTS
  Iodine contrast was highest for 70 kV and decreased with higher kV settings for all phantom sizes. The relative dose factor at 70 kV was <1.0 for all noise constraint >1.0, indicating potential for dose reduction, for the newborn, 1-year-old and 5-year-old age-equivalent phantom sizes. For the 10-year-old age-equivalent phantom, relative dose factor at 70 kV=1.22, 1.11, 1.01, 0.92 and 0.83 for noise constraint=1.00, 1.05, 1.10, 1.15, 1.20, respectively, indicating a dose penalty for noise constraint ≤1.10 and potential for dose reduction for noise constraint >1.10.
  
  
  CONCLUSIONS
  Using 70 kV does allow for radiation dose reduction if the radiologist is willing to accept a higher level of image noise as a trade-off for increased vessel contrast. This increase in noise is small (<5%) for the nominal newborn, 1- and 5-year-old but is >10% for the 10-year-old. Therefore, we recommend limiting 70 kV thoracic CT angiography to newborn through 5-year-old patients.
authors.affiliation: Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. robert.d.macdougall@childrens.harvard.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: MacDougall
authors.affiliation: Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Kleinman
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lifeng
authors.initials: L
authors.lastname: Yu
authors.affiliation: Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Lee
mesh_terms: D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography / Q000379:methods*; D003287:Contrast Media; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007455:Iodine; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D059629:Signal-To-Noise Ratio
chemical_list: D003287:Contrast Media; D007455:Iodine
keywords: 70 kV; Children; Computed tomography; Dose reduction; Phantom