• 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, and Paul Apfaltrer.
• Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC 29401, USA.
• Eur Radiol. 2013 May 1;23(5):1306-15.

ObjectivesTo 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.MethodsForty 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.ResultsMean 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.ConclusionsIR 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.

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