X-ray dose reduction using additional copper filtration for abdominal digital radiography: Evaluation using signal difference-to-noise ratio

PurposeX-ray dose reduction using additional copper filters (Cu-filters) for abdominal general radiography was indicated in a report using a simulation study. We validated the dose reduction effects using a clinical digital radiography system equipped with an indirect-type CsI detector and an automatic Cu-filter insertion function.MethodsThe image qualities were evaluated using signal difference-to-noise ratio (SDNR) for different radiation qualities with and without Cu-filters for a 20-cm acrylic phantom. Acrylic and bone equivalent material plates were used for contrast measurements. The dose reduction using Cu-filters was estimated from the ratios of the SDNR² values.ResultsFor the same entrance surface dose (ESD), Cu-filters with 0.1- and 0.2-mm thicknesses increased the image quality as evaluated by SDNR² and the estimated dose reduction without degrading the image quality. For the acrylic contrast, the dose reductions with the 0.1- and 0.2-mm-thick Cu-filters were approximately 30% and 44% at 70 kV and 29% and 35% at 80 kV, respectively. For the bone contrast, the reduction rates were slightly reduced.ConclusionsWe validated the dose reduction capability of additional Cu-filters without degrading the image quality for abdominal radiography. The estimated entrance surface dose reductions of the Cu-filters were approximately 30–40% and 20–30% for the acrylic and bone contrasts, respectively, and effective dose reductions for acrylic were nearly half of those for ESD. At these reduced dose conditions, the current time product values needed to be increased by factors of 1.4 and 1.8 for the 0.1- and 0.2-mm-thick Cu-filters, respectively.     

Association between subjective evaluation and physical parameters for radiographic images optimization

PurposeThe purpose of this study was to develop a methodology to optimize computed radiographic techniques to image the skull, chest, and pelvis of a standard patient.MethodsOptimization was performed by varying exposure levels with different tube voltages to generate images of an anthropomorphic phantom. Image quality was evaluated using visual grading analysis and measuring objective parameters such as the effective detective quantum efficiency and the contrast-to-noise ratio. Objective and subjective evaluations were compared to obtain an optimized technique for each anatomic region.ResultsGold standard techniques provided a significant reduction in X-ray doses compared to the techniques used in our radiology service, without compromising diagnostic accuracy. They were chosen as follows 102 kVp/1.6 mAs for skull; 81 kVp/4.5 mAs for pelvis and 90 kVp/3.2 mAs for chest.ConclusionThere is a range of acceptable techniques that produce adequate images for diagnosis in computed radiography systems. This aspect allows the optimization process to be focused on the patient dose without compromising diagnostic capabilities. This process should be performed through association of quantitative and qualitative parameters, such as effective detective quantum efficiency, contrast-to-noise ratio, and visual grading analysis.     

Monte Carlo simulation of eye lens dose reduction from CT scan using organ based tube current modulation

PurposeTo investigate lens dose reduction with organ based tube current modulation (TCM) using the Monte Carlo method.MethodsTo calculate lens dose with organ based TCM, 36 pairs of X-ray sources with bowtie filters were placed around the patient head using a projection angle interval of 10° for one rotation of Computed Tomography (CT). Each projection was simulated respectively. Both voxelized and stylized eye models and Chinese reference male phantoms were used in the simulation, and tube voltages 80, 100, 120 and 140 kVp were used.ResultsDose differences between two eye models were less than 20%, but large variations were observed among dose results from different projections of all tube voltages investigated. Dose results from 0° (AP) directions were 60 times greater than those from 180° (PA) directions, which enables organ based TCM reduce lens doses by more than 47%.ConclusionsOrgan based TCM may be used to reduce lens doses. Stylized eye models are more anatomically realistic compared with voxelized eye models and are more reliable for dose evaluation.     

Low-tube-voltage selection for non-contrast-enhanced CT: Comparison of the radiation dose in pediatric and adult phantoms

