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Diagnostic reference levels in pediatric radiology in Austria
Jochen Billinger1, Robert Nowotny, Peter Homolka
1Center for Biomedical Engineering and Physics, Medical University of Vienna, Vienna, Austria. Jochen.billinger@meduniwien.ac.at
Insights
Pediatric radiology requires dose optimization due to children's radiation sensitivity. A national survey revealed significant dose variations in pediatric X-rays, highlighting the need for audits against diagnostic reference levels to reduce patient exposure.
Area of Science:
- Radiology
- Pediatric Imaging
- Radiation Dose Optimization
Background:
- Children exhibit heightened sensitivity to ionizing radiation.
- Diagnostic reference levels (DRLs) are crucial for optimizing patient radiation doses in pediatric radiology.
- Standard radiographic procedures necessitate dose optimization in pediatric imaging.
Purpose of the Study:
- To assess radiation doses and dose variations in pediatric X-ray examinations nationwide.
- To establish dose values for common X-ray procedures across different pediatric age groups.
- To compare determined doses with established European, British, and German reference values.
Main Methods:
- A comprehensive national survey was performed to collect dose data.
- Dose values were determined for chest, skull, and abdomen X-ray procedures.
- Data were collected for pediatric patients across various age groups: newborns, 1, 5, 10, and 15-year-olds.
Main Results:
- Third quartiles of patient doses were calculated and compared to international DRLs.
- Significant variations in average doses were observed between hospitals, with ratios up to eightfold for similar examinations and ages.
- Individual patient dose variations were considerably higher than inter-hospital average dose variations.
Conclusions:
- While average pediatric radiation doses generally reflect good radiological practice, substantial inter-hospital variations exist.
- Auditing radiation doses against DRLs is recommended to guide optimization efforts in pediatric radiology.
- Implementing these optimization practices is expected to lead to reduced radiation doses for pediatric patients.
Background:
Because of the higher sensitivity to radiation in children, optimization plays an essential role in pediatric radiology. Diagnostic reference levels are a helpful tool to optimize patient dose for standard radiographic procedures.
Methods:
A nationwide survey was conducted to determine doses and variation in average dose applied to children for standard X-ray examinations. Dose values for chest, skull and abdomen X-ray procedures were determined for newborns, 1, 5, 10 and 15 year olds.
Results:
Third quartiles of patient doses are provided and compared to European, British and German reference values. Variation in average doses between hospitals (i.e., ratio of maximal to minimal applied average dose) for the same age and examination was found to be typically a factor of eight. Ratios of maximal to minimal applied doses to individual patients were found to be approximately a factor of six higher than variations of average doses between clinics.
Conclusions:
While average patient doses indicate the use of good radiological practice in general, variance in average doses applied by different hospitals indicate that audit of dose with respect to reference values will provide guidance for optimization. Such practice should result in lowering doses for pediatric examinations.
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