Direction de la qualité et de la gestion des risques, Hôpital Universitaire Necker Enfants Malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France.
Service de Radiologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France.
Eur Radiol. 2016 Jul;26(7):2030-8. doi: 10.1007/s00330-015-4032-5. Epub 2015 Oct 3.
To assess the impact of different protocols on radiation dose and image quality for paediatric coronary computed tomography (cCT).
From January-2012 to June-2014, 140 children who underwent cCT on a 64-slice scanner were included. Two consecutive changes in imaging protocols were performed: 1) the use of adaptive statistical iterative reconstruction (ASIR); 2) the optimization of acquisition parameters. Effective dose (ED) was calculated by conversion of the dose-length product. Image quality was assessed as excellent, good or with significant artefacts.
Patients were divided in three age groups: 0-4, 5-7 and 8-18 years. The use of ASIR combined to the adjustment of scan settings allowed a reduction in the median ED of 58 %, 82 % and 85 % in 0-4, 5-7 and 8-18 years group, respectively (7.3 ± 1.4 vs 3.1 ± 0.7 mSv, 5.5 ± 1.6 vs 1 ± 1.9 mSv and 5.3 ± 5.0 vs 0.8 ± 2.0 mSv, all p < 0,05). Prospective protocol was used in 51 % of children. The reduction in radiation dose was not associated with reduction in diagnostic image quality as assessed by the frequency of coronary segments with excellent or good image quality (88 %).
cCT can be obtained at very low radiation doses in children using ASIR, and prospective acquisition with optimized imaging parameters.
• Using ASIR allows 25 % to 41 % reduction in the ED. • Prospective protocol is used up to 51 % of children after premedication. • Low dose is possible using ASIR and optimized prospective paediatric cCT.
评估不同方案对儿童冠状动脉 CT （cCT）的辐射剂量和图像质量的影响。
从 2012 年 1 月至 2014 年 6 月，纳入了 140 名在 64 层扫描仪上进行 cCT 的儿童。进行了两次连续的成像方案改变：1）使用自适应统计迭代重建（ASIR）；2）优化采集参数。有效剂量（ED）通过剂量长度乘积的转换来计算。图像质量评估为优秀、良好或有明显伪影。
患者分为三个年龄组：0-4 岁、5-7 岁和 8-18 岁。使用 ASIR 结合扫描设置的调整，可使 0-4 岁、5-7 岁和 8-18 岁组的中位 ED 分别降低 58%、82%和 85%（7.3±1.4 与 3.1±0.7 mSv，5.5±1.6 与 1±1.9 mSv，5.3±5.0 与 0.8±2.0 mSv，均 p<0.05）。51%的儿童使用前瞻性方案。如冠状动脉节段具有优秀或良好图像质量的频率评估所示，降低辐射剂量与降低诊断图像质量无关（88%）。
在儿童中使用 ASIR 并结合前瞻性采集和优化的成像参数，可以获得极低的辐射剂量 cCT。
• 使用 ASIR 可使 ED 降低 25%至 41%。
• 预用药后，前瞻性方案在 51%的儿童中使用。
• 使用 ASIR 和优化的前瞻性儿科 cCT 可以实现低剂量。
