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A multi-institutional CT practices survey of pediatric head, chest, and abdomen-pelvis examinations
Elena Tonkopi1,2,3, Megan Iwaskow4,5, Cecilie Karlstad Lønningen6
1Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada.
Insights
This study surveyed pediatric CT radiation doses in Australia, Canada, and Norway. Local diagnostic reference levels (LDRLs) were established to help facilities optimize radiation exposure for young patients.
Area of Science:
- Medical Imaging
- Radiological Physics
- Pediatric Radiology
Background:
- Pediatric patients face heightened risks from ionizing radiation.
- Computed tomography (CT) is crucial for pediatric diagnosis.
- Diagnostic reference levels (DRLs) are key for optimizing radiation doses.
Purpose of the Study:
- To survey pediatric CT practices across Australia, Canada, and Norway.
- To establish local diagnostic reference levels (LDRLs) for radiation dose optimization.
- To provide a baseline for future pediatric CT dose assessments.
Main Methods:
- Retrospective data collection of dose indices, imaging, and demographics from PACS.
- Inclusion of unenhanced head, contrast-enhanced chest, and abdomen-pelvis CT scans (0-15 years).
- Determination of LDRLs using CT dose indices and size-specific dose estimates (SSDE); statistical analysis included Kruskal-Wallis and regression.
Main Results:
- LDRLs were determined for each country and age group.
- Canadian and Norwegian pediatric CT doses were similar; Australian doses were generally lower.
- A significant positive correlation was found between SSDE and patient weight across all examinations and countries.
Conclusions:
- Local reference levels offer valuable baselines for ongoing dose assessment.
- The findings support the implementation of LDRLs for pediatric CT dose management.
- This study provides a foundation for improving radiation safety in pediatric imaging.
Abstract:
Background: Pediatric patients are particularly vulnerable to the stochastic effects of ionizing radiation. Despite these risks, CT remains diagnostically essential in pediatric care. Diagnostic reference levels (DRLs) have been recommended as a radiation dose optimization tool to address these concerns. Purpose: This study aims to survey pediatric CT practices at different facilities in Australia, Canada, and Norway and to suggest local DRLs (LDRLs) at each facility as a baseline for future surveys. Materials and methods: Radiation dose indices, imaging, and demographic data were collected retrospectively at each facility using PACS for unenhanced CT head, contrast-enhanced chest, and contrast-enhanced abdomen-pelvis examinations in patients from 0 to 15 years of age. The LDRL values were determined for CT dose indices and size-specific dose estimate (SSDE) values. The Kruskal-Wallis test assessed the equality of populations across countries for all dosimetric quantities. Ordinary least squares regression was employed to express SSDE as a linear function of patient weight. Results: The LDRLs for Australian, Canadian, and Norwegian facilities were determined and examined for each age group. Canadian and Norwegian LDRL data were most similar, with Australian values being comparatively lower for all categories except for 11-15-year-old abdomen-pelvis examinations. The SSDE and patient weight were significantly positively correlated for each examination/country combination. Conclusion: The proposed local reference levels can provide local baselines for dose optimization and continuous dose assessment.
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