Skeletal radiology · 2026
Tin-filtered ultra-low-dose CT for lower limb torsion measurements in children and adolescents: a prospective study.
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Markart Stefan, Griessinger Jennifer, Graf Nicole, Leschka Sebastian, Cip Johannes, Dietrich Tobias Johannes, Wälti Stephan
Аннотация
OBJECTIVE: Accurate femoral and tibial torsion measurements are essential for planning lower extremity derotation surgeries in children/adolescents. Advances in modern CT scanners may enable reliable measurements using tin filtration in addition to an ultra-low-dose CT protocol, markedly reducing radiation exposure. This study evaluates image quality, reliability, and estimated effective radiation dose of this approach.
MATERIALS AND METHODS: Between April 2022 and December 2022, tin-filtered ultra-low-dose CTs were prospectively acquired from 52 children/adolescents using a 384-slice scanner. Two pediatric radiologists independently performed torsion measurements for all patients. Interrater agreement and image quality were assessed. Effective radiation doses of the scans were estimated.
RESULTS: The study population consisted of 52 participants (mean age, 12.7 years ± 2.0 [standard deviation]; 19 females, 33 males). All torsion measurements showed very high interrater agreement (intra-class correlation coefficient > 90% for all locations). The image quality of the vast majority of image datasets was rated as excellent. The mean total effective dose of the tin filtered ultra-low-dose protocol (including 3 spiral scans) was 0.026/0.025 mSv (boys/girls), compared to 0.184/0.215 mSv (boys/girls) of the previously published ultra-low-dose protocol without tin filtration. This represents a dose reduction of up to 88% compared to the previous protocol.
CONCLUSION: The use of tin filtration, in addition to an ultra-low-dose protocol, allows pediatric lower extremity torsion measurements to be performed with radiation doses in a lower range than a typical localizer dose, without compromising diagnostic confidence, pushing the limits of the ALARA (as low as reasonably achievable) principle.
MATERIALS AND METHODS: Between April 2022 and December 2022, tin-filtered ultra-low-dose CTs were prospectively acquired from 52 children/adolescents using a 384-slice scanner. Two pediatric radiologists independently performed torsion measurements for all patients. Interrater agreement and image quality were assessed. Effective radiation doses of the scans were estimated.
RESULTS: The study population consisted of 52 participants (mean age, 12.7 years ± 2.0 [standard deviation]; 19 females, 33 males). All torsion measurements showed very high interrater agreement (intra-class correlation coefficient > 90% for all locations). The image quality of the vast majority of image datasets was rated as excellent. The mean total effective dose of the tin filtered ultra-low-dose protocol (including 3 spiral scans) was 0.026/0.025 mSv (boys/girls), compared to 0.184/0.215 mSv (boys/girls) of the previously published ultra-low-dose protocol without tin filtration. This represents a dose reduction of up to 88% compared to the previous protocol.
CONCLUSION: The use of tin filtration, in addition to an ultra-low-dose protocol, allows pediatric lower extremity torsion measurements to be performed with radiation doses in a lower range than a typical localizer dose, without compromising diagnostic confidence, pushing the limits of the ALARA (as low as reasonably achievable) principle.