Optimization of head radiographic examination protocols in pediatric patients

Abstract

Introduction Head radiography comprises a common examination protocol in clinical routine. Diagnostic decisions are associated with the detected injuries. Consequently, image quality of the x-ray examinations is essential for the early diagnosis and appropriate treatment, especially for the sensitive population of children. Therefore each examination protocol should be appropriately optimized to achieve images of high diagnostic quality and minimum radiation burden to patients. Purpose To optimize the radiographic technique for head examination protocols in pediatric patients. Methods and materials Three anthropomorphic phantoms (ATOM Phantoms, CIRS, Norfolk, VA) representing the average individual as neonate, 5-year-old, and 10-year-old child were employed. The phantoms were subjected to head radiographs using a state of the art digital radiographic system (AGFA GAEVART, DX-D600) for various tube voltages (50–125 kVp) and current settings (0.2–50 mAs). For each exposure, image quality objective parameters, including contrast to noise ratio values (CNR) were estimated to determine figure of merit (FOM) in the optimization process. The technique associated with the higher CNR value for the same FOM was considered as the optimized method. Results Dose reduction of up to 88% was recorded for the same CNR value when decreasing tube voltage. CNR was found to be improved decreasing tube voltage for all ages of pediatric phantoms. However, due to larger exposure time, motion artifacts may be conspicuous. Conclusion A reliable optimization methodology for head radiographs in pediatric patients was presented. The method described may be also applied in other anatomical regions.