In-plane bismuth breast shields for pediatric CT: Effects on radiation dose and image quality using experimental and clinical data

OBJECTIVE. The purpose of our study was to evaluate the amount of radiation dose reduction and its effect on image quality when using an in-plane bismuth breast shield for multidetector CT (MDCT) of the chest and abdomen in female pediatric patients. SUBJECTS AND METHODS. Fifty consecutive MDCT examinations (chest, 29; abdomen, 21) of female pediatric patients (mean age, 9 years; range, 2 months-18 years) were performed with a 2-ply (1.7 g of bismuth per square centimeter) bismuth shield (three sizes to accommodate patients of varying sizes) overlying the patients breasts. MDCT images were evaluated for a perceptible difference in image quality in the lungs at the anatomic level under the shield as compared with nonshielded lung and whether the images were of diagnostic quality. In addition, 2-mm regions of interest were placed in the peripheral anterior and posterior portions of each lung in shielded and nonshielded areas, and noise (standard deviation in Hounsfield units) was measured in the regions. Differences among the regions in noise were compared for shielded versus nonshielded areas (paired t test). To measure differences in actual dose, we also evaluated the breast shield with an infant anthropomorphic phantom using thermoluminescent detectors in the breast tissue. The phantom was imaged with and without the breast shield using identical MDCT parameters. RESULTS. All MDCT scans of patients were of diagnostic quality with no perceptible difference in image quality in shielded versus nonshielded lung. We found no statistically significant difference in noise between the shielded and nonshielded lung regions of interest (shielded: mean noise, 17.3 H; nonshielded: mean noise, 18.8 H; p = 0.5180). Phantom measurements revealed a 29% reduction in radiation dose to the breast when a medium-dose MDCT protocol was used. CONCLUSION. Bismuth in-plane breast shielding for pediatric MDCT decreased radiation dose to the breast without qualitative or quantitative changes in image quality.