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Organ-based tube current modulation and bismuth eye shielding in pediatric head computed tomography

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Abstract

Background

Exposure of the eye lens to ionizing radiation results in cataract. Several dose optimization techniques to protect the lens are available for computed tomography (CT).

Objective

The radiation dose to the eye lens, volume CT dose index (CTDIvol) and image quality of various methods of dose optimization were evaluated for pediatric head CT: automated tube current modulation (ATCM), automated tube voltage selection (ATVS), organ-based tube current modulation (OBTCM) and bismuth shielding.

Materials and methods

An anthropomorphic phantom of a 5-year-old child was scanned with nine protocols: no dose optimization technique and then adding different dose optimization techniques alone and in combination. Dose to the eye, thyroid and breast were estimated using metal oxide semiconductor field effect transistor (MOSFET) dosimetry. CTDIvol, influence of timing of shield placement, image noise and attenuation values in 13 regions of interest of the head and subjective image quality were compared.

Results

The eye shield significantly reduced the eye lens dose when used alone, to a similar degree as when using all software-based techniques together. When used in combination with software-based techniques, the shield reduced the eye lens dose by up to 45% compared to the no dose optimization technique. Noise was significantly increased by the shield, most pronounced in the anterior portion of the eye.

Conclusion

The combination of ATCM, ATVS, OBTCM and a bismuth shield, with the shield placed after acquiring the localizer image, should be considered to reduce the radiation dose to the eye lens in pediatric head CT.

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Acknowledgments

We thank Damian Koller and Evelyn Wirth for their excellent technical support.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland

    Stefan Markart & Stephan L. Waelti

  2. Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Stefan Markart, Tim S. Fischer, Simon Wildermuth, Tobias J. Dietrich, Sebastian Leschka & Stephan L. Waelti

  3. Department of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Tobias J. Dietrich & Hatem Alkadhi

  4. Clinical Trials Unit, Biostatistics, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Sabine Guesewell

  5. Department of Diagnostic Imaging, Monash Children’s Hospital, Clayton, Australia

    Michael R. Ditchfield

  6. Radiation Protection and Medical Physics, Cantonal Hospital Aarau, Aarau, Switzerland

    Ismail Oezden & Gerd Lutters

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  1. Stefan Markart
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  2. Tim S. Fischer
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Correspondence to Stephan L. Waelti.

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Markart, S., Fischer, T.S., Wildermuth, S. et al. Organ-based tube current modulation and bismuth eye shielding in pediatric head computed tomography. Pediatr Radiol 52, 2584–2594 (2022). https://doi.org/10.1007/s00247-022-05410-x

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  • DOI: https://doi.org/10.1007/s00247-022-05410-x

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