Diagnostic reference level curves for paediatric fluoroscopic imaging in the Netherlands

Area of Science:

• Radiology
• Medical Physics
• Paediatric Imaging

Background:

• Establishing paediatric diagnostic reference levels (DRLs) is challenging due to limited data availability.
• Current European Guidelines on DRLs for Paediatric Imaging (PiDRL) necessitate updating existing DRLs.
• Paediatric fluoroscopic dose levels require assessment in clinical practice.

Purpose of the Study:

• To assess paediatric fluoroscopic dose levels in Dutch clinical practice.
• To update current Dutch diagnostic reference levels (DRLs) for paediatric fluoroscopy.
• To evaluate the utility of a dose-age curve method for establishing DRLs with sparse data.

Main Methods:

• Retrospective collection of Air Kerma-area Product (KAP) values from paediatric patients (0-18 years) undergoing fluoroscopic procedures (MCU, Upper GI, Lower GI) between 2017 and 2021.
• Application of PiDRL recommendations for sparse data: fitting the 75th percentiles of median KAP values per age group using an exponential dose-age curve.
• Comparison of proposed DRL values with existing Dutch and European DRLs.

Main Results:

• A total of 971 paediatric fluoroscopic examinations were analysed.
• The proposed DRL curve for micturating cystourethrography (MCU) was lower than current Dutch DRLs.
• The proposed DRL curve for upper gastrointestinal (Upper GI) procedures was lower than UK DRLs; no DRL curve could be established for lower gastrointestinal (Lower GI) due to insufficient data.

Conclusions:

• Paediatric fluoroscopic dose levels in the study are significantly lower than current Dutch DRLs, particularly for MCU.
• A dose-age curve method is proposed for updating Dutch paediatric DRLs, enabling DRL establishment even with sparse data.
• The proposed method facilitates the optimisation of radiation doses in paediatric patients.