Cardiovascular CT angiography in neonates and children: Image quality and potential for radiation dose reduction with iterative image reconstruction techniques

Francesco Tricarico, Anthony M. Hlavacek, U. Joseph Schoepf, Ullrich Ebersberger, John W. Nance, Rozemarijn Vliegenthart, Young Jun Cho, J. Reid Spears, Francesco Secchi, Giancarlo Savino, Riccardo Marano, Stefan O. Schoenberg, Lorenzo Bonomo, Paul Apfaltrer

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Objectives: To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CTA), comparing iterative reconstruction in image space (IRIS) and sinogram-affirmed iterative reconstruction (SAFIRE) with filtered back-projection (FBP) and estimate the potential for further dose reductions. Methods: Forty neonates and children underwent low radiation CTA with or without ECG synchronisation. Data were reconstructed with FBP, IRIS and SAFIRE. For ECG-synchronised studies, half-dose image acquisitions were simulated. Signal noise was measured and IQ graded. Effective dose (ED) was estimated. Results: Mean absolute and relative image noise with IRIS and full-dose SAFIRE was lower than with FBP (P < 0.001), while SNR and CNR were higher (P < 0.001). Image noise was also lower and SNR and CNR higher in half-dose SAFIRE studies compared with full-and half-dose FBP studies (P < 0.001). IQ scores were higher for IRIS, full-dose SAFIRE and half-dose SAFIRE than for full-dose FBP and higher for half-dose SAFIRE than for half-dose FBP (P < 0.05). Median weight-specific ED was 0.3 mSv without and 1.36 mSv with ECG synchronisation. The estimated ED of half-dose SAFIRE studies was 0.68 mSv. Conclusions: IR improves image noise, SNR, CNR and subjective IQ compared with FBP in low-radiation-dose paediatric CTA and allows further dose reductions without compromising diagnostic IQ. Key Points: • Iterative reconstruction techniques significantly improve non-invasive cardiovascular CT in children. • Using half traditional radiation dose image quality is higher with iterative reconstruction. • Iterative reconstruction techniques may allow further radiation reductions in paediatric cardiovascular CT.

Original languageEnglish (US)
Pages (from-to)1306-1315
Number of pages10
JournalEuropean Radiology
Issue number5
StatePublished - May 2013


  • Computed tomography
  • Congenital heart disease
  • Iterative image reconstruction
  • Pediatric imaging
  • Radiation dose

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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