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Diagnostic reference levels for indication-based CT categories in pediatric CT: data from an international registry
Denise Bos1,2, Yifei Wang3, Carly Stewart3
1Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany. denise.bos@uk-essen.de.
Insights
Diagnostic reference levels (DRLs) for pediatric computed tomography (CT) scans were established based on age, anatomy, and clinical indication. These DRLs aim to standardize CT radiation doses across different facilities and improve patient safety.
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.
Objectives:
Computed tomography (CT) radiation doses vary depending on medical indications, protocols, and local practice. Our aim is to establish diagnostic reference levels (DRLs) for CT categories based on clinical indications in pediatric patients.
Materials And Methods:
We analyzed CT data from an international dose registry retrospectively, including scans performed in children under 18 years at 143 facilities between January 2016 and January 2021. DRLs were calculated for volumetric CT dose index (CTDIvol), dose-length product (DLP), and size-specific dose estimate (SSDE) across 14 CT categories, which reflect both the anatomic areas and radiation dose levels (low, routine, high dose) required by imaging indications within the anatomic areas. We compared the routine dose categories for head, chest, and abdomen/pelvis scans between facilities in the United States (U.S.) and Europe.
Results:
A total of 95,047 CT scans (mean age, 10.4 ± 5.6 years, 54% male), including 41 different indications, were included. DRLs increased with increasing age group (p < 0.05 for trend). For the head and the abdomen/pelvis body regions, there was greater variation between the CT categories than between the indications within the categories, suggesting these categories are valid. For example, in 10- to 15-year-old children, the DRLs for the DLP increased from 362 mGy·cm for head low dose to 2058 mGy·cm for head high dose. The U.S. DRLs were similar to the European for head categories, but were around twice as high for routine dose chest, and abdomen/pelvis.
Conclusions:
We have established DRLs for indication-based CT category age groups to help standardize practice.
Key Points:
Question CT categories are needed to reflect body regions and clinical indications with similar radiation dose requirements in pediatric patients. Findings Doses varied more between CT categories than within. DRLs for chest and abdomen/pelvis were about twice as high in the U.S. as in Europe. Clinical relevance DRLs as a function of patient age were developed for 14 broad anatomy- and indication-based CT categories in children using registry data.
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