At a recent Society for Pediatric Radiology (SPR) meeting in San Francisco, one presentation addressed low-dose CT’s “bright future, but troubled present.” Texas Children’s Hospital’s Dr. R. Paul Guillerman touched on the many uncertainties and challenges involved in low-dose radiation optimization, citing that these goals are so complex that they may nearly be impossible.

But, let’s take another look at this. Yes—dose reduction is complex and full of potential traps leading to poor technique or image quality. However, that is not a reason to avoid implementing a dose reduction (technique optimization) program at your institution!

So, how do you lead your institution down a road towards dose reduction? First, start with Google. Read what you can find on the topic. Then, go to meetings, talks, and presentations given by experts with considerable experience in the endeavor. Finally, start at your own institution.

I would suggest trying one variable at a time. Implement a weight based (or cross-sectional area based) kVp selection program. Then, embark on understanding how to use weight (or BMI) based selection of Noise Index for automated tube current modulation. Don’t forget to check out the easy stuff – like patient centering, use of bismuth shields, and limiting Z axis. Realize that even your contrast injection protocols – volume, rate, blending – might benefit from a weight based approach. Decide how to implement iterative reconstruction, varied by body region.

With these steps you are set to embark on a continual journey. Get started… today!