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Pediatric craniosynostosis computed tomography: an institutional experience in reducing radiation dose while maintaining diagnostic image quality

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Abstract

Background

Children with craniosynostosis may undergo multiple computed tomography (CT) examinations for diagnosis and post-treatment follow-up, resulting in cumulative radiation exposure.

Objective

To reduce the risks associated with radiation exposure, we evaluated the compliance, radiation dose reduction and clinical image quality of a lower-dose CT protocol for pediatric craniosynostosis implemented at our institution.

Materials and methods

The standard of care at our institution was modified to replace pediatric head CT protocols with a lower-dose CT protocol utilizing 100 kV, 5 mAs and iterative reconstruction. Study-ordered, protocol-utilized and radiation-dose indices were collected for studies performed with routine pediatric brain protocols (n=22) and with the lower-dose CT protocol (n=135). Two pediatric neuroradiologists evaluated image quality in a subset (n=50) of the lower-dose CT studies by scoring visualization of cranial structures, confidence of diagnosis and the need for more radiation dose.

Results

During the 30-month period, the lower-dose CT protocol had high compliance, with 2/137 studies performed with routine brain protocols. With the lower-dose CT protocol, volume CT dose index (CTDIvol) was 1.1 mGy for all patients (0–9 years old) and effective dose ranged from 0.06 to 0.22 mSv, comparable to a 4-view skull radiography examination. CTDIvol was reduced by 98% and effective dose was reduced up to 67-fold. Confidence in diagnosing craniosynostosis was high and more radiation dose was considered unnecessary in all studies (n=50) by both radiologists.

Conclusion

Replacing the routine pediatric brain CT protocol with a lower-dose CT craniosynostosis protocol substantially reduced radiation exposure without compromising image quality or diagnostic confidence.

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Authors and Affiliations

  1. Division of Medical Physics, Department of Radiology, University of Florida, P.O. Box 100374, Gainesville, FL, 32610, USA

    Izabella L. Barreto

  2. Department of Radiology, University of Florida, Gainesville, FL, USA

    Ibrahim S. Tuna & Dhanashree A. Rajderkar

  3. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA

    Jessica A. Ching

  4. Craniofacial Center, UF Health Shands Children’s Hospital, Gainesville, FL, USA

    Jessica A. Ching & Lance S. Governale

  5. Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida, Gainesville, FL, USA

    Lance S. Governale

Authors
  1. Izabella L. Barreto
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  2. Ibrahim S. Tuna
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  3. Dhanashree A. Rajderkar
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  4. Jessica A. Ching
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  5. Lance S. Governale
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Correspondence to Izabella L. Barreto.

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Barreto, I.L., Tuna, I.S., Rajderkar, D.A. et al. Pediatric craniosynostosis computed tomography: an institutional experience in reducing radiation dose while maintaining diagnostic image quality. Pediatr Radiol 52, 85–96 (2022). https://doi.org/10.1007/s00247-021-05205-6

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  • DOI: https://doi.org/10.1007/s00247-021-05205-6

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