PurposeWe used pediatric and adult anthropomorphic phantoms to compare the radiation dose of low- and standard tube voltage chest and abdominal non-contrast-enhanced computed tomography (CT) scans. We also discuss the optimal low tube voltage for non-contrast-enhanced CT.MethodsUsing a female adult- and three differently-sized pediatric anthropomorphic phantoms we acquired chest and abdominal non-contrast-enhanced scans on a 320-multidetector CT volume scanner. The tube voltage was set at 80-, 100-, and 120 kVp. The tube current was automatically assigned on the CT scanner in response to the set image noise level. On each phantom and at each tube voltage we measured the surface and center dose using high-sensitivity metal-oxide-semiconductor field-effect transistor detectors.ResultsThe mean surface dose of chest and abdominal CT scans in 5-year olds was 4.4 and 5.3 mGy at 80 kVp, 4.5 and 5.4 mGy at 100 kV, and 4.0 and 5.0 mGy at 120 kVp, respectively. These values were similar in our 3-pediatric phantoms (p > 0.05). The mean surface dose in the adult phantom increased from 14.7 to 19.4 mGy for chest- and from 18.7 to 24.8 mGy for abdominal CT as the tube voltage decreased from 120 to 80 kVp (p < 0.01).ConclusionCompared to adults, the surface and center dose for pediatric patients is almost the same despite a decrease in the tube voltage and the low tube voltage technique can be used for non-contrast-enhanced chest- and abdominal scanning.     

Experimental assessment of the influence of beam hardening filters on image quality and patient dose in volumetric 64-slice X-ray CT scanners

Beam hardening filters have long been employed in X-ray Computed Tomography (CT) to preferentially absorb soft and low-energy X-rays having no or little contribution to image formation, thus allowing the reduction of patient dose and beam hardening artefacts. In this work, we studied the influence of additional copper (Cu) and aluminium (Al) flat filters on patient dose and image quality and seek an optimum filter thickness for the GE LightSpeed VCT 64-slice CT scanner using experimental phantom measurements. Different thicknesses of Cu and Al filters (0.5–1.6 mm Cu, 0.5–4 mm Al) were installed on the scanner’s collimator. A planar phantom consisting of 13 slabs of Cu having different thicknesses was designed and scanned to assess the impact of beam filtration on contrast in the intensity domain (CT detector’s output). To assess image contrast and image noise, a cylindrical phantom consisting of a polyethylene cylinder having 16 holes filled with different concentrations of K₂HPO₄ solution mimicking different tissue types was used. The GE performance and the standard head CT dose index (CTDI) phantoms were also used to assess image resolution characterized by the modulation transfer function (MTF) and patient dose defined by the weighted CTDI. A 100 mm pencil ionization chamber was used for CTDI measurement. Finally, an optimum filter thickness was determined from an objective figure of merit (FOM) metric. The results show that the contrast is somewhat compromised with filter thickness in both the planar and cylindrical phantoms. The contrast of the K₂HPO₄ solutions in the cylindrical phantom was degraded by up to 10% for a 0.68 mm Cu filter and 6% for a 4.14 mm Al filter. It was shown that additional filters increase image noise which impaired the detectability of low density K₂HPO₄ solutions. It was found that with a 0.48 mm Cu filter the 50% MTF value is shifted by about 0.77 lp/cm compared to the case where the filter is not used. An added Cu filter with approximately 0.5 mm thickness accounts for 50% reduction in radiation-absorbed dose as measured by the weighted CTDI. The FOM results indicate that with an additional filter of 0.5 mm Cu or minimum 4 mm Al, a good compromise between image quality and patient dose is achieved for CT images acquired at tube voltages of 120 and 140 kVp. The results seem to indicate that an optimum filter for high kVp acquisitions, routinely used in cardiovascular imaging, should be 0.5 mm copper or 4 mm aluminium minimum.     

LOSS OF NUTRIENTS FROM WATER SAMPLES BY FILTRATION AND ITS AFFECT ON ALGAL BIOASSAY PROCEDURES

SUMMARY

Water samples were collected from fourteen sampling points along the Hunyani River system and subjected to various filtration treatments involving glass fibre filters and 1,2 and 0,45 pm membrane filters. Chemical analyses of the filtered waters showed that nitrogen, phosphorus and iron were lost by different filtration treatments. Filtration by membrane filters led to a reduction of algal growth potential as demonstrated by algal bioassays using Selanastrwn capricornutum Printz as the test alga.

Algal bioassays showed that biologically available phosphorus was primarily removed by the 1,2 μm membrane filter while biologically available nitrogen and iron was principally lost by filtration through the 0,25 μm membrane filter. A refined algal bioassay designed to determine the identity of limiting micronutrients found that all essential micronutrients were affected by membrane filtration.     

