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Justification and optimisation of paediatric CT in prefectures around Tokyo
R Okamoto1, O Miyazaki1, M Kitamura1
1Department of Diagnostic Radiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan;
Insights
Physicians show low awareness of paediatric imaging guidelines, but ultrasound is common. Radiologists widely use Japan
Area of Science:
- Medical Imaging
- Paediatric Radiology
- Radiation Safety
Background:
- The principles of 'justification' and 'optimisation' are recommended for reducing paediatric medical radiation exposure.
- Implementation of these principles in general hospitals remains unclear.
Purpose of the Study:
- To assess the current implementation of justification and optimisation principles in paediatric acute abdomen imaging in Tokyo-area emergency hospitals.
- To evaluate physician awareness and utilisation of diagnostic guidelines and technologist adherence to radiation dose optimisation.
Main Methods:
- A survey was conducted among physicians (n=169) and radiology technologists (n=172) in Tokyo emergency hospitals.
- Data collected included diagnostic imaging methods used for paediatric acute abdomen and CT scan exposure doses.
Main Results:
- Physician awareness of acute appendicitis guidelines was low (<50%), with only 17% utilisation; ultrasound was the primary initial imaging test (77%).
- Technologist awareness of Japan's diagnostic reference level (DRL) was high (93%), with 83% of facilities applying optimisation.
- Some facilities exceeded DRLs, indicating a trend towards a long-tailed dose distribution.
Conclusions:
- Despite low guideline awareness, paediatric acute abdomen imaging is being justified in general hospitals.
- Wider adoption of guidelines may lead to further reduction in CT imaging phases.
- While DRLs are widely used and optimised, high-dose settings at some facilities require attention.
Abstract:
[Background] Although 'justification' and 'optimisation' are recommended as principles for reducing paediatric medical exposure, it is unclear whether these are actually implemented in general hospitals. [Method] Targeting emergency hospitals in the Tokyo area, we conducted a survey on the current status of paediatric acute abdomen, including diagnostic imaging methods used by physicians (n = 169) and exposure doses from CT scans employed by radiology technologists (n = 172). [Results] Fewer than half of physicians were aware of the guidelines for acute appendicitis, and utilisation was very low at 17%. However, ultrasound was the most commonly performed first imaging test at 77%. On the other hand, among technologists, 93% were aware of Japan's diagnostic reference level (DRL), and optimisation was applied at 83% of facilities. Otherwise, there were some facilities that used high-dose settings that exceeded the DRL, indicative of a trend towards a long-tailed distribution. [Discussion] Although awareness of the diagnostic guidelines was low, they were already being justified in general hospitals. As the guidelines become more widely known, the number of CT imaging phases may be further reduced. DRL was widely used and optimised. However, some facilities used high radiation settings, and these cannot be ignored.
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