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Vassileva J, Rehani M, Kostova-Lefterova D, Al-Naemi HM, Al Suwaidi JS, Arandjic D, Bashier EHO, Kodlulovich Renha S, El-Nachef L, Aguilar JG, Gershan V, Gershkevitsh E, Gruppetta E, Hustuc A, Jauhari A, Kharita MH, Khelassi-Toutaoui N, Khosravi HR, Khoury H, Kralik I, Mahere S, Mazuoliene J, Mora P, Muhogora W, Muthuvelu P, Nikodemova D, Novak L, Pallewatte A, Pekarovič D, Shaaban M, Shelly E, Stepanyan K, Thelsy N, Visrutaratna P, Zaman A. A study to establish international diagnostic reference levels for paediatric computed tomography. Radiat Prot Dosimetry 2015; 165:70-80. [PMID: 25836685 DOI: 10.1093/rpd/ncv116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.
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Affiliation(s)
- J Vassileva
- International Atomic Energy Agency, Vienna, Austria
| | - M Rehani
- Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | | | | | - J S Al Suwaidi
- Medical Education Department, Dubai Health Authority, Dubai, UAE
| | - D Arandjic
- Radiation Protection Department, Vinca Institute of Nuclear Sciences, Belgrade, Serbia
| | | | | | - L El-Nachef
- Lebanese Atomic Eneregy Commission, Beirut, Lebanon
| | - J G Aguilar
- National Institute for Nuclear Research, Carretera Mexico-Toluca, La Marquesa, Ocoyoacac, Mexico
| | - V Gershan
- Institute of Physics, Ss Cyril and Methodius University, Skopje, The former Yugoslav Republic of Macedonia
| | | | | | - A Hustuc
- National Centre of Public Health, Chisinau, Republic of Moldova
| | - A Jauhari
- Pusat Kajian Radiografi dan Imajing, Depok, Indonesia
| | | | - N Khelassi-Toutaoui
- Département de Physique Médicale, Centre de Recherche Nucléaire D'Alger, Algiers, Algiers
| | - H R Khosravi
- National Radiation Protection Department, Iranian Nuclear Regulatory Authority, Tehran, Iran
| | - H Khoury
- Universidade Federal de Pernambuco, Cidade Universitaria, Recife PE, Brazil
| | - I Kralik
- State Office for Radiological and Nuclear Safety, Zagreb, Croatia
| | - S Mahere
- Children Clinical University Hospital, Riga, Latvia
| | - J Mazuoliene
- Hospital of Lithuanian University of Health Science Kauno Klinikos, Kaunas, Lithuania
| | - P Mora
- Centro de Investigación en Ciencias Atómicas, Nucleares y Moleculares, Universidad de Costa Rica, San José, Costa Rica
| | - W Muhogora
- Tanzania Atomic Energy Commission, Arusha, Tanzania
| | - P Muthuvelu
- Ministry of Health Malaysia, Putrajaya Wilayah Persekutuan, Malaysia
| | - D Nikodemova
- Slovak Medical University, Limbova, Bratislava, Slovakia
| | - L Novak
- National Radiation Protection Institute, Prague, Czech Republic
| | - A Pallewatte
- Department of Radiology, The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - D Pekarovič
- Clinical Radiology Institute, University Medical Center, Ljubljana, Slovenia
| | - M Shaaban
- Al-Sabah Hospital, Kuwait City, Kuwait
| | - E Shelly
- Ministry of Health, Medical Technology and Infrastructure Administration, Jerusalem, Israel
| | - K Stepanyan
- Research Center of Radiation Medicine and Burns, Yerevan, Armenia
| | - N Thelsy
- Radiologist Ministry of Health, Yangon, Myanmar
| | - P Visrutaratna
- Faculty of Medicine, Department of Radiology, Chiang Mai University, Chiang Mai, Thailand
| | - A Zaman
- Institute of Nuclear Medicine and Oncology, PAEC, Lahore, Pakistan
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Vassileva J, Rehani MM, Applegate K, Ahmed NA, Al-Dhuhli H, Al-Naemi HM, Al Suwaidi JS, Arandjic D, Beganovic A, Benavente T, Dias S, El-Nachef L, Faj D, Gamarra-Sánchez ME, Aguilar JG, Gershan V, Gershkevitsh E, Gruppetta E, Hustuc A, Ivanovic S, Jauhari A, Kharita MH, Kharuzhyk S, Khelassi-Toutaoui N, Khosravi HR, Kostova-Lefterova D, Kralik I, Liu L, Mazuoliene J, Mora P, Muhogora W, Muthuvelu P, Nikodemova D, Novak L, Pallewatte AS, Shaaban M, Shelly E, Stepanyan K, Teo ELHJ, Thelsy N, Visrutaratna P, Zaman A, Zontar D. IAEA survey of paediatric computed tomography practice in 40 countries in Asia, Europe, Latin America and Africa: procedures and protocols. Eur Radiol 2012; 23:623-31. [PMID: 22940731 DOI: 10.1007/s00330-012-2639-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 07/25/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries. METHODS Under a project of the International Atomic Energy Agency, 146 CT facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses. RESULTS Modern MDCT systems are available in 77 % of the facilities surveyed with dedicated paediatric CT protocols available in 94 %. However, protocols for some age groups were unavailable in around 50 % of the facilities surveyed. Indication-based protocols were used in 57 % of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDI(vol) values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49 % of sites. CONCLUSION There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA.
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Affiliation(s)
- Jenia Vassileva
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
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