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Effect of low tube voltage and low iodine concentration abdominal CT on image quality and radiation dose in children: preliminary study

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Abstract

Purpose

To evaluate the image quality of a double-low protocol (low tube voltage and low iodine concentration) for abdominal CT in children.

Materials and methods

The double-low protocol was compared to the conventional protocol in pediatric patients weighing less than 40 kg from May 2016 to December 2016. Double-low protocol (Group A, n = 18): tube voltage, 70 kVp; and iodine concentration,: 250 mgI/mL versus Conventional protocol (Group B, n = 13): tube voltage, 80–100 kVp; and iodine concentration, 350 mgI/mL. Mean attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared between the two groups. Image contrast, noise, beam-hardening artifacts, and overall image quality were subjectively scored. Reader performance for correctly differentiating two groups by visual assessment was evaluated. Radiation dose and total iodine load were recorded.

Results

The mean attenuations of the portal vein and liver and the mean image noise in Group A were higher than in Group B (p = 0.04, 0.03, 0.004, respectively). The mean SNR and CNR of the main portal vein and liver were lower in Group A without any statistically significant difference. There were no statistically significant differences between the two groups in qualitative analysis (image contrast, image noise, and overall image quality) with substantial agreement between the reviewers (weighted kappa values; 0.59–0.76). Significantly diminished radiation dose and iodine load were observed in Group A compared with Group B (25.0%, 36.8% reduction; p = 0.007, 0.006, respectively).

Conclusion

The double-low protocol was feasible for pediatric abdominal CT and reduced both radiation dose and iodine load, while maintaining image quality.

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References

  1. Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, Feigelson HS, Roblin D, Flynn MJ, Vanneman N (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatrics 167:700–707

    Article  PubMed  PubMed Central  Google Scholar 

  2. Zacharias C, Alessio AM, Otto RK, Iyer RS, Philips GS, Swanson JO, Thapa MM (2013) Pediatric CT: strategies to lower radiation dose. AJR American Journal of Roentgenology 200:950–956

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yu L, Bruesewitz MR, Thomas KB, Fletcher JG, Kofler JM, McCollough CH (2011) Optimal tube potential for radiation dose reduction in pediatric CT: principles, clinical implementations, and pitfalls. Radiographics 31:835–848

    Article  PubMed  Google Scholar 

  4. Nakayama Y, Awai K, Funama Y, Hatemura M, Imuta M, Nakaura T, Ryu D, Morishita S, Sultana S, Sato N (2005) Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise 1. Radiology 237:945–951

    Article  PubMed  Google Scholar 

  5. Bae KT (2010) Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 256:32–61

    Article  PubMed  Google Scholar 

  6. Singh J, Daftary A (2008) Iodinated contrast media and their adverse reactions. Journal of Nuclear Medicine Technology 36:69–74

    Article  PubMed  Google Scholar 

  7. Beckett KR, Moriarity AK, Langer JM (2015) Safe use of contrast media: what the radiologist needs to know. Radiographics 35:1738–1750

    Article  PubMed  Google Scholar 

  8. Barrett BJ, Parfrey PS (2006) Preventing nephropathy induced by contrast medium. New England Journal of Medicine 354:379–386

    Article  CAS  PubMed  Google Scholar 

  9. Verghese PS (2014) Contrast nephropathy in children. Journal of Pediatric Intensive Care 3:045–052

    Google Scholar 

  10. Nyman U, Almén T, Aspelin P, Hellström M, Kristiansson M, Sterner G (2005) Contrast-medium-Induced nephropathy correlated to the ratio between dose in gram iodine and estimated GFR in mL/min. Acta Radiologica 46:830–842

    Article  CAS  PubMed  Google Scholar 

  11. Kim JH, Kim MJ, Kim HY, Lee MJ (2014) Radiation dose reduction and image quality in pediatric abdominal CT with kVp and mAs modulation and an iterative reconstruction technique. Clinical Imaging 38:710–714

    Article  PubMed  Google Scholar 

  12. Khawaja RDA, Singh S, Otrakji A, Padole A, Lim R, Nimkin K, Westra S, Kalra MK, Gee MS (2015) Dose reduction in pediatric abdominal CT: use of iterative reconstruction techniques across different CT platforms. Pediatric Radiology 45:1046–1055

    Article  PubMed  Google Scholar 

  13. Shen Y, Hu X, Zou X, Zhu D, Li Z, Hu D (2016) Did low tube voltage CT combined with low contrast media burden protocols accomplish the goal of “double low” for patients? An overview of applications in vessels and abdominal parenchymal organs over the past 5 years. International journal of clinical practice 70.

