Dual energy head CT to maintain image quality while reducing dose in pediatric patients

Published:February 07, 2019DOI:


      • Dual Energy CT head can be used routinely in a busy pediatric practice
      • Advantages include: Decreased artifact and radiation dose
      • Disadvantages include: Increased scan time and need for dual energy capable CT scanner



      The aim of this study was to use dual energy CT technology to maintain or improve image quality in pediatric head CT while simultaneously reducing radiation dose.

      Materials and methods

      In this retrospective study, helical head CTs performed using a standard head CT protocol were compared to studies performed with a dual energy (DE) protocol. Objective comparison was performed by measuring regions of interest in 11 areas of the brain. Subjective rating for image quality using a Likert scale, was performed by three radiologists. Radiation doses were evaluated using CT dose index and dose length product.


      Signal-to-noise ratio was, for the most part, not significantly different between the DE and conventional scans. Contrast-to-noise ratio was slightly lower for children over 6 year of age utilizing the dual energy protocol versus the standard protocol.
      Qualitatively, there was little difference in image quality in patients <6 years old, with the only significant difference in infratentorial noise. However, in patients >6 years of age, infratentorial noise, sharpness and diagnostic acceptability, as well as supratentorial sharpness were all significantly improved by DE CT technique. Radiation exposure as measured by CTDI and DLP was modestly lower with the dual energy protocol in all study populations.


      Dual energy CT can be used clinically in pediatric patients to maintain or improve image quality while reducing radiation dose.


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        • Curry T.
        • Dowdey J.
        • Murry R.
        Christensen's physics of diagnostic radiology.
        4th ed. Lea & Febiger, Philadelphia1990
        • Huda Walter
        Review of radiologic physics.
        Phys Med Biol. 2010;
        • Udayasankar U.K.
        • Braithwaite K.
        • Arvaniti M.
        • et al.
        Low-dose nonenhanced head CT protocol for follow-up evaluation of children with ventriculoperitoneal shunt: reduction of radiation and effect on image quality.
        AJNR Am J Neuroradiol. 2008; 29: 802-806
        • Park J.E.
        • Choi Y.H.
        • Cheon J.E.
        • et al.
        Image quality and radiation dose of brain computed tomography in children: effects of decreasing tube voltage from 120 kVp to 80 kVp.
        Pediatr Radiol. 2017; 47: 710-717
        • Pomerantz S.R.
        • Kamalian S.
        • Zhang D.
        • et al.
        Virtual monochromatic reconstruction of dual-energy unenhanced head CT at 65–75 keV maximizes image quality compared with conventional polychromatic CT.
        Radiology. 2013; 266: 318-325
        • McCollough C.H.
        • Leng S.
        • Yu L.
        • Fletcher J.G.
        Dual- and multi-energy CT: principles, technical approaches, and clinical applications.
        Radiology. 2015; 276: 637-653
        • McKnight C.D.
        • Watcharotone K.
        • Ibrahim M.
        • et al.
        Adaptive statistical iterative reconstruction: reducing dose while preserving image quality in the pediatric head CT examination.
        Pediatr Radiol. 2014; : 997-1003
        • Mullins M.E.
        • Lev M.H.
        • Bove P.
        • et al.
        Comparison of image quality between conventional and low-dose nonenhanced head CT.
        Am J Neuroradiol. 2004; 25 ([doi:15090337]): 533-538
        • Park J.
        • Choi Y.H.
        • Cheon J.-E.
        • et al.
        Advanced virtual monochromatic reconstruction of dual-energy unenhanced brain computed tomography in children: comparison of image quality against standard mono-energetic images and conventional polychromatic computed tomography.
        2017: 1648-1658