Diagnostic reference levels for chest computed tomography in children as a function of patient size

Paediatric diagnostic reference levels for common computed tomography procedures: A systematic review

BACKGROUND

Previous paediatric diagnostic reference levels (PDRL) literature reviews for commonly performed procedures of the brain, chest and abdomen revealed wide DRL variation and deviation of scanning protocols across CT centres. The current review went further to determine the extent and possible factors of DRL variation in the same procedure, age or weight group, between scanners and CT centres for the standardisation of CT practice globally.

METHODS

The preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow chart was used to screen articles in Science Direct, Medline, Academic Search Complete via EBSCOhost, PubMed, and CINAHL via EBSCOhost including the Google search engine.

RESULTS

A total of 6573 articles were retrieved and screened against the established criteria and finally, 52 articles were selected and synthesised narratively.

CONCLUSION

The findings of this review show variation of brain PDRLs up to a factor of 2 fold for the same examination and age group. Factors attributable to dose variations noted in this review were largely related to the setting of the scan protocols such as the use of different phantom sizes, dose parameters, and age groups. This indicates the need to standardise methods of establishing PDRLs and alignment with the European Commission and ICRP recommended guidelines are proposed.

IMPLICATION FOR PRACTICE

The review highlights different methods for establishing PDRLs and their implication which could guide radiographers and medical physicists in future PDRLs establishment for dose optimization.

Age-based diagnostic reference levels and achievable doses for paediatric CT: a survey in Shanghai, China

Computed tomography (CT) is extensively utilised in medical diagnostics due to its notable radiographic superiority. However, the cancer risk associated with CT examinations, particularly in children, is of significant concern. The assessment of cancer risk relies on the radiation dose to examinees. Diagnostic reference levels (DRLs) and achievable doses (ADs) were used to assess the level of radiation dose in CT examinations widely. Although the national DRLs of paediatric CT have been explored in China, few local DRLs at the city level have been assessed. To set up the local DRLs and ADs of paediatric CT, we investigated the radiation dose level for paediatric CT in Shanghai. In this survey, a total of 3061 paediatric CT examinations underwent in Shanghai in 2022 were selected by stratified sampling, and the dose levels in terms of volume CT dose index (CTDIvol) and the dose-length product (DLP) were analysed by 4 age groups. The DRLs and ADs were set at the 75th and 50th percentile of the distribution and compared with the previous studies at home and abroad. The survey results revealed that, for head scan, the DRLs of CTDIvolwere from 25 to 46 mGy, and the levels of DLP were from 340 to 663 mGy·cm. For chest, the DRLs of CTDIvolwere from 2.2 to 8.3 mGy, and the levels of DLP were from 42 to 223 mGy·cm. For abdomen, the DRLs of CTDIvolwere from 6.3 to 16 mGy, and the levels of DLP were from 181 to 557 mGy·cm. The ADs were about 60% lower than their corresponding DRLs. The levels of radiation doses in children-based hospitals were higher than those in other medical institutions (P< 0.001). In conclusion, there was still potential for reducing radiation dose of paediatric CT, emphasising the urgent need for optimising paediatric CT dose in Shanghai.