DAN Hongfu, YANG Jie, HE Chaoliang, WANG Chao, YUAN Chao, QIN Chun, FENG Hao
Objective To evaluate the value of combining spectral shaping, automatic tube current modulation (CARE Dose 4D), and the advanced modeled iterative reconstruction algorithm (ADMIRE) for ultra-low-dose chest CT in children.Methods 60 children clinically diagnosed with pneumonia and undergoing chest low-dose CT were enrolled. They were divided into two groups: control group A (conventional low-dose CT, n=30) and experimental Group B (ultra-low-dose CT, n=30). Images of group B were reconstructed using ADMIRE levels 3, 4, and 5, yielding subgroups B₁, B₂, and B₃. Two radiologists independently performed subjective evaluations of images from groups A, B₁, B₂ and B₃. Objective image parameters, radiation dose metrics, and the figure of merit (FOM) were measured, recorded, calculated, and statistically analyzed.Results Subjectively, all groups had subjective scores >1, acceptance rate >90% meeting diagnostic requirements. Inter-group differences were significant (P<0.001), with no significant difference only between group A and B₃, and between group B₁ and B₂ (P>0.05). Objectively, mean CT values of muscle and lung tissue showed no significant differences among groups (P>0.05). Significant overall differences existed among groups for muscle mean SD of muscle, overall mean SD of muscle (SD msub), signal to noise ratio (SNR), contrast to noise ratio (CNR), and FOM (P<0.001). Pairwise comparisons revealed no significant difference only between group A and B₃ for mean SD of muscle, SD msek, SNR, and CNR (P>0.05). FOM values progressively increased across the four groups, with Group B₃ having the highest. Dose in group B was significantly lower, with dose-length product reaching a minimum of 2.2 mGy·cm and effective dose a minimum of 0.04 mSv, representing an 82.4% reduction compared to group A.Conclusion The combined application of spectral shaping, CARE Dose 4D, and ADMIRE significantly reduces radiation dose while optimizing image quality to meet diagnostic requirements for pediatric chest CT, demonstrating substantial clinical value.