A study to establish international diagnostic reference levels for paediatric computed tomography

Abstract

The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.

Can a CT be Omitted in Pediatric Minor Head Trauma?

“…30 Our scanning parameters do not reach the reference levels compared with proposed international diagnostic reference levels (DRLs) from a large multi-center study 2015. 14 In general, pediatric CT scans in pediatric centers show a significant lower CTDI vol than those reported by adult trauma centers and the mean CTDI vol at children's hospitals was $7 mGy, lower than that at non-children's hospitals. 31 Skull fractures have a low sensitivity as a risk factor for an intracranial hemorrhage, and neurologically normal patients with linear skull fractures rarely require neurosurgery.…”

The effective dose result of18F-FDG PET-CT paediatric patients

“…Furthermore, other CT imaging parameters such as tube voltage, pitch, time per bed and rotation can be adjusted manually to obtain good images [22] rather than rely on AEC function only. As for paediatric patient the suggested PET acquisition mode is in 3D compared from 2D [26]. With the use of 3D acquisition mode, the PET detector is managed to collect more data from the photons that travel in the body which effect from the collimations interaction compared to 2 D which the ability to gain data is less due to filter design.…”

“…With this specialities, the administered dose activity to the patient can be minimise and this indirectly reduce the effective dose [28][29][30]. The use of 3D acquisition mode and OSEM reconstruction method is to ensure obtaining get a good quality image [26].…”

Applications of Diagnostic Reference Levels of Standard Doses in Nuclear Medicine

“…DRLs are neither dose limited nor it does not give boarder line between poor and good medical practice [24]. DRLs are proposed for the improvement of the picture quality.…”