Introduction

Pneumonia is a leading cause of morbidity and mortality in children worldwide. While chest X-ray remains the first-line imaging modality due to its availability and low radiation dose, CT offers superior anatomical detail. This study aims to compare the diagnostic and follow-up capabilities of CXR and CT in pediatric pneumonia.

Methods

Study Design

• A prospective, randomized clinical trial conducted over 24 months at a tertiary pediatric hospital.
• Participants: 200 children (ages 1 month to 12 years) with clinically suspected pneumonia were included.
• Groups: Participants were randomly assigned to two groups—100 children underwent initial evaluation with CXR, and 100 underwent CT as the primary imaging modality.

Inclusion Criteria

• Clinical signs of pneumonia (fever, cough, tachypnea, crackles on auscultation).
• Parental consent for imaging.
• No prior imaging or antibiotic treatment in the preceding 7 days.

Exclusion Criteria

• Known chronic lung diseases (e.g., cystic fibrosis, asthma exacerbation).
• Contraindications to CT, including allergy to contrast agents.

Imaging Protocols

• CXR: Posterior-anterior and lateral views were obtained using digital radiography with standard pediatric protocols to minimize radiation exposure.
• CT: Low-dose, contrast-enhanced protocols were used to optimize lung parenchyma visualization while adhering to ALARA (As Low As Reasonably Achievable) principles.

Data Collection

• Imaging findings: Evaluated for consolidation, ground-glass opacities, pleural effusion, interstitial changes, and complications such as abscess or empyema.
• Clinical correlation: Recorded laboratory markers (e.g., C-reactive protein, leukocyte count) and symptom resolution timeline.
• Radiation exposure: Calculated for each imaging study and compared between groups.
• Clinical impact: Assessed by changes in antibiotic therapy, hospital stay duration, and invasive procedures guided by imaging.

Outcome Measures

1. Diagnostic accuracy (sensitivity and specificity for confirmed pneumonia).
2. Radiation dose comparison (mSv).
3. Impact on clinical management, including changes in therapy and intervention.
4. Follow-up imaging utility for monitoring resolution and detecting complications.