Diagnostic Reference Level of Radiation Dose and Image Quality among Paediatric CT Examinations in A Tertiary Hospital in Malaysia.

Nor Azura Muhammad,Muhammad Khalis Abdul Karim,Mazliana Ahmad Kamarudin,Kwan Hoong Ng,Jeannie Hsiu Ding Wong,Hasyma Abu Hassan

doi:10.3390/diagnostics10080591

Abstract

Pediatrics are more vulnerable to radiation and are prone to dose compared to adults, requiring more attention to computed tomography (CT) optimization. Hence, diagnostic reference levels (DRLs) have been implemented as part of optimization process in order to monitor CT dose and diagnostic quality. The noise index has recently been endorsed to be included as a part of CT optimization in the DRLs report. In this study, we have therefore set local DRLs for pediatric CT examination with a noise index as an indicator of image quality. One thousand one hundred and ninety-two (1192) paediatric patients undergoing CT brain, CT thorax and CT chest-abdomen-pelvis (CAP) examinations were analyzed retrospectively and categorized into four age groups; group 1 (0–1 year), group 2 (1–5 years), group 3 (5–10 years) and group 4 (10–15 years). For each group, data such as the volume-weighted CT dose index (CTDIvol), dose-length product (DLP) and the effective dose (E) were calculated and DRLs for each age group set at 50th percentile were determined. Both CT dose and image noise values between age groups have differed significantly with p-value < 0.05. The highest CTDIvol and DLP values in all age groups with the lowest noise index value reported in the 10–15 age group were found in CT brain examination. In conclusion, there was a significant variation in doses and noise intensity among children of different ages, and the need to change specific parameters to fit the clinical requirement.

Highlights

The introduction of the Computed Tomography (CT) scanner in 1972 allowed a combination of a series of X-ray images to generate high contrast sectional images of the human anatomy
The Philips Ingenuity Core 128 multi-slice scanner was installed in the institution only in 2015, a larger number of CT brain cases
A diagnostic reference levels (DRLs) could serve as a good tool in optimizing the radiation doses of CT examinations in pediatric patients and ensuring good image quality [23,24,25]

Summary

Introduction

The introduction of the Computed Tomography (CT) scanner in 1972 allowed a combination of a series of X-ray images to generate high contrast sectional images of the human anatomy. The utilization of CT has increased in frequency, to the extent that safety concerns have been raised for patients, especially children, as they may be exposed to dangerous levels of ionizing radiation during the examinations [1]. This trend will continuously be Diagnostics 2020, 10, 591; doi:10.3390/diagnostics10080591 www.mdpi.com/journal/diagnostics. According to the report by Ogbole (2011), in the last three to five years, the use of CT had increased globally [3]. In Japan, a 1996 survey on the number of CT scanners in use for the country’s population was higher compared with the USA.

Objectives

Methods

Results

Discussion

Conclusion