Proposing diagnostic reference levels for paediatric computed tomography in Jordan: a national multicentre analysis

Area of Science:

• Medical Physics
• Radiology
• Radiation Protection

Background:

• Paediatric computed tomography (CT) requires dose optimization due to increased radiosensitivity in children.
• Existing national diagnostic reference levels (DRLs) for paediatric CT in Jordan are outdated, necessitating updated benchmarks.
• International DRLs serve as optimization tools but require national adaptation.

Purpose of the Study:

• To establish national DRLs for six paediatric CT protocols in Jordan.
• To assess inter-hospital and age-related variations in paediatric CT radiation doses.
• To compare Jordanian paediatric CT dose metrics with international benchmarks.

Main Methods:

• A retrospective multicentre study involving 3794 paediatric patients across six Jordanian hospitals.
• Data collection included volumetric CT dose index (CTDIvol) and dose-length product (DLP) for brain, chest, abdomen-pelvis, chest-abdomen-pelvis, sinuses, and neck CT protocols.
• DRLs were determined as the 75th percentile of institutional median CTDIvol and DLP values, with statistical analyses for variations and parameter associations.

Main Results:

• National DRLs for paediatric CT in Jordan were established.
• Significant inter-hospital variability in CTDIvol and DLP was observed, particularly for trunk protocols in younger children.
• Radiation dose generally increased with patient age for trunk protocols, while brain, sinuses, and neck CT doses remained relatively stable.
• Acquisition parameters (kVp, mAs, pitch, slice thickness) were significantly associated with dose variations, with kVp showing the strongest correlation.
• Jordanian brain CT dose metrics were found to be higher than international DRLs in several age groups.

Conclusions:

• The study successfully established national paediatric CT DRLs for Jordan.
• Significant variations in radiation doses highlight the need for standardized CT protocols and improved radiation protection practices.
• Periodic review and updating of DRLs are crucial for ongoing dose optimization in paediatric CT examinations.