The purpose of this study was to assess and analyze the radiation doses during head pediatric CT from different CT units within six Tunisian hospitals representing different geographic regions in order to optimize the dose given and minimize the radiology risk to this category of patients and towards the derivation of national diagnostic reference levels. Patient data and exposure parameters were collected for four age groups (<1, 1-5, 5-10 and 10-15 y). Clinical protocols and exposure settings were analyzed. Doses were collected in terms of CTDIvol and DLP values. Effective and Organ doses to specific radiosensitive organs were estimated using the Monte Carlo simulation software 'Impact CTDosimetry'. Results showed large variations in CT protocols and doses between different radiology departments. CTDIvol and DLP values demonstrated a broad range between the CT units and between the axial and helical scan techniques in the same unit. CTDI vol values were estimated to be 24.9, 31.7, 45.5 and 47.8 mGy for <1, 1-5, 5-10 and 10-15 y age groups, respectively. In term of DLP, median values were ~346, 528, 824, 897 mGy cm for the same age groups, respectively. Effective dose ranged from 1.4 to 5 mSv. Dose values were comparable with those reported in the literature. The study shows an evident need for continuous training of staff in radiation protection concepts, especially within the regional hospitals, emphasizes the importance of the production and the update of recommendations and good practice guidelines using interdisciplinary working groups and opens the way for the establishment of national DRLs.
Original ArticleAbstract Purpose: To assess the radiation doses to neonates from diagnostic radiography in order to derive the local diagnostic reference levels (LDRLs) for optimisation purposes. Methods: This study was carried out in the neonatal intensive care units (NICU) of two hospitals in Tunis. 134 babies, with weights ranging from 635 g to 6680 g, performed chest-abdomen X-ray examinations. Neonates were categorized into groups of birth weight. For each X-ray examination, patient data and exposure parameters were recorded. Dose area product (DAP) was measured and entrance surface dose (ESD) was estimated. Effective dose was calculated from the Monte Carlo simulation software PCXMC. Results: DAP values increased with neonatal weight and demonstrated a wide variation (5.0 -43.0 mGy.cm 2 , mean 23.4 mGy.cm 2 ) for patient weight from 600 g to 4000 g. A wide variation was also observed for ESD (14 -93 μGy, mean 55.2 μGy). The LDRLs expressed in term of DAP were estimated to be 17.6 mGy.cm 2 and 29.1 mGy.cm 2 for the first and the second NICU, respectively. In terms of effective dose, the average value was about 31.6 μSv single radiological examination. The results show the necessity to use a standardized protocol with high voltage technique combined to lower current time product (mAs) values and an adapted collimation which could lead to further reductions in the neonatal doses. Conclusion: This study presents the LDRLs and the effective doses for neonates in two NICUs and demonstrates the necessity to optimize patient protection for this category of patient.
This work focuses on the determination of the radiation doses for a total sample of 916 children, categorized in four age groups (<1,1-5, <5-10, <10-15 y) undergoing the most frequent pediatric CT scans performed in different scan facilities in Tunisia in order to establish the national Diagnostic Reference Levels (DRL). Dose evaluation concerned the dosimteric indicators: Volume Computed Tomography Dose Index (CTDIvol) and Dose Length Product (DLP). The different pediatric CT protocols and practices were also evaluated. Results show large variation in doses between different radiology departments. For head scans, the respective DRLs for <1, 1-5, 5-10 and 10-15 years were 26, 38, 51 and 51 mGy for CTDIvol, and 384, 664, 873 and 978 mGy cm for DLP. For the chest, the equivalent DRLs were 8, 10, 12 and 15 mGy for CTDIvol and 118, 330, 442 and 526 mGy cm for DLP. For the abdomen, the DRLs were 9,13,19,18 CTDIvol and 353, 485,592, 1073 mGy cm for DLP. This study shows that the optimization of pediatric CT procedures should be a priority especially within the regional hospitals. The implementation of corrective actions will take place after the initial DRLs. These actions, including recommendations and guidelines to good practice, should be a joint effort of all stakeholders, including health authorities, radiation protection regulator, professional societies and universities.
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