Diagnostic reference levels for indication-based CT categories in pediatric CT: data from an international registry

Area of Science:

• Medical Imaging
• Radiology
• Pediatric Imaging

Background:

• Computed tomography (CT) radiation doses exhibit significant variability due to differing medical indications, imaging protocols, and institutional practices.
• Standardizing radiation exposure is crucial for optimizing patient safety, particularly in pediatric populations where radiation sensitivity is higher.

Purpose of the Study:

• To establish age- and indication-based diagnostic reference levels (DRLs) for pediatric CT examinations.
• To create standardized CT categories that account for anatomical regions and specific clinical indications requiring varying radiation doses.

Main Methods:

• Retrospective analysis of 95,047 pediatric CT scans (under 18 years) from an international dose registry (143 facilities, 2016-2021).
• Calculation of DRLs for CTDIvol, DLP, and SSDE across 14 CT categories, defined by anatomy and dose requirements (low, routine, high).
• Comparison of routine dose categories for head, chest, and abdomen/pelvis CT scans between U.S. and European facilities.

Main Results:

• DRLs demonstrated a statistically significant increase with patient age (p < 0.05).
• CT categories proved valid, showing greater dose variation between categories than within indications for head and abdomen/pelvis scans.
• U.S. DRLs for routine chest and abdomen/pelvis CT were approximately double those in Europe, while head CT DRLs were comparable.

Conclusions:

• Established DRLs for pediatric CT, stratified by age, anatomy, and clinical indication, provide a framework for dose standardization.
• The findings highlight significant international disparities in pediatric CT radiation doses, particularly for chest and abdominal imaging.
• These DRLs serve as a valuable tool for optimizing radiation safety and quality in pediatric CT practices worldwide.