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Radiation exposure from CT scanning is of increasing concern as CT use in children has risen dramatically. This retrospective study of pediatric CT heads aimed to compare 60-keV with conventional images obtained with different acquisition protocols to evaluate whether a reduced radiation dose can be achieved in 60-keV without compromising image quality. On the basis of image analysis and observer agreement assessment, the authors found a dose reduction of 28% while maintaining superior image quality with a scan protocol of 180 mAs compared with 250 mAs on 60-keV virtual monoenergetic images from spectral detector CT in the pediatric head.