儿童头部CT辐射剂量降低的创新协议优化

BACKGROUND: Given children's heightened radiosensitivity and long-life expectancy, pediatric computed tomography (CT) requires minimizing ionizing radiation while preserving diagnostic performance, using as low as reasonably achievable (ALARA)-driven protocol optimization.

OBJECTIVE: To implement and validate a structured, physics-driven optimization method for non-contrast pediatric head CT that reduces radiation dose while preserving reader rated diagnostic acceptability.

METHODS: (1) Feasibility check: retrospective re-reconstruction using half slice thickness to increase apparent image noise by ∼50%; (2) anthropomorphic pediatric phantom scans to derive 17% and 30% dose reduction protocol variants; (3) quantitative Catphan testing; and (4) phased clinical roll out with predefined quality checks. Two board-certified radiologists, blinded to protocol, scored image quality of 133 head CT scans, before and after intervention. Dose endpoints were CT dose index volume and dose length product.

RESULTS: Reader rated image quality(IQ) scores were high under both standard- and lower-dose protocols, most rated good-excellent, with no clinically meaningful difference between protocols across predefined criteria (p > 0.10). Clinically implemented optimized protocol achieved ∼17% dose reduction relative to baseline, with an average DLP of ≈255 mGy·cm, while maintaining reader-rated diagnostic acceptability. These values are well below European pediatric Diagnostic Reference Levels for head CT. Conclusions Our stepwise, physics-anchored optimization method can reduce pediatric head CT dose while maintaining reader-rated diagnostically acceptable image quality. Further prospective validation is warranted before broader implementation and extension to additional protocols.