The Impact of 320 Detector Rows: Aquilion ONE in the Pediatric Setting

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Sponsored by Toshiba America Medical Systems

Dose is a central consideration in the CT suite for the pediatric patient, and finding a scanner that minimized dose to a level as low as technically achievable was the primary consideration for Arkansas Children’s Hospital (ACH), Little Rock, when it replaced its legacy 16-slice scanner. As it turned out, in reducing dose, the hospital’s new scanner also delivered uncommon speed, reducing the need for sedation and resulting in significant workflow advantages.

ACH was operating 64-detector and 16-detector CT scanners when it issued a request for proposal (RFP) for a new, state-of-the-art CT system. As the only freestanding pediatric hospital in Arkansas (and a statewide tertiary burn center), ACH faced a unique set of challenges when imaging its patient population. Due to the clinical complexity of patients and their variable age range, ACH’s CT suites were accommodating an average of one to two patients an hour.

While the radiology department took every opportunity to use dose at a rate as low as reasonably achievable, or ALARA, during scan protocols to minimize exposure for its patients, newer and faster scanners were coming onto the market, promising further dose reductions, faster scan times, and, therefore, the potential to minimize or even eliminate sedation.

The dose-reduction capabilities of the 320-detector CT system caught the attention of ACH’s radiology staff. The ability to scan a body part in a single rotation, dramatically reducing radiation exposure and minimizing the need for sedation, spoke volumes to a pediatric imaging service. “Our radiologists were very interested in that technology,” Karen Craig, director of radiology, recalls.

Though it entered into a formal RFP process and reviewed proposals from multiple vendors, in the end, ACH chose the Aquilion ONE 320-detector CT system from Toshiba America Medical Systems (TAMS), Tustin, California, above a competitor’s multislice CT scanner. TAMS had also supplied the hospital’s 16- and 64-slice scanners. Craig adds that the ability of the Aquilion to do volume imaging on small body parts with a single rotation was also a key decision point. “There was widespread support from physicians across the hospital to get this scanner,” Cynthia Holland, vice president of ancillary services, affirms.

Optimized for Pediatric Care

In March 2009, ACH replaced its 16-detector CT scanner with the Aquilion ONE system (Figure 1). When it comes to the primary reason that ACH selected the scanner—dose reduction—the system has not disappointed. Preliminary internal reviews at ACH show that, in a comparison of noncardiac gated angiograms on children three years old or younger, the 320-detector scanner offers a 70% reduction in dose over helical acquisition on the 64-detector unit. In gated cardiac studies, the dose reduction has been around 50%. Donna Hoover, imaging manager, notes that the Aquilion ONE has become the scanner of choice for most studies. “In the case of cardiac studies, we would only use the 320-detector CT now,” she says.

imageFigure 1. Technologists at Arkansas Children’s Hospital appear with their state-of-the-art 320-detector Aquilion ONE CT scanner, customized with jungle decals and featuring a monitor and voice prompts delivered by a child.

Though radiation exposure from imaging represents a concern for all age groups, the team at ACH has good reason to be particularly focused on dose reduction.1-4 “Our radiologists will do anything they can to minimize the dosage, the drugs, and the trauma that a child experiences,” Holland says. “This system has been great at addressing all three of those issues.”

Hoover reports that the features of the Aquilion ONE have simplified the creation of accurate pediatric-imaging protocols. In addition to providing options for reducing dose, the unit automatically estimates the radiation dose for each exam, giving radiologists and technologists the opportunity to work together to adjust scan protocols until the dose is at the lowest possible level that still results in good image quality. “We’ve always built multiple protocols into our scanners,” Hoover notes, “but with the Aquilion ONE, there are more options, and the dose estimate is very helpful when it comes to determining whether to scan in volume or helical mode.”

One of the Aquilion ONE’s most patient-popular features is a 12-inch flat-screen LCD monitor (mounted on the scanner) called iStation, which uses