Comparison of Radiation Dose and Image Quality of Pediatric High-Resolution Chest CT Between Photon-Counting Detector CT and Energy-Integrated Detector CT: A Matched Study.

Abstract

Background: Photon-counting detector (PCD) CT has been shown to reduce radiation dose and improve image quality in adult chest CT examinations; its potential impact in pediatric CT is not well documented. Purpose: To compare radiation dose, objective image quality, and subjective image quality between PCD CT and energy-integrating detector (EID) CT in children undergoing high-resolution CT (HRCT) of the chest. Methods: This retrospective study included 27 children (median age, 3.9; 10 girls, 17 boys) who underwent PCD CT between March 1, 2022 and August 31, 2022, and 27 children (median age, 4.0 years; 13 girls, 14 boys) who underwent EID CT between August 1, 2021 and January 31, 2022; all examinations comprised clinically indicated chest HRCT. Patients in the two groups were matched by age and water-equivalent diameter. Radiation dose parameters were recorded. One observer placed ROIs to measure objective parameters (lung attenuation, image noise, and SNR). Two radiologists independently assessed subjective measures (overall image quality and motion artifacts) using 5-point Likert scales (1=highest quality). Groups were compared. Results: PCD CT, in comparison with EID CT, showed lower median CTDIvol (0.41 vs 0.71 mGy, P<.001), DLP (10.2 vs 13.7 mGy*cm, p=.008), size-specific dose estimate (0.82 vs 1.34 mGy, P<.001), and mAs (48.0 vs 202.0, P<.001). PCD CT and EID CT showed no significant difference in right upper lobe (RUL) lung attenuation (-793 vs -750 HU, P=.09), right lower lobe (RLL) lung attenuation (-745 vs -716, P=.23), RUL image noise (55 vs 51 HU, P=.27), RLL image noise (59 vs 57 HU, P=.48), RUL SNR (-14.9 vs -15.8, P=.89), or RLL SNR (-13.1 vs -13.6, P=.79). PCD CT and EID CT showed no significant difference in median overall image quality for reader 1 (1.0 vs 1.0, P=.28) or reader 2 (1.0 vs 1.0, P=.07), or median motion artifacts for reader 1 (1.0 vs 1.0, P=.17) or reader 2 (1.0 vs 1.0, P=.22). Conclusion: PCD CT demonstrated significantly reduced dose levels, without significant difference in objective or subjective image quality compared with EID CT. Clinical Impact: These data expand understanding of the capabilities of PCD CT and support its routine in children.