Optimization of pediatric computed tomography protocols: dose reduction without loss of image quality

Maria Rosane Neczypor; Carla Roberta de Barros Dias; Jessica V. Real; Anna Luiza Malthez

doi:10.15392/2319-0612.2026.3034

Authors

Maria Rosane Neczypor Federal University of Technology of Paraná
Carla Roberta de Barros Dias Federal University of Technology of Paraná
Jessica V. Real Hospital de Clínicas Universidade Federal do Paraná
Anna Luiza Malthez Federal University of Technology of Paraná

DOI:

https://doi.org/10.15392/2319-0612.2026.3034

Keywords:

optimization, pediatric computed tomography, image quality

Abstract

This study aimed to optimize pediatric computed tomography (CT) protocols for abdomen and chest examinations, focusing on reducing radiation dose without compromising diagnostic image quality. Information was collected from factory protocols, current-modulated protocols, and those used in the routine of a university hospital, covering different age groups and acquisition parameters. The analyses included the evaluation of image quality metrics such as Signal-to-Noise Ratio (SNR), Contrast-to-Noise Ratio (CNR), Modulation Transfer Function (MTF50% and MTF10%), as well as dose indices (CTDIvol and DLP). Measurements were carried out using an ATOM 007/007TE anthropomorphic phantom, instead of a wire phantom, in accordance with international recommendations that recognize the applicability of different methods for determining MTF. Optimized protocols were proposed and tested. The data demonstrated that the suggested protocols allow significant dose reductions compared to the original protocols while maintaining adequate image quality levels. The comparison between factory, clinical routine, and optimized protocols highlighted the importance of adapting technical parameters to the pediatric profile and the available equipment, reinforcing the need for radioprotection practices aligned with the principles of justification and optimization. The results contribute to the development of safer and more effective guidelines in the context of pediatric CT, promoting highly accurate diagnoses with the lowest dose reasonably achievable, in accordance with the ALARA principle.

Downloads

Download data is not yet available.

References

[1] SANTOS, A.; NACIF, L. A. Tomografia computadorizada: fundamentos, técnica e aplicações. São Paulo: Atheneu, 2007.

[2] HOFER, K. Physics of Computed Tomography: Principles and Technical Aspects. Heidelberg: Springer, 2005.

[3] MOURÃO, A. P. Dosimetria em Tomografia Computadorizada: fundamentos físicos e aplicações clínicas. Belo Horizonte: UFMG, 2015.

[4] FINATTO, M. et al. Quality assurance in pediatric computed tomography: dose optimization and image quality control. Radiologia Brasileira, v. 48, n. 4, p. 225–232, 2015.

[5] INTERNATIONAL COMMISSION ON RADIATION UNITS AND MEASUREMENTS (ICRU). Report 87: Radiation Protection Principles. Bethesda, MD: ICRU, 2012.

[6] AWAD, M. A. et al. Optimization of radiation dose in pediatric CT imaging: current challenges and future directions. Pediatric Radiology, v. 50, n. 8, p. 1126–1136, 2020.

[7] BRENNER, D. J. et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. American Journal of Roentgenology, v. 176, n. 2, p. 289–296, 2001. DOI: https://doi.org/10.2214/ajr.176.2.1760289

[8] PEARCE, M. S. et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet, v. 380, n. 9840, p. 499–505, 2012. DOI: https://doi.org/10.1016/S0140-6736(12)60815-0

[9] OKUNO, E. Proteção radiológica e dosimetria: fundamentos. 2. ed. São Paulo: Oficina de Textos, 2018.

[10] LIU, X. et al. Pediatric anthropomorphic phantoms for computed tomography dosimetry: design, calibration and validation. Medical Physics, v. 42, n. 4, p. 1856–1865, 2015.

[11] AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE (AAPM). AAPM Report No. 204: Size-Specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations. College Park, MD: American Association of Physicists in Medicine, 2020.

[12] BONFLEUR, E. M. Optimization of pediatric CT protocols: balancing image quality and radiation dose. 2022. Dissertação (Mestrado em Engenharia Biomédica) – Universidade Tecnológica Federal do Paraná, Curitiba, 2022.

[13] AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE (AAPM). AAPM Report No. 233: Strategies for Image Quality and Dose Optimization in Pediatric CT. College Park, MD: AAPM, 2019.

[14] AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE (AAPM). AAPM Report No. 204: Size-Specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations. College Park, MD: AAPM, 2017.

[15] KALENDER, W. A. Computed Tomography: Fundamentals, System Technology, Image Quality, Applications. 3rd ed. Erlangen: Publicis Publishing, 2014.

[16] INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION (ICRP). Publication 135: Diagnostic Reference Levels in Medical Imaging. Oxford: Pergamon Press, 2017.

[17] HEIDORNE GUERRA, R. A. et al. Evaluation of radiation doses in pediatric computed tomography and proposal of optimization protocols. Brazilian Journal of Medical Physics, v. 13, n. 2, p. 85–93, 2019.

[18] SOUZA, V. F. Avaliação e otimização de protocolos de tomografia computadorizada pediátrica no Hospital Pequeno Príncipe. Curitiba: Hospital Pequeno Príncipe, 2023.

[19] HOSPITAL PEQUENO PRÍNCIPE (HPP). Relatório Anual de Produção em Diagnóstico por Imagem: Setor de Tomografia Computadorizada 2024. Curitiba: HPP, 2024.

[20] GONZALEZ, P. et al. Implementation of pediatric CT optimization protocols: impact on image quality and patient dose. Radiation Protection Dosimetry, v. 169, n. 1-4, p. 232–240, 2016.

[21] ALCANTARA, M. S. et al. Pediatric CT imaging optimization and radiation protection: review and institutional practices. Journal of Applied Clinical Medical Physics, v. 23, n. 10, p. 1–14, 2022.