Size-specific dose estimation in pediatric computed tomography: From dose characterization to individualized optimization

Table 3 Summary of the translational roles of size-specific dose estimate in pediatric computed tomography dose management

Application domain	Representative studies	Evidence summary	Practical implication
Pediatric DRL	Kanal et al[61], Hwang et al[64], Bos et al[63], Kamdem et al[48], and Ploussi et al[65]	DRL should be stratified by age, body weight, body diameter, examination site, and clinical indication	SSDE can complement CTDIvol and DLP for establishing pediatric DRLs that better reflect body-size differences
Automated dose monitoring	Bos et al[63], Abdulkadir et al[36], Anam et al[27]	Automated extraction of dose reports and automated calculation of Dw and SSDE can support high-throughput quality control	Become a core function of pediatric CT dose-management platforms
Patient-level cumulative dose assessment	Tabari et al[66]	Simple summation of CTDIvol or SSDE cannot characterize local peak dose along the Z-axis	Scan start and end positions, scan length, tube-current modulation, and dose line integral should be recorded
Image-quality constraints	Raslau et al[51], Kim and Newman[41], Sayed et al[68]	Dose reduction may alter image noise and low-contrast resolution; optimization should be based on the diagnostic task	SSDE should be jointly modeled with image-quality metrics to avoid diagnostically insufficient low-dose imaging

DRL: Diagnostic reference level; SSDE: Size-specific dose estimate; CTDI_vol: Conventional volume computed tomography dose index; D_w: Water-equivalent diameter; CT: Computed tomography; DLP: Dose-length product.