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The patients were matched according to water-equivalent diameters. Quantitative evaluation of image quality comprised a region of interest (ROI)-based analysis, calculating image noise, signal-to-noise (SNR) and contrast-to-noise (CNR) ratio. Differences of the attenuation variation of the paraspinal and the pectoral muscles were calculated to measure beam hardening artifacts. Volume CT dose index (CTDI\n                      <jats:sub>vol<\/jats:sub>\n                      ) and dose length product (DLP) were documented, and the effective radiation dose was calculated for each patient. Statistical analysis comprised\n                      <jats:italic>t<\/jats:italic>\n                      -tests and Wilcoxon signed rank tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age of the children on PCD CT was 794\u2009\u00b1\u20091016 days, similar to the mean age of 815\u2009\u00b1\u2009957 days of the children on EID CT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.76). Moreover, age, height, weight, and body mass index (BMI) were also not significantly different between the two groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2265\u20090.32). Radiation exposure was significantly lower on PCD CT (CTDI\n                      <jats:sub>vol<\/jats:sub>\n                      0.20\u2009\u00b1\u20090.12 mGy and DLP 4.06\u2009\u00b1\u20093.22 mGy*cm) versus EID CT (CTDI\n                      <jats:sub>vol<\/jats:sub>\n                      0.37\u2009\u00b1\u20090.17 mGy\n                      <jats:italic>, p<\/jats:italic>\n                      \u2009&lt;\u20090.001 and DLP 7.21\u2009\u00b1\u20094.67 mGy*cm\n                      <jats:italic>, p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No significant differences in SNR, CNR, or beam hardening artifacts could be observed. Qualitative image quality was also comparable for PCD CT versus EID CT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With a reduction in radiation exposure exceeding 40% by using PCD CT, image quality remained stable compared to EID CT. Reducing radiation with PCD CT while preserving image quality might substantially advance cardiac imaging in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Children are particularly sensitive to radiation exposure, highlighting the need for dose reduction<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Radiation dosage can be significantly reduced while preserving image quality when using photon-counting detector (PCD) CT in pediatric patients with congenital heart disease<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Since radiation exposure can be significantly reduced by PCD CT compared to energy-integrating detector (EID) CT, while image quality was comparable, PCD CT is advisable for children with congenital heart disease<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11719-6","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T01:53:49Z","timestamp":1751507629000},"page":"324-333","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Reduction of radiation exposure and preserved image quality using photon-counting detector\u00a0cardiac computed tomography without electrocardiographic gating\u00a0in children with congenital heart disease"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9604-2691","authenticated-orcid":false,"given":"Susanne","family":"Hellms","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Werncke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"B\u00f6ttcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph M.","family":"Happel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Eckstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus Benedikt","family":"Krueger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Panknin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Pfeil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till F.","family":"Kaireit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Beerbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Vogel-Claussen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Wacker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane Miriam","family":"Renz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"11719_CR1","doi-asserted-by":"publisher","first-page":"5489","DOI":"10.1007\/s00330-023-09533-z","volume":"33","author":"L Natale","year":"2023","unstructured":"Natale L, Vliegenthart R, Salgado R et al (2023) Cardiac radiology in Europe: status and vision by the European Society of Cardiovascular Radiology (ESCR) and the European Society of Radiology (ESR). 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As such, they have not participated in the selection or review processes for this article. C.P. is affiliated with Siemens Healthineers. 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