Paediatric Computed Tomography Examinations Research Articles

Characterizing pediatric head patient size in Moroccan population: Establishing age-dependent relationships for accurate CT dose estimation

Accurate dose estimation in computed tomography (CT) scans is crucial and relies on precise normalization of output dose, typically measured by the volume CT dose index (CTDIvol). Key metrics, including effective diameter (Deff) and water-equivalent diameter (Dw), play pivotal roles in characterizing patient size. However, a notable gap exists in delineating the specific relationships between age and head patient size (Deff and Dw) for pediatric patients in Morocco. The primary objective of this study was to establish these critical associations between patient age and head patient size (Deff and Dw), providing a foundation for calculating size-specific dose estimates (SSDE) in pediatric head CT examinations. A retrospective analysis of data from 134 pediatric patients, aged 0–13 yr, comprising 71 males and 63 females who underwent head CT scans, was conducted. Utilizing the Radiant DICOM Viewer, patient sizes were measured in terms of both lateral and anterior-posterior dimensions for Deff and Dw calculations based on CT images in DICOM format. Our analysis revealed robust correlations between patient size (Deff and Dw) and the patient’s age, with R2 values ranging from 0.65 to 0.86. Notably, larger Dw values were consistently observed compared to Deff. For male patients, Deff measurements ranged from 9.02 to 18.77 cm, with Dw values spanning 9.83 to 20.16 cm. Female patients exhibited Deff values ranging from 8.77 to 17.41 cm and Dw values ranging from 8.92 to 18.37 cm. These findings shed light on the crucial relationship between age and patient size, facilitating more precise dose calculations.

Comparison of pediatric lens scattered dose measurements between axial 40-mmand helical 160-mmdetector widthcomputed tomographyscan modes.

Reports comparing field lens doses between helical scans with a 40-mm detector width and axial scans with a 160-mm detector width using different computed tomography (CT) scanners are currently scarce. To compare scatter doses for lenses between a helical scan with a 40-mm detector width and an axial scan with a 160-mm detector width when using different CT scanners in the context of pediatric chest examinations. Two different CT machines were used: Revolution CT (GE Healthcare, Waukesha, WI) with a 256-row, 0.625-mm multidetector; and Aquilion ONE GENESIS Edition (Canon Medical Systems, Otawara, Japan) with a 320-row, 0.5-mm multidetector. Three pediatric anthropomorphic phantoms were used, with optically stimulated luminescence dosimeters (OSLDs) placed on the left and right lenses. The scatter dose values measured by the OSLDs were compared between a helical scan with a 40-mm detector width and an axial scan with a 160-mm detector width during pediatric chest CT examinations. Median equivalent doses for the helical and axial scans were 0.12 and 0.12 mSv/mGy for the newborn, 0.17 and 0.16 mSv/mGy for the 1-year-old, and 0.18 and 0.15 mSv/mGy for the 5-year-old, respectively, when using the Revolution CT. With the Revolution CT, no significant differences were observed in the scatter doses between helical and axial scans in the newborn and 1-year-old phantoms. However, the lens scatter dose for the helical scan was approximately 20-35% higher than that for the axial scan in the 5-year-old phantom (P<0.01). The median equivalent doses of eye lenses for the helical and axial scans were 0.12 and 0.07 mSv/mGy for the newborn, 0.07 and 0.05 mSv/mGy for the 1-year-old, and 0.14 and 0.12 mSv/mGy for the 5-year-old, respectively, when using the Aquilion ONE. With the Aquilion ONE, lens scatter doses for the helical scan were approximately 70%, 40%, and 30% higher in the newborn, 1-year-old, and 5-year-old phantoms, respectively, than those for the axial scan (P<0.01). When using the Aquilion ONE, lens scatter doses for the helical scan were significantly higher in all three phantoms than those for the axial scan. In contrast, when using the Revolution CT, the lens scatter dose for the helical scan was significantly higher in the 5-year-old phantom than that for the axial scan. These results suggest that although scattered doses may vary with respect to the CT scanner and body size, they are generally lower in the case of axial scans.

