For pediatric patients, using 0.25-0.9 mm Cu filtration in the x-ray beam while maintaining 50-55 kVp, depending on patient size, provided optimal x-ray image quality to dose ratios. These settings, adjusted for x-ray tube loading limits and clinically acceptable image quality, should provide a useful strategy for optimizing iodine contrast agent based cardiac x-ray imaging. Removing the antiscatter grid improved the FOM for the 8.5 and 12 cm phantoms, therefore grid removal is recommended for younger children. Improvement for the 16 cm phantom declined into the estimated margin of error for the FOM; the need for grid removal for older children would depend on practical feasibility in the clinical environment.
We investigated the potential for digital tomosynthesis (DT) to reduce pediatric x-ray dose while maintaining image quality. We utilized the DT feature (VolumeRad TM) on the GE Definium TM 8000 flat panel system installed in the Winnipeg Children's Hospital. Facial bones, cervical spine, thoracic spine, and knee of children aged 5, 10, and 15 years were represented by acrylic phantoms for DT dose measurements. Effective dose was estimated for DT and for corresponding digital radiography (DR) and computed tomography (CT) patient image sets. Anthropomorphic phantoms of selected body parts were imaged by DR, DT, and CT. Pediatric radiologists rated visualization of selected anatomic features in these images. Dose and image quality comparisons between DR, DT, and CT determined the usefulness of tomosynthesis for pediatric imaging. CT effective dose was highest; total DR effective dose was not always lowest-depending how many projections were in the DR image set. For the cervical spine, DT dose was close to and occasionally lower than DR dose. Expert radiologists rated visibility of the central facial complex in a skull phantom as better than DR and comparable to CT. Digital tomosynthesis has a significantly lower dose than CT. This study has demonstrated DT shows promise to replace CT for some facial bones and spinal diagnoses. Other clinical applications will be evaluated in the future.
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