The role of a commercial radiation dose index monitoring system in establishing local dose reference levels for fluoroscopically guided invasive cardiac procedures

PurposeThe primary goal was to evaluate local dose level for fluoroscopically guided invasive cardiac procedures in a high-volume activity catheterization laboratory, using automatic data registration with minimal impact on operator workload. The secondary goal was to highlight the relationship between dose indices and acquisition parameters, in order to establish an effective strategy for protocols optimization.MethodsFrom September 2016 to December 2018, a dosimetric survey was conducted in the 2 rooms of the catheterization laboratory of our institution. Data collection burden was minimized using a commercial Radiation Dose Index Monitoring System (RDIMs) that analyzes dicom files automatically sent by the x-ray equipment. Data were combined with clinical information extracted from the HIS records reported by the interventional cardiologist. Local dose levels were established for different invasive cardiac procedures.ResultsA total of 3029 procedures performed for 2615 patients were analyzed. Median KAP were 21 Gycm² for invasive coronary angiography (ICA) procedures, 61 Gycm² for percutaneous coronary intervention (PCI) procedures, 59 Gycm² for combined (ICA+PCI) procedures, 87 Gycm² for structural heart intervention (TAVI) procedures. A significant dose reduction (51% for ICA procedures and 58% for PCI procedures) was observed when noise reduction acquisition techniques were applied.ConclusionsRDIMs are effective tools in the establishment of local dose level in interventional cardiology, as they mitigate the burden to collect and register extensive dosimetric data and exposure parameters. Systematic review of data support the multi-disciplinary team in the definition of an effective strategy for protocol management and dose optimization.     

Geometric and dosimetric quality assurance using logfiles and a 3D helical diode detector for Dynamic WaveArc

PurposeTo conduct patient-specific geometric and dosimetric quality assurance (QA) for the Dynamic WaveArc (DWA) using logfiles and ArcCHECK (Sun Nuclear Inc., Melbourne, FL, USA).MethodsTwenty DWA plans, 10 for pituitary adenoma and 10 for prostate cancer, were created using RayStation version 4.7 (RaySearch Laboratories, Stockholm, Sweden). Root mean square errors (RMSEs) between the actual and planned values in the logfiles were evaluated. Next, the dose distributions were reconstructed based on the logfiles. The differences between dose-volumetric parameters in the reconstructed plans and those in the original plans were calculated. Finally, dose distributions were assessed using ArcCHECK. In addition, the reconstructed dose distributions were compared with planned ones.ResultsThe means of RMSEs for the gantry, O-ring, MLC position, and MU for all plans were 0.2°, 0.1°, 0.1 mm, and 0.4 MU, respectively. Absolute means of the change in PTV D_99% were 0.4 ± 0.4% and 0.1 ± 0.1% points between the original and reconstructed plans for pituitary adenoma and prostate cancer, respectively. The mean of the gamma passing rate (3%/3 mm) between the measured and planned dose distributions was 97.7%. In addition, that between the reconstructed and planned dose distributions was 99.6%.ConclusionsWe have demonstrated that the geometric accuracy and gamma passing rates were within AAPM 119 and 142 criteria during DWA. Dose differences in the dose-volumetric parameters using the logfile-based dose reconstruction method were also clinically acceptable in DWA.     

Optimization of the exposure parameters in digital mammography using contrast-detail metrics

PurposeOptimization studies in digital mammography aid to assure the image quality and radiological protection of the patient. The aim of this work is to test effectiveness and applicability of a method based on a Figure of Merit (FOM = (IQF_inv)²/AGD) to improve all the exposure parameters (Target/Filter combination, kVp and mAs) in order to improve the image acquisition technique that will provide the best compromise between image quality and the average glandular dose (AGD).MethodsA contrast-detail analysis, employing the test object CDMAM, was carried out for the digital mammography unit manufactured by Lorad Hologic – model Selenia. We simulated two breast thicknesses using phantoms and a Figure of Merit as optimization tool, which includes an indicator of image quality, the IQF_inv and the average glandular dose. Images of the ACR and TORMAM phantoms were obtained with both, automatic and optimized exposure parameters. In order to compare the image quality, the SNR (Signal to Noise Ratio) was measured in each image.ResultsIn the two phantoms, for both 4.5 and 7.5 cm thicknesses, the AGDs obtained with the optimized parameters show a reduction. In addition, the images obtained with the optimized exposure parameters, had the same or a better image quality when compared to the images obtained using the automatic mode.ConclusionsThe proposed optimization methodology proved to be an effective tool to improve the digital mammography unit, due to the use of objective metrics for evaluation and validation of the results.     