Age-based diagnostic reference levels and achievable doses for paediatric CT: a survey in Shanghai, China

Computed tomography (CT) is extensively utilised in medical diagnostics due to its notable radiographic superiority. However, the cancer risk associated with CT examinations, particularly in children, is of significant concern. The assessment of cancer risk relies on the radiation dose to examinees. Diagnostic reference levels (DRLs) and achievable doses (ADs) were used to assess the level of radiation dose in CT examinations widely. Although the national DRLs of paediatric CT have been explored in China, few local DRLs at the city level have been assessed. To set up the local DRLs and ADs of paediatric CT, we investigated the radiation dose level for paediatric CT in Shanghai. In this survey, a total of 3061 paediatric CT examinations underwent in Shanghai in 2022 were selected by stratified sampling, and the dose levels in terms of volume CT dose index (CTDIvol) and the dose-length product (DLP) were analysed by 4 age groups. The DRLs and ADs were set at the 75th and 50th percentile of the distribution and compared with the previous studies at home and abroad. The survey results revealed that, for head scan, the DRLs of CTDIvol were from 25 to 46 mGy, and the levels of DLP were from 340 to 663 mGy·cm. For chest, the DRLs of CTDIvol were from 2.2 to 8.3 mGy, and the levels of DLP were from 42 to 223 mGy·cm. For abdomen, the DRLs of CTDIvol were from 6.3 to 16 mGy, and the levels of DLP were from 181 to 557 mGy·cm. The ADs were about 60% lower than their corresponding DRLs. The levels of radiation doses in children-based hospitals were higher than those in other medical institutions (P < 0.001). In conclusion, there was still potential for reducing radiation dose of paediatric CT, emphasising the urgent need for optimising paediatric CT dose in Shanghai.

Advancing pediatric head CT dose prediction: correlating patient size metrics with AP and LAT dimensions in Moroccan population

This study aims to establish comprehensive relationships between patient size, focusing on effective diameter (Deff) and water-equivalent diameter (Dw), in conjunction with anterior-posterior (AP) and lateral (LAT) dimensions. The primary goal is to refine precise patient dose estimations in pediatric head computed tomography (CT) examinations. Our examination involved a dataset of 105 pediatric head CT images sourced from a Moroccan pediatric university hospital. These images, selected from the central scanning range, underwent quantification for LAT, AP, Deff, and Dw, with measurements carried out using RadiAnt Dicom Viewer for lateral and anteroposterior dimensions. Our analytical approach encompassed modeling Deff and Dw as functions of LAT, AP, and combined AP + LAT dimensions. Additionally, Dw was modeled as a function of Deff and calculated Size Specific Dose Estimates (SSDE) based on Dw was compared to SSDE computed from one single dimension. The outcomes revealed strong correlations among Deff, Dw, and fundamental geometric dimensions (LAT, AP, and AP + LAT), as indicated by consistently high coefficients of determination (R² > 0.8). SSDE calculated from Dw shows impressive correlation with SSDE computed from a single dimension (R² > 0.9). This study offers insights into the relationships between patient size and critical dimensions, identifying high correlations that can represent a significant advancement in predicting doses for pediatric head CT examinations. This introduces the potential for streamlining the determination of head diameter and dose by relying on a single dimension, thereby enhancing the efficiency of dose predictions by facilitating the monitoring of radiation exposure of this population in clinical routine.

Optimization of Routine Pediatric Computed Tomography Examinations in Hawassa City, Sidama Regional State, Ethiopia

Computed tomography (CT) has considerable impact in patient care. However, it is the most irradiating medical imaging technique in diagnostic radiology department. Optimization of pediatric CT is not well-practiced in developing countries. Protocols for some age groups were missed, and scan parameters are not adapted to the patient body size and age group. Furthermore, there are no established diagnostic reference levels to enhance dose optimization for pediatric patients at the local, regional, and national levels. Therefore, this study aimed to assess the optimization of routine pediatric CT examinations in Hawassa city, Ethiopia. A total of 360 pediatric dose records were reviewed for routine pediatric CT performed between January 1st, 2021 - May 30th, 2022. The data were analyzed using the statistical package for social science version 25 software. The Local Diagnostic Reference Levels (LDRLs) were established at the 75th percentile of CT dose quantities. The average KVp, mAs, and scan length used for pediatric head, chest, and abdomen CT were (112.8, 260.6, and 19.8), (112.9, 64.7, and 31.5), and (113.3, 79.4, and 32.9) respectively. The range of the established LDRLs in terms of volumetric CT dose index for the head, chest, and abdomen CT were (31.5 to 47, 2.3 to 6.1, 1.7 to 4.7) mGy. Whereas the range in terms of dose length product per scan for the head, chest, and abdomen CT were (723.4 to 1126.7, 55.9 to 258.9, and 38.1 to 242.5) mGy cm respectively. The obtained results show that the LDRLs for volumetric CT does index for head and chest CT were equivalent to the international studies. Whereas the local DRLs in terms of dose length product per scan were higher than the reports other studies except in Japan where the values for chest CT were comparable to the results of this study. Finally, the findings suggested that non-optimized pediatric head and chest CT were performed across all age groups.

