Participants
This research was approved by the ethics committee of Jilin University (date of approval: February 1th 2017) and written informed consent was provided to every participant. During a 7-month period from February to September 2017, pediatric patients were recommended to undergo a non-contrast head CT examination for various clinical symptoms form neurosurgery, neurology and emergency department. Finally, 83 patients are recruited in the study, male 47, female 36, age 1-17 years old, their demographic characteristics are summarized in Table1. 15 patients were selected as the conventional group by random number method, who receive standard brain CT protocol(tube current 250mAs). The range of head circumference is 48.1-59.2cm (53.75±3.14cm). The other 68 patients were randomly separated into 3 low-dose group based on the HC: group A, 54.1-57.0cm, (56.00±0.24cm); group B, 51.1-54.0 cm, (52.98±0.20cm); group C, 48.1-51.0cm, (49.54±0.23cm). General information and scan parameters for conventional and low-dose group is in Table2.
Scanning Protocol
All subject’s head CT examination were performed with a 64-slice MDCT scanner (Light Speed, GE Healthcare, USA) in the axial plane with the patient in the supine position. The tube current in conventional group was 250mAs. The tube currents in low-dose groups were 200mAs, 150mAs and 100mAs for group A, B and C, respectively. The following remaining scanning parameters were the same for four groups: 120 kVp, 5mm section thickness, 0.45mm interval, 360ms rotation time and a FOV of 38mm×38mm.
Organ-Specific-Radiation Dose Levels Estimation
Radimetrics, researched and developed by Byer Healthcare from Germany, an analysis platform based on Monte-Carlo-Simulation was used to calculate the radiation doses of sensitive organs.14, 15 The total organ dose is calculated first for each slice using the CTDIvol at that slice and then summed over the slices that all into the scan region:
See Formula 1 in the Supplemental Files
Where coeff is the ratio of the simulated organ to the simulated CTDIvol as described above, and i indicates slice specific values.
Subjective image quality score assessment
Subjective image quality analysis was performed by two neuroradiologists with 8 and 20 years’ experience, respectively. The neuroradiologists were blind to the scanner, scan parameters and slice thickness . Images were displayed using a fixed brain window setting (window width, 80Hu; window level, 40Hu). In the subject image quality assessment (1) severity of background noise, (2) severity of imaging artefacts, and (3) clarity of demonstration of lesions and anatomical structure were taken into account. Five grade were designed to each factor with 5 representing the best quality (Table 3). The scores from the three domains determined by the two neuroradiologist were then averaged to generate an overall score for image quality. An image quality score ≥3 was consider a qualified image for the demand of diagnostic.
Objective image quality score assessment
All head CT images measurement were carried out on GE workstation ADW4.4 in our department. The bilateral thalamus and centrum ovale were selected to place equal ROIs by a 10 years’ experience neuroradiologist who were blind to the scanner, scan parameters and slice thickness. Average values on both sides. The standard deviation (SD) of mean CT density (Hounsfield unit) was used to measure the noise. The signal to noise ratio (SNR) was the HU/SD . The representative image measurement in FIG 1.
Statistical analysis
All data were analyzed using SPSS (Version 22; IBM, New York, USA). An initial analysis was performed using the Anderson–Darling test to evaluate whether the data were normally distributed. Numerical data were expressed as means ± standard deviation (SD) and compared by Mann–Whitney U test or ANOVA, as appropriate. ANOVA test was used to compare the difference of radiation dose and image quality score of sensitive organs in each group. When the difference was significant, tukey-kramer pairwise comparison would be conducted. Wilcoxon rank sum test was used for non-normal distribution. The consistency of the analysis results of two radiologists was checked by Kappa-test. The K value > 0.6 was good, 0.4≤ K value ≤0.6 was moderate, and the K value < 0.4 was poor. The statistical significance level was set as P<0.05.