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Objectives: High-pitch imaging in computed tomography (CT) reduces scan time and radiation dose at the expense of increased noise. Recent advances in iterative reconstruction techniques allow for noise reduction without a significant increase in processing time, by using Sinogram-Affirmed Iterative Reconstruction (SAFIRE). We evaluated the combined effects of high-pitch imaging with SAFIRE in CT of the thorax and abdomen on image quality, diagnostic confidence, and radiation dose in children. Methods: Consecutive CT examinations of the thorax and abdomen performed in young children (age <12 years) on a dual-source CT scanner using standard-pitch, filtered back-projection (group A) between January 2012 and February 2013 were compared retrospectively with those using high-pitch dual-source imaging with SAFIRE between March 2013 and December 2014 (group B). Radiation dose, objective image quality (noise and signal-tonoise ratio), subjective image quality (sharpness, noise, and beam-hardening artifacts), and diagnostic confidence for the two groups were compared by two independent blinded operators. Results: Noise and signal-to-noise ratios of lung parenchyma were similar in the two groups, whereas those of the trachea were better in group B (p < 0.001). In the abdomen, both noise and signal-to-noise ratios of the liver and aorta were similar. Sharpness (p = 0.011) and noise (p = 0.005) were improved in the thorax for group B, but beam hardening worsened (p = 0.001). Both independent readers had excellent diagnostic confidence on all CT examinations in both groups. The combination of high-pitch imaging, iterative reconstruction, and reduction of tube current in group B allowed the radiation dose to be significantly lowered in the thorax (1.70 vs 2.71 mGy; p = 0.012), and slightly lowered in the abdomen (1.93 vs 3.26 mGy; p = 0.08). Conclusion: The combination of high-pitch imaging with an iterative reconstruction algorithm allows the radiation dose to be lowered while offering preserved or even improved diagnostic image quality in paediatric patients.

High-pitch Dual-source Computed Tomography Coupled with Sinogram-affirmed Iterative Reconstruction: Image Quality and Radiation Dose in Children