Comparing Fourth Generation Statistical Iterative Reconstruction Technique to Standard Filtered Back Projection in Pediatric Head Computed Tomography Examinations

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Although advanced statistical iterative reconstruction (IR) techniques are valued in pediatric computed tomography (CT) imaging, there is little published data on how these techniques affect image quality and radiation dose in the pediatric population. This is particularly true in the context of pediatric head CT examinations. This study analyzed the differences in image quality and several standard metrics of radiation dose on multidetector pediatric head CT examinations performed using standard filtered back projection (FBP) with reconstructions using iDose4, a fourth-generation statistical iterative reconstruction technique.

Materials and Methods

Using a retrospective review of 282 pediatric head CT examinations, we compared how iDose4 fared against FBP for effects on several standard metrics of radiation dose and qualitative and quantitative assessment of image quality.


Our assessment revealed that examinations obtained using low-dose protocols reconstructed using iDose4, when compared with standard-dose examinations reconstructed using FBP, resulted in significant radiation dose reduction while performing equally or better in quantitative image quality parameters. For most qualitative image quality parameters, the iDose4 group demonstrated equal performance to standard filtered back technique with a few notable exceptions. In the parameter of image sharpness in the 1.5 to 7 year olds, iDose4 fared better than FBP. However, FBP outperformed iDose4 in the qualitative parameters of decreased image graininess/noise in patients older than 13 years, improved image sharpness in patients aged between 7 and 13 years, and improved visibility of small parts for those aged 7 to 13 years.


We conclude that iDose4 is effective at allowing significant radiation dose reduction while maintaining or, rarely, even improving quantitative image quality compared with FBP in the setting of pediatric head CT examinations. However, for certain qualitative image quality parameters in older-aged children, the use of iDose4 resulted in a poorer performance compared with FBP.

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