Bacteriology of Air-Conditioning Ducts with Special Reference to Operating Rooms

The number of bacteria in air, before filtration with five different easily available filters in the low positive-pressure type of airconditioning system of the Winnipeg General Hospital, was between 3 and 4/cu. ft., and after filtration between 1 and 2/cu. ft. with all types of filters. Cl. welchii contributed about 1% and Staph. pyogenes about 0.1% of this total. Sampling the exhaust air from an operating room during an operation showed that the bacterial count fluctuated with the degree of activity in the room and was from two to 10 times as high as in the air delivered to the room.Atlhough every reasonable attempt should be made to diminish the bacterial count of air in hospitals, if much energy and money is to be spent it would probably be wiser to investigate sources of hospital infection other than the type of air-conditioning system described in this report.     

DIGITAL FILTERS IN AUDITORY PHYSIOLOGY

ABSTRACT

In auditory research, the manipulation of signals by filtering with analog electronic filters plays an important role. Recently, digital filters that compute signal modifications in realtime became available. They can mimic all functions of analog filters, and additionally make possible new experimental concepts.

This tutorial paper introduces the concept of digital filters by using analogies from acoustics. Even complex acoustical environments can be simulated with digital filters, as they allow the programming of almost arbitrary frequency and phase responses.     

Abdominal imaging dose in radiology and radiotherapy – Phantom point dose measurements,effective dose and secondary cancer risk

PurposeTo compare abdominal imaging dose from 3D imaging in radiology (standard/low-dose/dual-energy CT) and radiotherapy (planning CT, kV cone-beam CT (CBCT)).MethodsDose was measured by thermoluminescent dosimeters (TLD’s) placed at 86 positions in an anthropomorphic phantom. Point, organ and effective dose were assessed, and secondary cancer risk from imaging was estimated.ResultsOverall dose and mean organ dose comparisons yield significantly lower dose for the optimized radiology protocols (dual-source and care kV), with an average dose of 0.34±0.01 mGy and 0.54±0.01 mGy (average ± standard deviation), respectively. Standard abdominal CT and planning CT involve considerably higher dose (13.58 ± 0.18 mGy and 18.78±0.27 mGy, respectively). The CBCT dose show a dose fall-off near the field edges. On average, dose is reduced as compared with the planning or standard CT (3.79 ± 0.21 mGy for 220° rotation and 7.76 ± 0.37 mGy for 360°), unless the high-quality setting is chosen (20.30 ± 0.96 mGy). The mean organ doses show a similar behavior, which translates to the estimated secondary cancer risk. The modelled risk is in the range between 0.4 cases per million patient years (PY) for the radiological scans dual-energy and care kV, and 300 cases per million PY for the high-quality CBCT setting.ConclusionsModern radiotherapy imaging techniques (while much lower in dose than radiotherapy), involve considerably more dose to the patient than modern radiology techniques. Given the frequency of radiotherapy imaging, a further reduction in radiotherapy imaging dose appears to be both desirable and technically feasible.     

Radiation dose comparison between V/P-SPECT and CT-angiography in the diagnosis of pulmonary embolism

PurposeThe aim of this study is to compare two routine protocols at our institution, CTPA and V/P-SPECT, in terms of radiation dose to the most exposed organs (lungs and breast) and to the embryo/fetus in the case of pregnant patients.MethodsAt our institution, the CTPA protocol includes a contrast enhanced CT (scan parameters: 100 kVp, 700 mA, 0.5 s/rot, pitch 0.984) and in some cases a non-contrast enhanced CT acquisition (120 kVp, 400 mA, 0.5 s/rot, pitch 1.375).In the V/P-SPECT protocol, ventilation SPECT was performed after inhalation of 99mTc-Technegas, reaching 30 MBq in the lungs; perfusion was performed after intravenous administration of 60–120 MBq of 99mTc-MAA.The absorbed doses (mGy) to lungs and breast from CTPA were estimated using the “ImPACT CT Patient Dosimetry Calculator”. The embryo/fetus dose was estimated for different gestational stages (0–7, 8–12, 13–25 and 26–40 weeks) using the web based calculation tool “COnceptus Dose Estimation” (CODE).Doses to organs and embryo/fetus from V/P-SPECT were estimated based on published dose data normalized to administered activity (mGy/MBq).ResultsEmbryo/fetus absorbed doses are similar for CTPA and V/P-SPECT and bellow 1 mGy. The calculated dose to the lungs (breast) was 1.3–10.6 (27–136) times higher from CTPA when compared with V/P-SPECT.ConclusionFor the diagnosis of PE in women, if both imaging modalities are available, it is recommended to proceed with V/P-SPECT rather than CTPA due to the considerably lower radiation dose to the breast.     