  14. Durand S, Paul J-F (2014) Comparison of image quality between 70ákVp and 80ákVp: application to paediatric cardiac CT. European Radiology 24:3003–3009

    Article  PubMed  Google Scholar 

  15. Nakagawa M, Ozawa Y, Sakurai K, Shimohira M, Ohashi K, Asano M, Yamaguchi S, Shibamoto Y (2015) Image quality at low tube voltage (70 kV) and sinogram-affirmed iterative reconstruction for computed tomography in infants with congenital heart disease. Pediatric Radiology 45:1472–1479

    Article  PubMed  PubMed Central  Google Scholar 

  16. Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex-and age-specific conversion factors used to determine effective dose from dose-length product 1. Radiology 257:158–166

    Article  PubMed  Google Scholar 

  17. Marin D, Nelson RC, Schindera ST, Richard S, Youngblood RS, Yoshizumi TT, Samei E (2009) Low-tube-voltage, high-tube-current multidetector abdominal ct: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm—initial clinical experience 1. Radiology 254:145–153

    Article  Google Scholar 

  18. Takahashi H, Okada M, Hyodo T, Hidaka S, Kagawa Y, Matsuki M, Tsurusaki M, Murakami T (2014) Can low-dose CT with iterative reconstruction reduce both the radiation dose and the amount of iodine contrast medium in a dynamic CT study of the liver? European Journal of Radiology 83:684–691

    Article  PubMed  Google Scholar 

  19. Nakaura T, Nakamura S, Maruyama N, Funama Y, Awai K, Harada K, Uemura S, Yamashita Y (2012) Low contrast agent and radiation dose protocol for hepatic dynamic CT of thin adults at 256–detector row CT: effect of low tube voltage and hybrid iterative reconstruction algorithm on image quality. Radiology 264:445–454

    Article  PubMed  Google Scholar 

  20. Namimoto T, Oda S, Utsunomiya D, Shimonobo T, Morita S, Nakaura T, Yamashita Y (2012) Improvement of image quality at low-radiation dose and low-contrast material dose abdominal CT in patients with cirrhosis: intraindividual comparison of low tube voltage with iterative reconstruction algorithm and standard tube voltage. Journal of Computer Assisted Tomography 36:495–501

    Article  PubMed  Google Scholar 

  21. Zhang X, Li S, Liu W, Huang N, Li J, Cheng L, Xu K (2016) Double-low protocol for hepatic dynamic CT scan: effect of low tube voltage and low-dose iodine contrast agent on image quality. Medicine 95:e4004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Geyer LL, Schoepf UJ, Meinel FG, Nance Jr JW, Bastarrika G, Leipsic JA, Paul NS, Rengo M, Laghi A, De Cecco CN (2015) State of the art: iterative CT reconstruction techniques. Radiology 276:339–357

    Article  PubMed  Google Scholar 

  23. Padole A, Ali Khawaja RD, Kalra MK, Singh S (2015) CT radiation dose and iterative reconstruction techniques. American Journal of Roentgenology 204:W384–W392

    Article  PubMed  Google Scholar 

  24. Kalra MK, Woisetschläger M, Dahlström N, Singh S, Lindblom M, Choy G, Quick P, Schmidt B, Sedlmair M, Blake MA (2012) Radiation dose reduction with Sinogram Affirmed Iterative Reconstruction technique for abdominal computed tomography. Journal of Computer Assisted Tomography 36:339–346

    Article  PubMed  Google Scholar 

  25. Schabel C, Fenchel M, Schmidt B, Flohr TG, Wuerslin C, Thomas C, Korn A, Tsiflikas I, Claussen CD, Heuschmid M (2013) Clinical evaluation and potential radiation dose reduction of the novel sinogram-affirmed iterative reconstruction technique (SAFIRE) in abdominal computed tomography angiography. Academic Radiology 20:165–172

