Abstract
Objectives: To establish local diagnostic reference levels (LDRLs) for emergency paediatric head computed tomography (CT) scans performed at a South African (SA) tertiary-level hospital and to compare these with published data.Materials and methods: A retrospective analysis was conducted of volume-based CT dose index (CTDIvol) and dose length product (DLP) data from uncontrasted paediatric head CT scans performed in the Trauma and Emergency Unit of a tertiary-level SA hospital from January to June 2013. A random sample of 30 patients in each of 3 age groups (0–2, >2–5 and >5–10 years) was used. LDRL values were compared with several national DRLs from Europe and Australia. Results: Mean CTDIvol and DLP values were: 30 mGy and 488 mGy.cm for the 0–2 years age group; 31 mGy and 508 mGy.cm for the >2–5 years group, and 32 mGy and 563 mGy.cm for the >5–10 years group, respectively. The mean DLP for 0–2 year-olds was the only parameter outside the range of corresponding published reference data. Stratification into narrower age groupings showed an increase in DLP values with age. Conclusion: An institutional review of the head CT scanning technique for emergency studies performed on children less than 2 years of age is recommended. The current study highlights the role of LDRLs in establishing institutional dosimetry baselines, in refining local imaging practice, and in enhancing patient safety. Standard age stratification for DRL and LDRL reporting is recommended.
Highlights
There is a burgeoning global demand for computed tomography (CT)
As with all diagnostic studies, CT scans should be clinically justified, provide potential patient benefit and utilise appropriate imaging protocols, to keep radiation doses as low as reasonably achievable (ALARA).[3]. With the latter in mind, the International Commission on Radiological Protection (ICRP) introduced the concept of diagnostic reference levels (DRLs) in 1996.4,7 DRLs are accepted as the standard tool to enable optimisation of absorbed dose delivered to the patient undergoing X-ray imaging
Comparison with published DRLs showed that mean CTDIvol values were either lower than, or within the range of, other published third quartile national DRLs.[12,13,14,15]
Summary
There is a burgeoning global demand for computed tomography (CT). Compared with plainfilm radiography, CT accounts for relatively large doses of ionising radiation, with CT exposure currently representing the largest manmade contribution of absorbed dose to the general population. As with all diagnostic studies, CT scans should be clinically justified, provide potential patient benefit and utilise appropriate imaging protocols, to keep radiation doses as low as reasonably achievable (ALARA).[3] With the latter in mind, the International Commission on Radiological Protection (ICRP) introduced the concept of diagnostic reference levels (DRLs) in 1996.4,7 DRLs are accepted as the standard tool to enable optimisation of absorbed dose delivered to the patient undergoing X-ray imaging. These are intended to monitor radiation dose for specific procedures, set the bar for good clinical practice, identify ‘outliers’ with unacceptably high radiation doses, allow comparison of equipment and protocols, and provide a mechanism for fine-tuning absorbed doses.[8]
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