An audit of radiation doses received by paediatric patients undergoing computed tomography investigations at academic hospitals in South Africa

Merwe, Cornelis M. van der; Mahomed, Nasreen

doi:10.4102/sajr.v24i1.1823

Cited by 4 publications

(4 citation statements)

References 19 publications

(34 reference statements)

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“…We compared our 75th percentile DRL values with local DRL values suggested by Van der Merwe et al as shown in Table 5 . 14 The CTDI vol values, except for 0–1 year and 1–5 year age groups, and DLP values for all age groups were higher than locally suggested DRLs, with the largest discrepancy observed in the 5–10 year and 10–15 year age groups. Thus the majority of patients in this audit were exposed to unnecessary high levels of ionising radiation, which could have long-term health implications.…”

Section: Discussionmentioning

confidence: 80%

“…Patients were divided into age groups (< 1 year, 1–5 years, 5–10 years and 10–15 years) and DRL values rounded to the nearest single digit for CTDI vol and nearest 5 for DLP, similar to Van der Merwe et al to compare the results with suggested local DRL values. 14 None of the patients in our study were aged 16 years, and thus this age group was not included in the age categories.…”

Section: Resultsmentioning

confidence: 99%

“…However, they did observe an increase in DLP values during after-hour studies at both hospitals, thought to be attributed to reduced staff members, particularly senior trained staff, experienced in imaging paediatric patients. 14 …”

Section: Introductionmentioning

confidence: 99%

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Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit

2022

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Background: Traumatic brain injury (TBI) is a common cause of paediatric morbidity and mortality, with higher TBI rates in low- and middle-income countries. Non-contrast brain CT is the gold standard for diagnosing intracranial injuries; however, it exposes patients to ionising radiation. The Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) aids clinicians in their decision-making processes whilst deciding whether a patient at very low risk of a clinically important TBI (ciTBI) requires a CT scan.Objectives: To establish whether the introduction of the PECARN CDR would affect CT utilisation rates for paediatric patients presenting with minor blunt head injuries to an academic hospital in Gauteng, South Africa.Method: This was an audit of paediatric patients who presented with minor blunt head injuries and were referred for CT imaging at an academic hospital in Gauteng, compared with PECARN CDR recommendations, over a 1-year period.Results: A total of 100 patients were referred for CT imaging. Twenty patients were classified as very low risk, none of whom had any CT findings of a TBI or ciTBI (p 0.01). A total of 61 patients were classified as intermediate risk and 19 as high risk. In all, 23% of the intermediate and 47% of the high-risk patients had CT features of a TBI, whilst 8% and 37% had a ciTBI, respectively.Conclusion: Computed tomography brain imaging may be omitted in patients classified as very low risk without missing a clinically important TBI. Implementing the PECARN CDR in appropriate patients would reduce CT utilisation rates.

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Section: Discussionmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

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Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit

2022

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“…The contrast agent used was Nucopark 320 mgL/mL, stored in a thermostatic box at 37°C. The volume CT dose index (CTDI vol ) and dose-length product (DLP) were recorded for all children, and the effective dose (ED) was calculated using the formula ED = DLP × k (k = 0.015) (5,6). Iodine intake was compared between the 2 groups as follows: For the control group, iodine intake (g) = contrast concentration (mgI/kg) × body weight (kg) × 2 mL/kg and, for the experimental group, iodine intake (g) = contrast concentration (mgI/kg) × body mass (kg) × 1.5 mL/kg.…”

Section: Equipment and Methodsmentioning

confidence: 99%

Study of Low kV, Low Contrast Agent Dosage, and Low Contrast Agent Flow Rate Scan in Computed Tomography Angiography of Children's Liver

Wu,

Tang,

Chen

et al. 2024

I J Radiol

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Background: During computed tomography (CT) examinations, the presence of radiation material undoubtedly has a certain impact on patients, particularly children, who are more susceptible to radiation. Consequently, finding ways to minimize radiation dosage and mitigate radiation-related risks while enhancing the quality and accuracy of CT scans has become a crucial concern for medical professionals in CT equipment manufacturing companies and radiology departments to contemplate. Objectives: This study aimed to explore the feasibility of low dose and low contrast medium combined with low flow rate scanning in CT angiography (CTA) of children's liver. Patients and Methods: A total of 59 children who visited our department for liver vascular CT scans between April 2021 and December 2022 were prospectively selected and randomly divided into 2 groups: the experimental group and the control group. The experimental group consisted of 28 children who received an injection of 80 kV, automatic tube current, low contrast dose (1.5 mL/kg), and low flow rate of 20 s. The control group included 31 children who were injected with 100 kV, automatic tube current, contrast agent dose (2 mL/kg), and flow rate of 16 s. The objective and subjective image quality, radiation dose, and iodine intake in the arterial, portal, and venous phases were compared between the 2 groups. Results: During the arterial, portal, and venous phases, the experimental group exhibited lower signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) compared to the control group (P < 0.05). However, there was no significant difference in subjective quality scores between the 2 groups (P > 0.05). The effective dose (ED), volume CT dose index (CTDIvol), and dose-length product (DLP) of the experimental group were lower than those of the control group (P < 0.05). Additionally, the iodine intake in the experimental group was lower than that in the control group (P < 0.05). Conclusion: In the examination of hepatic vascular CTA in children, the use of a 3-low scanning technique can effectively decrease radiation and contrast agents while ensuring sufficient image quality for accurate clinical diagnosis.

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An audit of published South African diagnostic reference level data

Trauernicht¹,

Pitcher²

2021

J. Radiol. Prot.

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Diagnostic reference levels (DRLs) are accepted as a dose optimisation tool for patients undergoing x-ray imaging and are required by South African (SA) legislation for 26 fluoroscopically guided procedures (FGPs). The aim of this paper is to collate all published SA data on DRLs in preparation for a project to establish national DRLs. Systematic searches were conducted of various applicable databases. All research that proposed DRLs for any imaging procedure in South Africa was included. Twenty-one works met inclusion criteria, the earliest from 2001. Two-thirds of all work reported on FGPs and five studies documented computed tomography DRLs. Three publications focussed exclusively on paediatric imaging DRLs. No studies on mammography or dental radiography were found. For clinical procedures with more than one proposed DRL, the range of proposed DRL varied by up to a factor of five. The highest proposed DRL is 373.1 Gy cm2 for endovascular aneurysm/aortic repair procedures. Data were collected in six public hospitals and two private hospital groups. Thirty-six authors contributed to the manuscripts, but only six studies had an inter-disciplinary authorship. This is the first paper to provide a comprehensive review of SA DRL data and thereby advances international radiation protection initiatives. The data suggests there is room for more interdisciplinary work and that there must be rigorous standardization of reported parameters and data collection. This audit also highlights the need for standardized terminology, particularly for FGPs.

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An audit of radiation doses received by paediatric patients undergoing computed tomography investigations at academic hospitals in South Africa

Cited by 4 publications

References 19 publications

Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit

Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit

Study of Low kV, Low Contrast Agent Dosage, and Low Contrast Agent Flow Rate Scan in Computed Tomography Angiography of Children's Liver

An audit of published South African diagnostic reference level data

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