This retrospective study assessed radiation dose and image quality in 37 children undergoing pediatric cardiac CT using photon-counting detector CT (PCD CT) in comparison with 37 matched patients imaged with energy-integrating detector CT (EID CT). PCD CT resulted in significantly lower radiation exposure, with a volume CT dose index (CTDIvol) of 0.20 ± 0.12 mGy versus 0.37 ± 0.17 mGy with EID CT, and a dose-length product (DLP) of 4.06 ± 3.22 mGy*cm versus 7.21 ± 4.67 mGy*cm (p < 0.001). Quantitative and qualitative image quality, including signal-to-noise ratio, contrast-to-noise ratio, and beam hardening artifacts, were comparable between the two modalities. PCD CT enabled a greater than 40% reduction in radiation dose compared with EID CT, without compromising diagnostic performance and offering a promising strategy for pediatric cardiac imaging without the need for electrocardiographic gating.
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