Assessment of two optimization strategies for pediatric computed tomography examinations: Bismuth shielding & organ-based tube current modulation

Background: It is well known that pediatric patients are different from adult patients. Not only are children of a smaller physical size, but their anatomy differs as well. They are also more vulnerable to ionizing radiation than adults are, since their larger attributable life-time risk for cancer. This entitles children as extra radiosensitive patients, and special concern should be taken regarding their radiosensitive organs. Computed tomography (CT) examinations inevitably involve exposure of all skin-deep organs although rarely being objects for the diagnostic task. For example, multiple CT head examinations increase the risk of radiation induced cataract in eye lenses. Absorbed dose to these radiosensitive skin-deep organs should therefore be decreased by available optimization strategies in accordance withthe ALARA principle -as low as reasonably achievable- which guides the process of optimization anddose reduction. Two optimization strategies to decrease absorbed dose to skin-deep organs are Bismuth (Bi) shielding and organ-based tube current modulation (organ-based TCM). Aim: The aim of this work was to assess two dose optimization strategies for decreasing absorbed dose to skin-deep organs in pediatric CT imaging: Bi shielding and organ-based TCM. The specific patient categories chosen were newborn, one year old and five year old. Materials and Methods: Three anthropomorphic phantoms representing newborn, one year old and five year old were scanned with CT protocol parameters selected in accordance with clinical routine for pediatric CT examinations at Karolinska University Hospital in Stockholm. Dose differences from introducing the optimization strategies were obtained by using thermoluminescence dosimeters (TLDs) and metal oxide semiconductor feld effect transistor dosimeters (MOSFETs). Monte Carlo estimated dose values were introduced as a comparison to further establish the validity of the obtained measured values. Results: The benefit in decreased radiation dose to anterior skin-deep organs - when applying the optimization strategies - depended on both body region and body size. Bi shielding was more advantageous the smaller and less attenuating the body was. Organ-based TCM was more advantageous, if an increased dose to posterior organs could be accepted. A less attenuating and smaller phantom did not benefit by organ-based TCM due to increased posterior irradiation. Conclusions: The general conclusion is that the optimal choice of optimization strategy will depend on both body region being scanned and age. Regarding CT head examinations, pediatric patients of ages between newborn and five year old will benefit most by application of organ-based TCM, if an increased dose to backside head can be justified. Regarding CT thorax examinations, newborn and one year old patients will benefit most by application of Bi shielding, while organ-based TCM is preferable for five year old patients