Optimization of image quality and accuracy of low iodine concentration quantification as function of kVp pairs for abdominal imaging using dual-source CT: A phantom study

PurposeTo determine the suitable kVp pair for optimal image quality of the virtual monochromatic images (VMIs) and iodine quantification accuracy at low concentration, using a third generation dual-source CT (DSCT).Materials and methodsMulti-energy CT phantoms with and without body rings were scanned with a DSCT using four kVp pairs (tube “A”/“B” voltage): 100/Sn150, 90/Sn150, 80/Sn150 and 70/Sn150 kVp. The reference mAs was adjusted to obtain a CTDI_vol close to 11 mGy. HU values accuracy (RMSD_HU), noise (SD) and contrast-to-noise ratio (CNR) of iodine inserts of 0.5, 1, 2 and 5 mg/mL concentrations were assessed on VMIs at 40/50/60/70 keV. Iodine quantification accuracy was assessed using the RMSD_iodine and iodine bias (IB_iodine).ResultsThe RMSD_HU decreased when the tube “A” voltage increased. The mean noise value increased significantly with tube “A” voltage (p < 0.001) but decreased between 80/Sn150 and 90/Sn150 kVp for the small phantom (1.1 ± 0.1%; p = 0.047). The CNR significantly decreased with tube “A” voltage (p < 0.001), except between 80/Sn150 and 90/Sn150 kVp for all inserts and between 90/Sn150 kVp and 100/Sn150 kVp for the 1.0 and 0.5 mg/mL inserts in the large phantom. In the small phantom, no significant difference was found between 80/Sn150 kVp and 90/Sn150 kVp for all inserts and between 80/Sn150, 90/Sn150 and 100/Sn150 kVp for the 1 and 0.5 mg/mL inserts. The RMSD_iodine and IB_iodine decreased as the tube “A” voltage of the kVp pair increased.ConclusionThe kVp pair of 70/Sn150 led to better image quality in VMIs and sufficient iodine accuracy.     

Combined PET/CT for IMRT treatment planning of NSCLC: Contrast-enhanced CT images for Monte Carlo dose calculation

PurposeCombined PET/CT imaging has been proposed as an integral part of radiotherapy treatment planning (TP). Contrast-enhanced CT (ceCT) images are frequently acquired as part of the PET/CT examination to support target delineation. The aim of this dosimetric planning study was to investigate the error introduced by using a ceCT for intensity modulated radiotherapy (IMRT) TP with Monte Carlo dose calculation for non-small cell lung cancer (NSCLC).Material and methodsNine patients with NSCLC prior to chemo-RT were included in this retrospective study. For each patient non-enhanced, low-dose CT (neCT), ceCT and [¹⁸F]-FDG-PET emission data were acquired within a single examination. Manual contouring and TP were performed on the ceCT. An additional set of independent target volumes was auto-segmented in PET images. Dose distributions were recalculated on the neCT. Differences in dosimetric parameters were evaluated.ResultsDose differences in PTV and lungs were small for all patients. The maximum difference in all PTVs when using ceCT images for dose calculation was ?2.1%, whereas the mean difference was less than ?1.7%. Maximum differences in the lungs ranged from ?1.8% to 2.1% (mean: ?0.1%). In four patients an underestimation of the maximum spinal cord dose between 2% and 3.2% was observed, but treatment plans remained clinically acceptable.ConclusionsMonte Carlo based IMRT planning for NSCLC patients using ceCT allows for correct dose calculation. A direct comparison to neCT-based treatment plans revealed only small dose differences. Therefore, ceCT-based TP is clinically safe as long as the maximum acceptable dose to organs at risk is not approached.     

Lipoproteins Removed from Serum and Plasma by Membrane Filtration

Abstract

Tangential (crossflow) filtration of a plasma/serum mixture through 0.2μm-poresize polycarbonate track-etch membrane filters (PC) at pressures < 10 psi removes low density lipoproteins (LDL) and very low density lipoproteins (VLDL) but not high density lipoproteins (HDL) from the filtrate. At pressures > 10 psi all lipoproteins pass through the PC. Once the filters have been intruded with LDL and VLDL those lipoproteins continue to pass the filters despite subsequent reduction in differential pressure below 10 psi.     

