Indication-based national diagnostic reference levels for paediatric CT: a new approach with proposed values

Area of Science:

• Medical Imaging
• Radiology
• Radiation Protection

Background:

• Establishing diagnostic reference levels (DRLs) is crucial for optimizing radiation dose in paediatric computed tomography (CT).
• Existing DRLs may not adequately address the variability in patient size and specific examination indications in paediatric populations.
• Paediatric CT examinations require tailored dose optimization strategies due to anatomical and physiological differences.

Purpose of the Study:

• To propose indication-based national diagnostic reference levels (DRLs) for common paediatric computed tomography (CT) examinations.
• To develop DRLs that account for patient weight and specific clinical indications.
• To provide a benchmark for radiation dose optimization in paediatric CT.

Main Methods:

• Collected patient dose data (CTDIvol and dose length product) from over 1000 paediatric patients across four university hospitals.
• Analyzed dose data for common CT indications including chest, abdomen, abdomen+pelvis, chest+abdomen, and head CT.
• Developed DRLs as exponential curves based on patient weight for body examinations and age groups for head CT.

Main Results:

• Proposed DRL curves (75% and 50% levels) as a function of patient weight for body CT examinations, applicable across multiple indications.
• Established age-specific DRLs for head CT, differentiating between routine scans and those for ventricular size assessment.
• The proposed DRLs were found to be generally lower than previously published DRLs from other countries.

Conclusions:

• The proposed indication-based DRLs provide a more refined approach to radiation dose management in paediatric CT.
• The weight- and age-based DRL curves facilitate tailored dose optimization across diverse paediatric patient groups and indications.
• These lower proposed DRLs suggest potential for improved radiation safety in paediatric imaging practices.