European Radiology

, Volume 23, Issue 5, pp 1306–1315 | Cite as

Cardiovascular CT angiography in neonates and children: Image quality and potential for radiation dose reduction with iterative image reconstruction techniques

  • Francesco Tricarico
  • Anthony M. Hlavacek
  • U. Joseph SchoepfEmail author
  • Ullrich Ebersberger
  • John W. NanceJr.
  • Rozemarijn Vliegenthart
  • Young Jun Cho
  • J. Reid Spears
  • Francesco Secchi
  • Giancarlo Savino
  • Riccardo Marano
  • Stefan O. Schoenberg
  • Lorenzo Bonomo
  • Paul Apfaltrer



To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CTA), comparing iterative reconstruction in image space (IRIS) and sinogram-affirmed iterative reconstruction (SAFIRE) with filtered back-projection (FBP) and estimate the potential for further dose reductions.


Forty neonates and children underwent low radiation CTA with or without ECG synchronisation. Data were reconstructed with FBP, IRIS and SAFIRE. For ECG-synchronised studies, half-dose image acquisitions were simulated. Signal noise was measured and IQ graded. Effective dose (ED) was estimated.


Mean absolute and relative image noise with IRIS and full-dose SAFIRE was lower than with FBP (P < 0.001), while SNR and CNR were higher (P < 0.001). Image noise was also lower and SNR and CNR higher in half-dose SAFIRE studies compared with full-and half-dose FBP studies (P < 0.001). IQ scores were higher for IRIS, full-dose SAFIRE and half-dose SAFIRE than for full-dose FBP and higher for half-dose SAFIRE than for half-dose FBP (P < 0.05). Median weight-specific ED was 0.3 mSv without and 1.36 mSv with ECG synchronisation. The estimated ED of half-dose SAFIRE studies was 0.68 mSv.


IR improves image noise, SNR, CNR and subjective IQ compared with FBP in low-radiation-dose paediatric CTA and allows further dose reductions without compromising diagnostic IQ.

Key Points

Iterative reconstruction techniques significantly improve non-invasive cardiovascular CT in children.

Using half traditional radiation dose image quality is higher with iterative reconstruction.

Iterative reconstruction techniques may allow further radiation reductions in paediatric cardiovascular CT.


Computed tomography Congenital heart disease Radiation dose Iterative image reconstruction Pediatric imaging 



Contrast/Noise Ratio


CT angiography




Effective radiation dose equivalent


Filtered back projection


Hounsfield units


Image quality


Iterative reconstruction in image space


Region of interest


Sinogram affirmed iterative reconstruction


Standard deviation


Signal-to-noise ratio


Volume-rendered technique



UJS is a consultant for and receives research support from Bayer, Bracco, GE, Medrad and Siemens. The other authors have no conflicts of interest to disclose.


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Francesco Tricarico
    • 1
    • 2
  • Anthony M. Hlavacek
    • 1
    • 3
  • U. Joseph Schoepf
    • 1
    • 3
    • 4
    Email author
  • Ullrich Ebersberger
    • 1
    • 5
  • John W. NanceJr.
    • 1
    • 6
  • Rozemarijn Vliegenthart
    • 1
    • 7
  • Young Jun Cho
    • 1
    • 8
  • J. Reid Spears
    • 1
  • Francesco Secchi
    • 1
    • 9
  • Giancarlo Savino
    • 2
  • Riccardo Marano
    • 2
  • Stefan O. Schoenberg
    • 10
  • Lorenzo Bonomo
    • 2
  • Paul Apfaltrer
    • 1
    • 10
  1. 1.Department of Radiology and Radiological ScienceMedical University of South Carolina, Ashley River TowerCharlestonUSA
  2. 2.Department of Bioimaging and Radiological SciencesCatholic University of the Sacred Heart, “A. Gemelli” HospitalRomeItaly
  3. 3.Division of Pediatric CardiologyChildren’s Hospital, Medical University of South CarolinaCharlestonUSA
  4. 4.Division of Cardiology, Department of MedicineMedical University of South CarolinaCharlestonUSA
  5. 5.Department of Cardiology and Intensive Care MedicineHeart Centre Munich-BogenhausenMunichGermany
  6. 6.The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins HospitalBaltimoreUSA
  7. 7.Centre for Medical Imaging—North East Netherlands, Department of RadiologyUniversity Medical Centre Groningen/University of GroningenGroningenThe Netherlands
  8. 8.Department of RadiologyKonyang University School of MedicineDaejeonRepublic of Korea
  9. 9.Department of Medical and Surgical Sciences, Radiology UnitUniversity of Milan School of Medicine IRCCS Policlinico San DonatoMilanItaly
  10. 10.Institute of Clinical Radiology and Nuclear MedicineUniversity Medical Centre Mannheim, Medical Faculty Mannheim—Heidelberg UniversityMannheimGermany

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