Towards the establishment of national diagnostic reference levels in Tunisia: a multicentre survey in paediatric CT

Abstract

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.