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Published on: January 29, 2018
Local diagnostic reference levels for skeletal surveys in suspected physical child abuse
B Mussmann1, M Hardy2, R Rajalingam3
1Department of Radiology, Odense University Hospital, Denmark; Research and Innovation Unit, University of Southern, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Norway.
Insights
A local diagnostic reference level (DRL) for paediatric skeletal surveys was established for children aged 1-11 months. This benchmark aids in auditing radiation doses for suspected physical abuse cases.
Area of Science:
- Radiology
- Paediatric Imaging
- Radiation Dose Optimization
Background:
- Establishing diagnostic reference levels (DRLs) is crucial for optimizing radiation dose in paediatric imaging.
- Age-based DRLs are essential for skeletal surveys in infants and young children.
- Retrospective data analysis can be used to derive local DRLs.
Purpose of the Study:
- To determine if an age-based, local diagnostic reference level (DRL) for paediatric skeletal surveys could be established.
- To assess the feasibility of using retrospective data for DRL determination in paediatric skeletal surveys.
- To provide a benchmark for radiation dose in skeletal surveys for suspected physical abuse.
Main Methods:
- Retrospective analysis of 45 paediatric skeletal surveys from children under two years old.
- Data collection included Dose Area Product (DAP) and acquisition parameters from PACS.
- The 75th percentile of DAP was used to establish the DRL.
Main Results:
- A local DRL of 520 mGy*cm² was determined for children aged 1-11 months.
- Sufficient data (n=27) was available for the 1-11 month age group to establish a reliable DRL.
- Effective doses ranged from 0.18 to 0.26 mSv across age groups.
Conclusions:
- A local DRL of 520 mGy*cm² was successfully established for children aged 1-11 months undergoing skeletal surveys for suspected abuse.
- This DRL serves as an initial benchmark for radiation dose comparison and future audits.
- The findings support the use of age-based DRLs in paediatric skeletal surveys.
Introduction:
The purpose was to determine if an age based, local diagnostic reference level for paediatric skeletal surveys could be established using retrospective data.
Methods:
All children below two years of age referred for a primary skeletal survey as a result of suspected physical abuse during 2017 or 2018 (n = 45) were retrospectively included from a large Danish university hospital. The skeletal survey protocol included a total of 33 images. Dose Area Product (DAP) and acquisition parameters for all images were recorded from the Picture Archival and Communication System (PACS) and effective dose was estimated. The 75th percentile for DAP was considered as the diagnostic reference level (DRL).
Results:
The 75th percentile for DAP was 314 mGy∗cm2, 520 mGy∗cm2 and 779 mGy∗cm2 for children <1 month, 1-11 months and 12 < 24 months of age respectively. However, only the age group 1-11 months had a sufficient number of children (n = 27) to establish a local DRL. Thus, for the other groups the DAP result must be interpreted with caution. Effective dose was 0.19, 0.26 and 0.18 mSv for children <1, 1-11 months and 12 < 24 months of age respectively.
Conclusion:
For children between 1 and 11 months of age, a local diagnostic reference level of 520 mGy∗cm2 was determined. This may be used as an initial benchmark for primary skeletal surveys as a result of suspected physical abuse for comparison and future discussion.
Implications For Practice:
While the data presented reflects the results of a single department, the suggested diagnostic reference level may be used as a benchmark for other departments when auditing skeletal survey radiation dose.
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