Effects of shielding on pelvic and abdominal IORT dose distributions

PurposeTo study the impact of shielding elements in the proximity of Intra-Operative Radiation Therapy (IORT) irradiation fields, and to generate graphical and quantitative information to assist radiation oncologists in the design of optimal shielding during pelvic and abdominal IORT.MethodAn IORT system was modeled with BEAMnrc and EGS++ Monte Carlo codes. The model was validated in reference conditions by gamma index analysis against an experimental data set of different beam energies, applicator diameters, and bevel angles. The reliability of the IORT model was further tested considering shielding layers inserted in the radiation beam. Further simulations were performed introducing a bone-like layer embedded in the water phantom. The dose distributions were calculated as 3D dose maps.ResultsThe analysis of the resulting 2D dose maps parallel to the clinical axis shows that the bevel angle of the applicator and its position relative to the shielding have a major influence on the dose distribution. When insufficient shielding is used, a hotspot nearby the shield appears near the surface. At greater depths, lateral scatter limits the dose reduction attainable with shielding, although the presence of bone-like structures in the phantom reduces the impact of this effect.ConclusionsDose distributions in shielded IORT procedures are affected by distinct contributions when considering the regions near the shielding and deeper in tissue: insufficient shielding may lead to residual dose and hotspots, and the scattering effects may enlarge the beam in depth. These effects must be carefully considered when planning an IORT treatment with shielding.     

Homogeneous vs. patient specific breast models for Monte Carlo evaluation of mean glandular dose in mammography

PurposeTo compare, via Monte Carlo simulations, homogeneous and non-homogenous breast models adopted for mean glandular dose (MGD) estimates in mammography vs. patient specific digital breast phantoms.MethodsWe developed a GEANT4 Monte Carlo code simulating four homogenous cylindrical breast models featured as follows: (1) semi-cylindrical section enveloped in a 5-mm adipose layer; (2) semi-elliptical section with a 4-mm thick skin; (3) semi-cylindrical section with a 1.45-mm skin layer; (4) semi-cylindrical section in a 1.45-mm skin layer and 2-mm subcutaneous adipose layer. Twenty patient specific digital breast phantoms produced from a dedicated CT scanner were assumed as reference in the comparison. We simulated two spectra produced from two anode/filter combinations. An additional digital breast phantom was produced via BreastSimulator software.ResultsWith reference to the results for patient-specific breast phantoms and for W/Al spectra, models #1 and #3 showed higher MGD values by about 1% (ranges [–33%; +28%] and [−31%; +30%], respectively), while for model #4 it was 2% lower (range [−34%; +26%]) and for model #2 –11% (range [−39%; +14%]), on average. On the other hand, for W/Rh spectra, models #1 and #4 showed lower MGD values by 2% and 1%, while for model #2 and #3 it was 14% and 8% lower, respectively (ranges [−43%; +13%] and [−41%; +21%]). The simulation with the digital breast phantom produced with BreastSimulator showed a MGD overestimation of +33%.ConclusionsThe homogeneous breast models led to maximum MGD underestimation and overestimation of 43% and 28%, respectively, when compared to patient specific breast phantoms derived from clinical CT scans.     

CT dose reduction using Automatic Exposure Control and iterative reconstruction: A chest paediatric phantoms study

PurposeTo evaluate the impact of Automatic Exposure Control (AEC) on radiation dose and image quality in paediatric chest scans (MDCT), with or without iterative reconstruction (IR).MethodsThree anthropomorphic phantoms representing children aged one, five and 10-year-old were explored using AEC system (CARE Dose 4D) with five modulation strength options. For each phantom, six acquisitions were carried out: one with fixed mAs (without AEC) and five each with different modulation strength. Raw data were reconstructed with Filtered Back Projection (FBP) and with two distinct levels of IR using soft and strong kernels. Dose reduction and image quality indices (Noise, SNR, CNR) were measured in lung and soft tissues. Noise Power Spectrum (NPS) was evaluated with a Catphan 600 phantom.ResultsThe use of AEC produced a significant dose reduction (p < 0.01) for all anthropomorphic sizes employed. According to the modulation strength applied, dose delivered was reduced from 43% to 91%. This pattern led to significantly increased noise (p < 0.01) and reduced SNR and CNR (p < 0.01). However, IR was able to improve these indices. The use of AEC/IR preserved image quality indices with a lower dose delivered. Doses were reduced from 39% to 58% for the one-year-old phantom, from 46% to 63% for the five-year-old phantom, and from 58% to 74% for the 10-year-old phantom. In addition, AEC/IR changed the patterns of NPS curves in amplitude and in spatial frequency.ConclusionsIn chest paediatric MDCT, the use of AEC with IR allows one to obtain a significant dose reduction while maintaining constant image quality indices.