Paediatric diagnostic reference levels in computed tomography: a systematic review

Area of Science:

• Medical Imaging
• Radiology
• Radiation Protection

Background:

• Diagnostic Reference Levels (DRLs) are essential for optimizing radiation doses in medical imaging.
• Paediatric computed tomography (CT) procedures require specific considerations for dose assessment due to children's radiosensitivity.
• Existing literature shows significant global variation in how paediatric CT DRLs are established.

Purpose of the Study:

• To review current literature on diagnostic reference levels (DRLs) for paediatric CT.
• To analyze the methodologies employed worldwide for establishing these paediatric DRLs.
• To identify discrepancies and propose improvements for consistent DRL implementation.

Main Methods:

• A comprehensive literature search was conducted in PubMed and Google Scholar.
• Keywords included 'paediatric DRL', 'dose reference level', 'diagnostic reference level', and 'DRL'.
• Twenty-three articles from 15 countries, primarily based on retrospective patient surveys, were included in the analysis.

Main Results:

• Significant differences were observed in methodologies for establishing paediatric CT DRLs, including phantom sizes, data collection, and stratification.
• Commonly reported dosimetric quantities were CTDIvol and DLP, with size-specific dose estimates gaining traction.
• Wide ranges in DRLs for head, chest, and abdomen were noted, attributed to methodological inconsistencies and lack of dose optimization.

Conclusions:

• There is a need for an internationally accepted protocol for establishing paediatric CT DRLs to ensure consistency.
• Variations in DRLs underscore the importance of developing national DRLs tailored to specific country contexts.
• Standardization will facilitate better radiation dose management and patient safety in paediatric CT imaging.