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. 2020 Jan-Feb;96(1):92-99.
doi: 10.1016/j.jped.2018.07.010. Epub 2018 Sep 17.

Ultra-low-dose chest computed tomography without anesthesia in the assessment of pediatric pulmonary diseases

Cristina Manera Dorneles  1 , Gabriel Sartori Pacini  2 , Matheus Zanon  2 , Stephan Altmayer  2 , Guilherme Watte  3 , Marcelo C Barros  4 , Edson Marchiori  5 , Matteo Baldisserotto  6 , Bruno Hochhegger  7
Affiliations

Ultra-low-dose chest computed tomography without anesthesia in the assessment of pediatric pulmonary diseases

Cristina Manera Dorneles et al. J Pediatr (Rio J). 2020 Jan-Feb.

Abstract
in English, Portuguese

Objective: To evaluate the feasibility of using ultra-low-dose computed tomography of the chest with iterative reconstruction without anesthesia for assessment of pulmonary diseases in children.

Methods: This prospective study enrolled 86 consecutive pediatric patients (ranging from 1 month to 18 years) that underwent ultra-low-dose computed tomography due to suspicion of pulmonary diseases, without anesthesia and contrast. Parameters used were: 80kVp; 15-30mA; acquisition time, 0.5s; and pitch, 1.375. The adaptive statistical iterative reconstruction technique was used. Subjective visual evaluation and quantitative assessment of image quality were done using a 5-point scale in 12 different structures of the chest.

Results: Mean age was 66 months (interquartile range, 16-147). Final diagnosis was performed in all exams, and 44 (51.2%) were diagnosed with cystic fibrosis, 27 (31.4%) with bronchiolitis obliterans, and 15 (17.4%) with congenital pulmonary airways malformations. Diagnostic quality was achieved in 98.9%, of which 82.6% were considered excellent and 16.3% were slightly blurred but did not interfere with image evaluation. Only one case (1.2%) presented moderate blurring that slightly compromised the image, and previous examinations demonstrated findings compatible with bronchiolitis obliterans. Mean effective radiation dose was 0.39±0.15mSv. Percentages of images with motion artifacts were 0.3% for cystic fibrosis, 1.3% for bronchiolitis obliterans, and 1.1% for congenital pulmonary airways malformations.

Conclusion: Chest ultra-low-dose computed tomography without sedation or anesthesia delivering a sub-millisievert dose can provide image quality to allow identification of common pulmonary anatomy and diseases.

Objetivo: Avaliar a viabilidade do uso de tomografia computadorizada com ultrabaixa dose com reconstrução iterativa sem anestesia para avaliação de doenças pulmonares em crianças.

Métodos: Este estudo prospectivo envolveu 86 pacientes pediátricos consecutivos (um mês a 18 anos) submetidos à tomografia computadorizada com ultrabaixa dose por suspeita de doenças pulmonares, sem anestesia e contraste. Os parâmetros utilizados foram: 80 kVp; 15-30 mA; tempo de aquisição, 0,5 s; e pitch de 1,375. Foi utilizada a técnica de reconstrução estatística adaptativa iterativa. A avaliação visual subjetiva e a avaliação quantitativa da qualidade da imagem foram feitas com uma escala de 5 pontos em 12 estruturas do tórax.

Resultados: A média de idade foi de 66 meses (intervalo interquartil, 16-147). O diagnóstico final foi feito em todos os exames e 44 (51,2%) foram diagnosticados com fibrose cística, 27 (31,4%) com bronquiolite obliterante e 15 (17,4%) com malformação congênita pulmonar das vias aéreas. A qualidade diagnóstica foi alcançada em 98,9% dos casos, dos quais 82,6% foram considerados excelentes e 16,3% alteração leve na definição, mas isso não interferiu na avaliação da imagem. Apenas um caso (1,2%) apresentou alteração moderada na definição, comprometeu discretamente a imagem, e exames prévios demonstraram achados compatíveis com bronquiolite obliterante. A dose de radiação média efetiva foi de 0,39 ± 0,15 mSv. As porcentagens de imagens com artefatos de movimento foram de 0,3% para fibrose cística, 1,3% para bronquiolite obliterante e 1,1% para malformação congênita pulmonar das vias aéreas.

Conclusão: É possível realizar a tomografia computadorizada com ultrabaixa dose torácica sem sedação ou anestesia, administrando uma dose de submilisievert, com qualidade de imagem suficiente para a identificação pulmonar anatômica e de doenças pulmonares comuns.

Keywords: Computed tomography; Iterative reconstruction; Pacientes pediátricos; Pediatric patients; Radiação de dose ultrabaixa; Reconstrução iterativa; Thorax; Tomografia computadorizada; Tórax; Ultra-low-dose radiation.

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Figures

Figure 1
Figure 1
Male, 8-year-old. Axial (A) and coronal (B) ultra-low-dose CT images demonstrated perihilar (central) cylindrical bronchiectasis (arrows), suggestive of cystic fibrosis. (C) Axial and coronal (D) ultra-low-dose CT images showed a case of a 3-year-old male with bronchial wall thickening (white arrow) and atelectasis in the left lower lobe (black arrow), suggestive of bronchiolitis obliterans. Axial (E) and coronal (F) ultra-low-dose CT images demonstrated a case of type I congenital pulmonary airway malformation in the left upper lobe (arrow) – adenomatous cystic pulmonary malformation – in a 5-year-old female.
Figure 2
Figure 2
(A) Median noise ratio index according to age; (B) median dose–length product according to the age cutoffs.
See this image and copyright information in PMC

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References

    1. Pearce M.S. Patterns in paediatric CT use: an international and epidemiological perspective. J Med Imaging Radiat Oncol. 2011;55:107–109. - PubMed
    1. Brenner D.J., Hall E.J. Computed tomography – an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284. - PubMed
    1. Pearce M.S., Salotti J.A., Little M.P., McHugh K., Lee C., Pyo Kim K., et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380:499–505. - PMC - PubMed
    1. McCollough C.H., Primak A.N., Braun N., Kofler J., Yu L., Christner J. Strategies for reducing radiation dose in CT. Radiol Clin North Am. 2009;47:27–40. - PMC - PubMed
    1. Vardhanabhuti V., Loader R.J., Mitchell G.R., Riordan R.D., Roobottom C.A. Image quality assessment of standard- and low-dose chest CT using filtered back projection, adaptive statistical iterative reconstruction, and novel model-based iterative reconstruction algorithms. Am J Roentgenol. 2013;200:545–552. - PubMed