Optimisation of radiation dose and image quality in paediatric chest and abdominal CT examinations: A systematic review.

INTRODUCTION: Computed tomography (CT) is indispensable for the rapid evaluation of paediatric chest and abdominal pathology, yet it delivers relatively high ionizing radiation doses compared with other imaging modalities. Wide inter-institutional variability in dose metrics underscores the need for systematic optimisation that balances radiation safety with diagnostic image quality. The purpose of the study is to systematically evaluate how low-dose acquisition strategies and advancements in reconstruction techniques affect radiation exposure and image quality in paediatric CT Chest and Abdomen. METHODS: A systematic review of existing research published between 2010 and 2025 was conducted through relevant databases such as PubMed, Scopus, Web of Science, and Embase. The inclusion criteria comprised CT chest and abdomen examinations of humans (≤18 years) that reported quantitative dose metrics such as volume Computed Tomography Dose Index (CTDIvol), Dose Length Product (DLP), Size Specific Dose Estimate (SSDE), or effective dose (ED) alongside objective or subjective image quality (OIQ/SIQ) assessments. Dose optimisation strategies included reduced kVp, tube current modulation, dual-energy CT (DECT), spectral shaping, iterative reconstruction (IR), and deep learning iterative reconstruction (DLIR). Meta-analysis was not conducted due to data heterogeneity. Risk of bias was assessed using ROBINS-I. RESULTS: Fourteen studies comprising patients were included, as they provided both quantitative and qualitative data, with reported dose reductions ranging from 5% to 93.8%. Most studies used common dose reduction techniques, such as low kilovolt peak (kVp) and milliampere-seconds (mAs). CONCLUSION: Advanced reconstruction techniques, including IR or DLIR, effectively maintain diagnostic image quality while enabling radiation dose reduction in paediatric body CT. IMPLICATIONS FOR PRACTICE: Implementing patient-specific dose-optimisation strategies in paediatric CT imaging can significantly reduce radiation exposure while maintaining diagnostic image quality, thereby improving patient safety and clinical outcomes.