Pediatric chest CT radiation dose reduction: protocol refinement based on noise injection for pulmonary nodule detection accuracy

To establish appropriate chest computed tomography (CT) acquisition protocols that balance radiation dose and diagnostic capability in pediatric bone marrow transplant patients by assessing the accuracy of pulmonary nodule detection at simulated lower-radiation acquisitions, chest CT images from bone marrow transplant patients were reviewed by four pediatric radiologists at artificially reduced CT dose levels (0%, 30%, and 60%). Average accuracy for nodule detection in 31 randomly selected cases was 0.87 at 0% dose reduction, 0.90 at 30% reduction, and 0.86 at 60% reduction. We observed no clinically relevant difference in acceptability of images or accuracy levels with tested dose reductions to 60%.