Body region and clinical indication-based diagnostic reference levels for pediatric CT: Multicenter study from the...

There are no published data on pediatric reference dose levels (DRLs) for the Middle East and North Africa (MENA). To fill this gap, we conducted a multicenter study to collect and describe data characteristics for establishing body region- and clinical indication-based CT DRLs in the MENA region based on dose information from 15,707 pediatric patients.

Our multicenter study (n = 38), conducted in collaboration with the Middle East Federation of Organizations of Medical Physics (MEFOMP), included the collection of retrospective and prospective CT dose data, with approval from a central institutional review board. We invited sites across the MENA region to participate in our study via direct email and social media platforms. A total of 38 imaging sites from 17 MENA countries provided demographic, size, CT scanners, acquisition factors, clinical indications, and dose-related data for consecutive head, chest, abdomen-pelvis, and chest-abdomen-pelvis CT in children under 18 years. Participating sites and countries were categorized into low- and high-gross domestic product (GDP) countries based on their 2024 GDP. For multi-phase CT, we added the series DLP to derive the total DLP and obtained the median CTDI vol for the entire exam (DLP for the scout/planning radiograph as well as for monitoring/pre-monitoring phases were excluded). Next, we estimated the 50th (ADs) and 75th (DRLs) percentiles of CTDI-vol and DLP for each age group and body region. In addition, we calculated ADs and DRLs for the most common clinical indications. Kruskal-Wallis and Mann-Whitney tests were used to compare the non-normally distributed data.

We received CT dose data of 15,707 patients (females: males 6567:9140, mean age: 7 ± 5 years) with 90% of all head CT being single phase (n = 6258/6759) as compared to 81% chest CT (n = 3094/3789), 77% abdomen-pelvis CT (n = 2598/3355) and 60% single-phase chest-abdomen-pelvis CT (n = 1075/1804). The ADs and DRLs for chest, abdomen-pelvis, and chest-abdomen-pelvis CT were higher than the US reference doses in children between 0-15 years. For patients between 15-18 years, MENA doses were equal to or lower than US doses. The DRLs for both CTDI_vol and DLP across all body regions were significantly higher in countries with low GDP than in those with high GDP (p < 0.001).

Our study establishes protocol- and clinical indication-based ADs and DRLs for pediatric head, chest, abdomen-pelvis, and chest-abdomen-pelvis CT in the MENA region. Sadly, but as expected, radiation doses were significantly higher in the MENA countries with low GDP compared with high GDP countries.

CT scans are important for diagnosing illness in children, but it is important to keep radiation exposure as low as possible. This study collected dose information from >15,000 children who underwent CT scans at 38 imaging centres across 17 countries in the Middle East and North Africa to establish regional dose reference levels. This study found that radiation doses for many types of CT scans were higher than United States reference levels for children up to 15 years old, and were higher in lower-income countries than in higher-income countries within the region. This matters because regional dose benchmarks can help healthcare providers identify opportunities to reduce radiation exposure and improve the safety of CT imaging for children.