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U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations
Kalpana M Kanal1, Priscilla F Butler1, Mythreyi B Chatfield1
1From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Radiology
|October 26, 2021
Summary
New diagnostic reference levels (DRLs) and achievable doses (ADs) for pediatric CT scans were established using national registry data. These benchmarks help facilities optimize radiation doses for young patients based on age and size.
Area of Science:
- Medical Imaging
- Radiology
- Radiation Dose Optimization
Background:
- Diagnostic reference levels (DRLs) and achievable doses (ADs) are crucial for optimizing radiation exposure in medical imaging.
- Previous DRLs and ADs for pediatric computed tomography (CT) examinations may not reflect current practices or national standards.
- The American College of Radiology Dose Index Registry provides a valuable dataset for establishing such benchmarks.
Purpose of the Study:
- To establish robust, current, national DRLs and ADs for the 10 most frequently performed pediatric CT examinations in the United States.
- To develop these benchmarks as a function of patient age and size, enabling more precise dose assessment.
- To provide updated guidance for radiation dose management in pediatric CT.
Main Methods:
- Analysis of data from 1,543,935 pediatric CT examinations (patients ≤18 years) conducted between 2016 and 2020 at 1625 facilities.
- Dose indexes (CTDIvol, DLP, SSDE) were analyzed based on patient age for head/neck CT and patient age and effective diameter for body CT.
- Medians were calculated for ADs, and 75th percentiles for DRLs, stratified by examination type, age, and size.
Main Results:
- Data represented a diverse range of healthcare facilities, with community hospitals comprising the majority (66%).
- For head CT without contrast, age-based CTDIvol ADs ranged from 19 to 46 mGy, and DRLs from 23 to 55 mGy, increasing with age.
- For body CT, DRLs and ADs for CTDIvol, SSDE, and DLP consistently increased with the patient's effective diameter.
Conclusions:
- National DRLs and ADs were successfully developed for 10 common pediatric CT examinations, considering age and effective diameter.
- These established benchmarks serve as essential tools for CT facilities to evaluate and adjust their pediatric protocols.
- Implementation of these benchmarks can lead to optimized radiation doses for pediatric patients undergoing CT examinations.
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