Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Ultra-low dose computed tomography chest vs chest radiography in paediatric primary ciliary dyskinesia: A prospective study
Michael G Waldron, Patrick W O'Regan, Michael Lane, Sahil S Shet, Eid Kakish, Fiachra Moloney, Niamh Moore, Mary Jane Murphy, Louise Beagan, Barry J Plant, David Mullane, Muireann Ni Chroinin, David J Ryan, Kevin O'Regan, Stephen P Power, Michael M Maher
Michael G Waldron, Patrick W O'Regan, Fiachra Moloney, David J Ryan, Kevin O'Regan, Stephen P Power, Michael M Maher, Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
Michael Lane, David Mullane, Muireann Ni Chroinin, Department of Paediatrics, Cork University Hospital, Cork T12 DC4A, Ireland
Sahil S Shet, Eid Kakish, Niamh Moore, Department of Radiology, School of Medicine, University College Cork, Cork T12 AK54, Ireland
Mary Jane Murphy, Louise Beagan, Department of Radiography, Cork University Hospital, Cork T12 DC4A, Ireland
Barry J Plant, Department of Respiratory Medicine, Cork University Hospital, Cork T12 DC4A, Ireland
Author contributions: Waldron MG contributed to investigation; Waldron MG and O'Regan PW contributed to writing - original draft; O'Regan PW contributed to visualization; Lane M contributed to data collection; Shet SS, Kakish E, Mullane D, Ni Chroinin M, and O'Regan K contributed to writing - review and editing; Moloney F, Moore N, Beagan L, Plant BJ, Mullane D, and Ni Chroinin M contributed to resources; O'Regan PW and Murphy MJ contributed to data curation; Plant BJ and Ryan DJ contributed to supervision; Plant BJ, Power SP, and Maher MM contributed to validation; Ryan DJ and Power SP contributed to methodology; O'Regan K and Maher MM contributed to project administration; Power SP contributed to formal analysis; Maher MM contributed to conceptualization.
Institutional review board statement: This prospective study received approval from the local institutional review board (Clinical Research Ethics Committee Reference Number: ECM 4 (n) 12/11/2019 & ECM 3 (ll) 28/06/2022).
Informed consent statement: Written informed consent was obtained from each patient or their guardian prior to participation.
Conflict-of-interest statement: There is no conflict of interest associated with any of the authors who contributed their efforts in this manuscript.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sahil S Shet, Lecturer, Research Fellow, Department of Radiology, School of Medicine, University College Cork, College Road, Cork T12 AK54, Ireland.
sshet@ucc.ie
Received: June 7, 2025
Revised: June 23, 2025
Accepted: July 23, 2025
Published online: August 28, 2025
Processing time: 83 Days and 14.8 Hours
BACKGROUND
Primary ciliary dyskinesia (PCD) is a rare condition characterised by dysmotile, immotile, or absent cilia. As a result of the impairment in respiratory mucociliary clearance, patients with PCD typically develop neonatal respiratory distress, nasal congestion, otitis media and recurrent respiratory infections leading to bronchiectasis and structural lung changes. These changes have been shown by chest computed tomography (CT) to develop in infancy and early childhood. Recent development and refinement of radiation-reducing CT techniques have allowed significant radiation dose reductions, with chest CT doses now in the range of chest radiography (CR).
AIM
To evaluate the efficacy of ultra-low dose CT (ULDCT) chest in identifying pulmonary changes within a PCD paediatric patient cohort.
METHODS
Paediatric patients with PCD who presented for routine clinical outpatient follow-up within the study period, were eligible for inclusion in the study. ULDCT and CR were performed on these patients and the results compared. Comparison metrics included radiation dose, subjective and objective image quality and disease severity.
RESULTS
Six paediatric patients (mean age 9 years) underwent clinically indicated ULDCT chest examinations and CR for surveillance of their PCD. The mean effective dose was 0.08 ± 0.02 mSv, a dose that approximates that of a frontal and lateral chest radiograph. The average Brody II score across the entire cohort was 12.92, with excellent inter-rater reliability and intra-class correlation coefficient (ICC) of 0.98. The average Chrispin-Norman score on CR was 1 with excellent inter-rater reliability and ICC of 0.92.
CONCLUSION
ULDCT demonstrates superior diagnostic capabilities, minimal radiation dose penalty, and high interobserver reliability in comparison to CR. Thus, we advocate for ULDCT to be the preferred modality for surveillance imaging in paediatric PCD.
Core Tip: Ultra-low dose computed tomography (ULDCT) is an exciting technique developed over the last decade that allows acquisition of diagnostic quality images at remarkably low radiation doses. This technique is especially important in patients requiring regular repeated imaging such as children with primary ciliary dyskinesia (PCD). Patients with PCD frequently suffer from recurrent respiratory tract infections and develop structural lung changes that require regular imaging to monitor. While chest radiography is traditionally used, subtle findings may be missed due to limitations of this modality. Our study offers an alternative; ULDCT which is superior in diagnostic capability with a minimal radiation dose penalty.
