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Body region and clinical indication-based diagnostic reference levels for pediatric CT: Multicenter study from the
Lina Karout1, Shady Alkhazzam2, Mohammad Hassan Kharita2
1Massachusetts General Hospital, Harvard Medical School, United States.
Journal of Medical Imaging and Radiation Sciences
|August 11, 2026
Summary
Pediatric CT dose reference levels (DRLs) were established for the Middle East and North Africa (MENA) region. Radiation doses were higher in low-GDP countries and for children under 15 compared to US reference levels.
Area of Science:
- Medical Physics
- Radiology
- Pediatric Imaging
Background:
- Establishing pediatric diagnostic reference levels (DRLs) is crucial for optimizing radiation dose in medical imaging.
- No published pediatric DRLs exist for the Middle East and North Africa (MENA) region, creating a data gap.
- Computed Tomography (CT) is a vital diagnostic tool for children, necessitating dose optimization.
Purpose of the Study:
- To establish body region- and clinical indication-based CT DRLs for pediatric patients in the MENA region.
- To address the lack of published pediatric DRL data in the MENA region.
- To compare pediatric CT dose data within the MENA region across different economic (GDP) levels.
Main Methods:
- A multicenter study involving 38 imaging sites across 17 MENA countries collected retrospective and prospective CT dose data from 15,707 pediatric patients.
- Data included patient demographics, scanner details, acquisition parameters, clinical indications, and dose metrics (CTDIvol, DLP).
- Dose data were analyzed to estimate 50th (Average Doses - ADs) and 75th (DRLs) percentiles for various age groups, body regions, and indications, comparing low-GDP vs. high-GDP countries.
Main Results:
- Pediatric CT doses (ADs and DRLs) for chest, abdomen-pelvis, and chest-abdomen-pelvis CT were higher than US reference doses for children aged 0-15 years.
- For patients aged 15-18 years, MENA CT doses were comparable to or lower than US reference doses.
- DRLs for CTDIvol and DLP were significantly higher in low-GDP countries compared to high-GDP countries within the MENA region (p < 0.001).
Conclusions:
- The study successfully established protocol- and clinical indication-based ADs and DRLs for pediatric CT in the MENA region.
- Radiation doses in pediatric CT scans were significantly higher in low-GDP MENA countries than in high-GDP countries.
- These regional DRLs provide benchmarks for optimizing radiation safety and improving the quality of pediatric CT imaging in the MENA region.
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