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Local diagnostic reference levels for pediatric fluoroscopy in a Brazilian tertiary referral center: A weight‑based
Claudia M C Ribeiro1, Tainá O Chaves1, Marcos Decnop2
1Department of Radiology, Fernandes Figueira National Institute of Women's, Children's and Adolescents' Health (IFF/FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil.
Purpose:
To establish the first DRLs for contrast-enhanced diagnostic pediatric fluoroscopic procedures in Brazil, stratified by body weight, based on data collected in a single tertiary referral public hospital of Rio de Janeiro city.
Methods:
This descriptive, cross-sectional study included 928 diagnostic fluoroscopy examinations performed in patients aged 0-18 years between December 2020 and December 2024 at a national pediatric referral center. Dosimetric parameters such as Air kerma-area product (PKA), Air kerma at patient entrance reference point (Ka,r), fluoroscopy time, and number of images were extracted from automatically generated reports. Results were compared with existing international DRLs.
Results:
Local median doses showed overall agreement with European and UK reference levels in lower weight and age groups, but higher values were observed in patients with higher body mass. Compared with other single-center studies, local KAP values were higher, likely reflecting differences in case complexity and exposure parameters. Weight-based stratification proved more reliable than age-based grouping for defining pediatric DRLs, supporting its use as the preferred reference criterion.
Conclusion:
This is the first Brazilian study to systematically report DRLs for diagnostic pediatric fluoroscopy using weight-based stratification, that support the need for structured dose monitoring, protocol optimization, and continuous professional training.
