Paediatric diagnostic reference levels for common computed tomography procedures: A systematic review

Abstract

BackgroundPrevious paediatric diagnostic reference levels (PDRL) literature reviews for commonly performed procedures of the brain, chest and abdomen revealed wide DRL variation and deviation of scanning protocols across CT centres. The current review went further to determine the extent and possible factors of DRL variation in the same procedure, age or weight group, between scanners and CT centres for the standardisation of CT practice globally. MethodsThe preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow chart was used to screen articles in Science Direct, Medline, Academic Search Complete via EBSCOhost, PubMed, and CINAHL via EBSCOhost including the Google search engine. ResultsA total of 6573 articles were retrieved and screened against the established criteria and finally, 52 articles were selected and synthesised narratively. ConclusionThe findings of this review show variation of brain PDRLs up to a factor of 2 fold for the same examination and age group. Factors attributable to dose variations noted in this review were largely related to the setting of the scan protocols such as the use of different phantom sizes, dose parameters, and age groups. This indicates the need to standardise methods of establishing PDRLs and alignment with the European Commission and ICRP recommended guidelines are proposed. Implication for practiceThe review highlights different methods for establishing PDRLs and their implication which could guide radiographers and medical physicists in future PDRLs establishment for dose optimization.