    Article  PubMed  Google Scholar 

  26. NNakaura T, Awai K, Maruyama N, Takata N, Yoshinaka I, Harada K, Uemura S, Yamashita Y (2011) Abdominal dynamic CT in patients with renal dysfunction: contrast agent dose reduction with low tube voltage and high tube current–time product settings at 256–detector row CT. Radiology 261:467–476

    Article  PubMed  Google Scholar 

  27. Raman SP, Johnson PT, Deshmukh S, Mahesh M, Grant KL, Fishman EK (2013) CT dose reduction applications: available tools on the latest generation of CT scanners. Journal of the American College of Radiology 10:37–41

    Article  PubMed  Google Scholar 

  28. Wang W, Zhao YE, Qi L, Li X, Zhou CS, Zhang LJ, Lu GM (2017) Prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp with 30 mL contrast agent: an intraindividual comparison with sequential scanning at 120 kVp with 60 mL contrast agent. European Journal of Radiology 90:97–105

    Article  PubMed  Google Scholar 

  29. Li X, Ni QQ, Schoepf UJ, Wichmann JL, Felmly LM, Qi L, Kong X, Zhou CS, Luo S, Zhang LJ, Lu GM (2015) 70-kVp high-pitch computed tomography pulmonary angiography with 40 mL contrast agent: initial experience. Academic Radiology 22:1562–1570

    Article  PubMed  Google Scholar 

  30. Chen GZ, Fang XK, Zhou CS, Zhang LJ, Lu GM (2017) Cerebral CT angiography with iterative reconstruction at 70kVp and 30 mL iodinated contrast agent: initial experience. European Journal of Radiology 88:102–108

    Article  PubMed  Google Scholar 

  31. Karcaaltincaba M, Oguz B, Haliloglu M (2009) Current status of contrast-induced nephropathy and nephrogenic systemic fibrosis in children. Pediatric Radiology 39:382–384

    Article  PubMed  Google Scholar 

  32. Maliborski A, Żukowski P, Nowicki G, Bogusławska R (2011) Contrast-induced nephropathy–a review of current literature and guidelines. Medical science monitor: international medical journal of experimental and clinical research 17: RA199.

  33. Saint-Laurent Q Consensus Guidelines for the Prevention of Contrast Induced Nephropathy.

  34. Trout AT, Dillman JR, Ellis JH, Cohan RH, Strouse PJ (2011) Patterns of intravenous contrast material use and corticosteroid premedication in children—a survey of Society of Chairs of Radiology in Children’s Hospitals (SCORCH) member institutions. Pediatric Radiology 41:1272–1283

    Article  PubMed  Google Scholar 

  35. Zo’o M, Hoermann M, Balassy C, Brunelle F, Azoulay R, Pariente D, Panuel M, Le Dosseur P (2011) Renal safety in pediatric imaging: randomized, double-blind phase IV clinical trial of iobitridol 300 versus iodixanol 270 in multidetector CT. Pediatric Radiology 41:1393

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, Chungnam National University College of Medicine, Daejeon, Republic of Korea

    Sun Kyoung You

  2. Department of Radiology, Chungnam National University Hospital, Daejeon, Republic of Korea

    Sun Kyoung You

  3. Department of Radiology, Seoul National University Children’s Hospital, Seoul, Republic of Korea

    Young Hun Choi, Jung-Eun Cheon, Woo Sun Kim & In-One Kim

  4. Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Young Hun Choi, Jung-Eun Cheon, Woo Sun Kim & In-One Kim

  5. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea

    Jung-Eun Cheon, Woo Sun Kim & In-One Kim

  6. Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea

    So Mi Lee

  7. Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea

    Hyun-Hae Cho

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  1. Sun Kyoung You
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Correspondence to Young Hun Choi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of our institution and was waived the requirement for informed consent.

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You, S.K., Choi, Y.H., Cheon, JE. et al. Effect of low tube voltage and low iodine concentration abdominal CT on image quality and radiation dose in children: preliminary study. Abdom Radiol 44, 1928–1935 (2019). https://doi.org/10.1007/s00261-019-01896-6

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  • DOI: https://doi.org/10.1007/s00261-019-01896-6

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