Pediatric CT Head (Low Dose)

Indications

• Trauma (per PECARN), shunt evaluation (hydrocephalus), suspected hemorrhage
• Acute neurologic change, macrocephaly, craniosynostosis (bone)
• Follow-up of known intracranial process

Patient prep

• Image Gently principles—lowest dose to achieve diagnosis; child-size technique
• Immobilization (feeding/swaddling, vacuum bag); sedation avoided when possible, feed-and-swaddle for infants
• Usually non-contrast; contrast only for specific indications (infection, mass, vascular)
• Remove metal; involve child life if available

Contrast

Technique

• Supine, head in holder; axial or helical per scanner
• Coverage skull base/foramen magnum through vertex
• Weight/age/head-size-based kV (often 80-100 kV in small children) and reduced mAs; iterative reconstruction to lower dose
• Recon soft tissue (brain) 3-5 mm and bone kernel; add 3D for craniosynostosis
• Minimize repeat scanning; use dose-reduction (organ-based modulation, eye shielding considerations)

Series / Sequences

Key points

• Image Gently: child-size the kV/mAs; never use adult protocols on children
• Apply PECARN to limit CT use in minor head trauma; consider rapid MRI/observation alternatives
• Iterative reconstruction allows substantial dose reduction at preserved diagnostic quality
• Feed-and-swaddle and immobilization reduce motion and avoid sedation
• Low-dose limited protocol for VP shunt series; consider rapid-sequence MRI to avoid radiation in follow-up

References