Optimized low-dose positron emission tomography/computed tomography schemes in pediatric tumor patients: a randomized clinical trial

BACKGROUND: It’s clinically relevant to reduce the radiation dose to children while ensuring their positron emission tomography/computed tomography (PET/CT) image quality. The optimal protocol for whole-body PET/CT imaging in children (non-model) has been less studied. In this study, we investigated the optimal protocol for PET/CT imaging of pediatric oncology by analyzing the radiation dose and image quality in18F-fluoro-2-deoxy-D-glucose ((18)F-FDG) PET/CT imaging of children with oncology. METHODS: One hundred children with tumors who underwent (18)F-FDG PET/CT were included. CT grouping: randomly divided into 18 groups A–R according to the combination of three parameters: tube voltage (80/120 kV), automatic milliamp range (20–39/40–59/60–80 mA), and noise index (NI) (8/12/14). PET grouping: randomly divided into 9 groups a–i according to the combination of two parameters: the pharmaceuticals injection dose (0.08/0.12/0.15 mCi/kg) and time per bed (120/150/180 s). The effective radiation dose (ED) was calculated separately for each group and the image quality of CT and PET was evaluated subjectively using standard deviation (SD) and coefficient of variation (CV) objective evaluation and 5-point evaluation method, respectively. RESULTS: Ninety-seven images in CT and 57 images in PET were included. The best quality of CT images was in group K (120 kV/40–59 mA/8); there are 9 groups had good image quality and lower dose length product (DLP) than group K (SD ±10), while the difference in DLP between groups was large. The Kruskal-Wallis (K-W) test showed that the difference in image quality between the 9 groups was not statistically significant. The best PET image quality was in group i [0.15 (mCi/kg)/180 s]; there are four groups had good image quality and lower ED(PET) than group i (CV ±3.5%), while the difference in ED(PET) between groups was large (4.4–6.5 mSv), and the K-W test showed that the difference in image quality between the four groups was not statistically significant (P>0.05), with the lowest ED(PET) being in the g group. CONCLUSIONS: The optimal protocols for CT scanning and PET imaging in this experiment were group H (80 kV/40–59 mA/14) and group g [0.08 (mCi/kg)/180 s], respectively. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200061386.