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Expansion of Typical Values for Paediatric Patients in Ireland and Comparison with Published DRLs - Experiences of a
Andrew Lyons1, Ali Mohammed Ali2, Andrew England1
1Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland.
Insights
This study established weight-based typical values (TVs) for paediatric radiography, finding they correlate with patient weight and exam type. Variations in radiation dose metrics were observed between X-ray rooms, highlighting the need for weight-based diagnostic reference levels (DRLs).
Area of Science:
- Medical Imaging
- Radiology
- Radiation Protection
Background:
- Ionising radiation exposure necessitates the establishment of typical values (TVs) and diagnostic reference levels (DRLs) to maintain radiation doses 'as low as reasonably practicable'.
- Paediatric radiation dose metrics should be size-dependent rather than age-dependent for accurate risk management.
- Standardised radiation dose metrics are crucial for comparative analysis in diagnostic imaging.
Purpose of the Study:
- To establish and compare paediatric typical values (TVs) for chest, abdomen, and pelvis radiography.
- To investigate the correlation between patient weight and radiation dose metrics in paediatric patients.
- To identify variations in radiation dose metrics across different X-ray rooms for paediatric examinations.
Main Methods:
- Retrospective acquisition of Kerma-area product (KAP) values from 407 paediatric X-ray examinations.
- Categorisation of paediatric patients into weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg).
- Stratification of data by examination type (chest, abdomen, pelvis) and X-ray room, followed by analysis using Microsoft Excel.
Main Results:
- Established paediatric TVs for chest, abdomen, and pelvis radiography across defined weight categories.
- Demonstrated a clear trend of increasing TVs with increasing patient weight for all examined radiographic procedures.
- Observed significant variations in TVs between different X-ray rooms, ranging from -60% to 119% for chest, -50% to 103% for abdomen, and -14% to 24% for pelvis.
Conclusions:
- Paediatric TVs for radiography align with established trends related to patient weight and examination type.
- Significant inter-room variability in radiation dose metrics necessitates further investigation.
- Weight-based TVs/DRLs are recommended for paediatric settings due to the imperfect correlation between age and size.
Introduction:
To reduce the risks involved with ionising radiation exposure, typical values (TVs) and diagnostic reference levels (DRLs) have been established to help keep radiation doses 'as low as reasonably practicable. TVs/DRLs provide standardised radiation dose metrics that can be used for comparative purposes. However, for paediatrics, such values should consider the size of the child instead of their age. This study aimed to establish and compare paediatric TVs for chest, abdomen and pelvis radiography.
Methods:
Study methods followed processes for establishing paediatric DRLs as outlined by the Health Information and Quality Authority (HIQA). Kerma-area product (KAP) values, excluding rejected images, were retrospectively acquired from the study institution's Picture Archiving and Communications System (PACS). Paediatric patients were categorised into the following weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg) and stratified based on the examination that was performed (chest, abdomen, and pelvis), and where it was performed (the different X-ray rooms). Anonymised data were inputted into Microsoft Excel for analysis. Median and 3rd quartile KAP values were reported together with graphical illustrations.
Results:
Data from 407 X-ray examinations were analysed. For the previously identified weight categories (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg), TVs for the chest were 0.10, 0.19, 0.37 and 0.53 dGy.cm2, respectively. For the abdomen 0.39, 1.04, 3.51 and 4.05 dGy.cm2 and for the pelvis 0.43, 0.87, 3.50 and 7.58 dGy.cm2. Between X-ray rooms TVs varied against the institutional TVs by -60 to 119 % (chest), -50 to 103 % (abdomen) and -14 and 24 %% (pelvis).
Conclusion:
TVs in this study follow established trends with patient weight and examination type and are comparable with published literature. Variations do exist between individual examination rooms and reasons are multifactorial. Given that age and size do not perfectly correlate further work should be undertaken around weight-based TVs/DRLs in the paediatric setting.
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