Establishing paediatric diagnostic reference levels using reference curves – A feasibility study including conventional and CT examinations

Abstract

To derive Regional Diagnostic Reference Levels (RDRL) for paediatric conventional and CT examinations using weight-based DRL curves and compare the outcome with DRL derived using the weight groups. Methods: Data from 1722 examinations performed at 29 hospitals in four countries were included. DRL was derived for four conventional x-ray (chest, abdomen, pelvis, hips/joints) and two types of CT examinations (thorax, abdomen). DRL curves were derived using an exponential fit to the data using weight as an independent variable and the respective radiation dose indices (P KA , CTDI vol , DLP) as dependent variables. DRL was also derived for weight groups for comparison. The result was compared with national diagnostic reference level (NDRL) curves. Results: The derived curves show similarities with the NDRL curves available and corresponded sufficiently well with DRL for weight groups using the same data set, if sufficient number of data was available. Conclusions: We conclude that weight-based DRL curves are a feasible approach and could be used together with DRL for weight groups. The main advantage of DRL curves is its application in the clinic. When the examination frequency is low, time to collect enough data to establish typical values for one or several weight groups may be unreasonably long. The curve provides the means to compare dose level faster and with fewer data points.

Projection radiography of the ankle; the views used for different indications vary between medical imaging departments

“…The variation in combinations of views was more than expected, although previous surveys have indicated such differences in ankle radiography [16]. More recent studies have also revealed a difference in the numbers of views for the same body part and indication [17].…”

Introducing fitting models for estimating age‐specific dose and effective dose in paediatric patients undergoing head, chest and abdomen–pelvis imaging protocols: a patient study

“…This leads to an underestimation of the dose for average‐sized adults and paediatric by 40–70% 21 . To address this concern, conversion factors to acquire size‐specific dose estimates (SSDEs) for specific patients have been suggested 15,22 . The SSDE is introduced to set the CTDI vol to show the effect of sizes of the patients on the average radiation dose, particularly for overweight patients with larger sizes and paediatric patients with smaller sizes 23,24 .…”

“… 21 To address this concern, conversion factors to acquire size‐specific dose estimates (SSDEs) for specific patients have been suggested. 15 , 22 The SSDE is introduced to set the CTDI vol to show the effect of sizes of the patients on the average radiation dose, particularly for overweight patients with larger sizes and paediatric patients with smaller sizes. 23 , 24 The approaches and recommendations of calculating the SSDE have been updated in a later report; 25 however, its accuracy in estimating individual organ dose has been limited.…”

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

“…A major problem is the large variation in patient size in infants and children in the same age group. This partially explains the large variation in radiation dose, in addition to other individual, institutional and national factors, all contributing to large variations across patients, institutions and countries [ 11 – 17 ]. Further, there is little consistency in grouping of patients into age and weight groups [ 1 , 16 – 18 ].…”