Evolution of CT radiation dose in pediatric patients undergoing hybrid 2-[(18)F]FDG PET/CT between 2007 and 2021

OBJECTIVES: To evaluate the evolution of CT radiation dose in pediatric patients undergoing hybrid 2-[(18)F]fluoro-2-deoxy-D-glucose (2-[(18)F]FDG) PET/CT between 2007 and 2021. METHODS AND MATERIALS: Data from all pediatric patients aged 0–18 years who underwent hybrid 2-[(18)F]FDG PET/CT of the body between January 2007 and May 2021 were reviewed. Demographic and imaging parameters were collected. A board-certified radiologist reviewed all CT scans and measured image noise in the brain, liver, and adductor muscles. RESULTS: 294 scans from 167 children (72 females (43%); median age: 14 (IQR 10–15) years; BMI: median 17.5 (IQR 15–20.4) kg/m(2)) were included. CT dose index-volume (CTDIvol) and dose length product (DLP) both decreased significantly from 2007 to 2021 (both p < 0.001, Spearman’s rho coefficients −0.46 and −0.35, respectively). Specifically, from 2007 to 2009 to 2019–2021 CTDIvol and DLP decreased from 2.94 (2.14–2.99) mGy and 309 (230-371) mGy*cm, respectively, to 0.855 (0.568–1.11) mGy and 108 (65.6–207) mGy*cm, respectively. From 2007 to 2021, image noise in the brain and liver remained constant (p = 0.26 and p = 0.06), while it decreased in the adductor muscles (p = 0.007). Peak tube voltage selection (in kilovolt, kV) of CT scans shifted from high kV imaging (140 or 120kVp) to low kV imaging (100 or 80kVp) (p < 0.001) from 2007 to 2021. CONCLUSION: CT radiation dose in pediatric patients undergoing hybrid 2-[(18)F]FDG PET/CT has decreased in recent years equaling approximately one-third of the initial amount. ADVANCES IN KNOWLEDGE: Over the past 15 years, CT radiation dose decreased considerably in pediatric patients undergoing hybrid imaging, while objective image quality may not have been compromised.