Detection of Incidental Nonosseous Thoracic Pathology on State-of-the-Art Ultralow-Dose Protocol Computed Tomography in Pediatric Patients With Pectus Excavatum

Objective The aim of the study was to compare a pediatric ultralow-dose pectus excavatum computed tomography (CT) protocol versus standard-dose pediatric thoracic CT in terms of radiation dose, subjective and objective image quality, and its ability to detect incidental nonosseous thoracic pathology compared with imaging and clinical reference. Methods A single institution radiology database identified a total of 104 ultralow-dose pediatric thoracic CT cases with an equal number of age-matched standard-dose chest CT cases also selected for retrospective analysis. Objective image quality (contrast-to-noise and signal-to-noise ratios) and radiation dose were assessed. Qualitative Likert scorings of the bone, lung, and soft tissues were performed by 2 expert radiologists. Electronic health records of the ultralow-dose cohort were reviewed for at least 1 year to evaluate for potentially missed thoracic pathology and symptoms. Variables were compared using parametric and nonparametric tests in R software 4.0.5. Results The ultralow-dose protocol group had statistically significant reductions (P < 0.001) in the volume CT dose index (0.31 +/- 0.19 vs 2.20 +/- 1.64 mGy), effective radiation dose (0.14 +/- 0.08 vs 1.07 +/- 0.86 mSv), and size-specific dose estimates (0.50 +/- 0.30 vs 3.43 +/- 2.56 mGy) compared with the standard protocol, yielding an 86.51% and 85.32% reduction, respectively. The signal-to-noise ratio (20.49 +/- 6.19 vs 36.48 +/- 10.20), contrast-to-noise (21.65 +/- 6.57 vs 38.47 +/- 10.59), and subjective measures of image quality (lung parenchyma [3.07 +/- 0.92 vs 4.42 +/- 0.47], bony structures [3.30 +/- 0.86 vs 4.52 +/- 0.51], and surrounding soft tissues [2.57 +/- 0.63 vs 3.89 +/- 0.65]) were also significantly lower in the ultralow-dose protocol (P < 0.001). No differences were seen in the number and size of pulmonary nodules between groups. Clinical and imaging follow of all 104 patients undergoing ultralow-dose CT demonstrated no evidence of missed thoracic pathology causing symptoms. Conclusions Ultralow-dose thoracic CT is an acceptable modality for imaging pediatric patients with pectus excavatum and other conditions primarily causing osseous pathology, with effective radiation dose comparable to plain radiographs and a moderate increase in image noise that did not significantly reduce its ability to detect incidental nonosseous thoracic pathology.