Correlation between Age and Abdominal Diameter for Estimating Size-Specific dose in Pediatric CT examination

This study aims to investigate the correlation between abdominal diameter against the their ages in pediatric Computed Tomography (CT) examination. The retrospective images from 96 patients ranging from 0–16 years scanned by the Siemens Somatom Go Top 128 Multi-slice CT scanner were evaluated. In a total of 46 patients were scanned by tube current modulation (TCM) approach and the remaining 50 patients were examined whitout TCM. The effective diameter (Deff) for every patient was automatically calculated using IndoseCT. The evaluation of the size and age correlation was carried out using a regression approach from AAPM Task Group 204. In addition, size-specific dose estimate (SSDE) was also calculated using IndoseCT. The results shows that the patient’s diameters increase along the increase of ages (R2 &gt; 0.68) with rapid growth in the ages of 0-1 years. It is also found that the increase in the patient’s diameter leds to the decrease of SSDE in the non-TCM protocol, while the trend in the TCM protocol is different. The SSDE had a tendency to increase along with the increase in patient sizes (R2 &lt; 0.40).

Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults

Over one million European children undergo computed tomography (CT) scans annually. Although moderate- to high-dose ionizing radiation exposure is an established risk factor for hematological malignancies, risks at CT examination dose levels remain uncertain. Here we followed up a multinational cohort (EPI-CT) of 948,174 individuals who underwent CT examinations before age 22 years in nine European countries. Radiation doses to the active bone marrow were estimated on the basis of body part scanned, patient characteristics, time period and inferred CT technical parameters. We found an association between cumulative dose and risk of all hematological malignancies, with an excess relative risk of 1.96 (95% confidence interval 1.10 to 3.12) per 100 mGy (790 cases). Similar estimates were obtained for lymphoid and myeloid malignancies. Results suggest that for every 10,000 children examined today (mean dose 8 mGy), 1–2 persons are expected to develop a hematological malignancy attributable to radiation exposure in the subsequent 12 years. Our results strengthen the body of evidence of increased cancer risk at low radiation doses and highlight the need for continued justification of pediatric CT examinations and optimization of doses.

Reporting Diagnostic Reference Levels for Paediatric Patients Undergoing Brain Computed Tomography.

Brain computed tomography (CT) is a diagnostic imaging tool routinely used to assess all paediatric neurologic disorders and other head injuries. Despite the continuous development of paediatric CT imaging, radiation exposure remains a concern. Using diagnostic reference levels (DRLs) helps to manage the radiation dose delivered to patients, allowing one to identify an unusually high dose. In this paper, we propose DRLs for paediatric brain CT examinations in Saudi clinical practices and compare the findings with those of other reported DRL studies. Data including patient and scanning protocols were collected retrospectively from three medical cities for a total of 225 paediatric patients. DRLs were derived for four different age groupings. The resulting DRL values for the dose-length product (DLP) for the age groups of newborns (0-1 year), 1-y-old (1-5 years), 5-y-old (5-10 years) and 10-y-old (10-15 years) were 404 mGy cm, 560 mGy cm, 548 mGy cm, and 742 mGy cm, respectively. The DRLs for paediatric brain CT imaging are comparable to or slightly lower than other DRLs due to the current use of dose optimisation strategies. This study emphasises the need for an international standardisation for the use of weight group categories in DRL establishment for paediatric care in order to provide a more comparable measurement of dose quantities across different hospitals globally.

Effect of iodine concentration reduction by comparison of virtual monoenergetic image quality with dual-energy computed tomography

This study aimed to evaluate the image quality of virtual monoenergetic images (VMIs) with tube voltage modulation in pediatric abdominal computed tomography (CT) examination and to determine the effect of decreasing contrast agent concentration. Using a 1-year old pediatric phantom, five contrast agent concentration diluent tubes of 100%, 80%, 60%, 40%, and 20% of the same concentration as the average Hounsfield unit (HU) in the descending aorta were inserted, and the mixed image and VMIs (40, 60, and 80 keV) acquired using dual-energy CT were compared with single-energy CT (SECT) images. For quantitative evaluation, the HU and coefficient of variation (COV) of each image were compared and analyzed. The analysis revealed that the HU of the 40 keV VMIs, acquired with a tube voltage of 70 kV and 100% contrast agent concentration, was 61% higher than that of the SECT image. The results showed that SECT had the lowest COV among all contrast agent concentration and tube voltage combinations, while the 40 keV image acquired at 70 kV had the second-lowest COV value. The HU of the 40 keV image acquired at 70 kV at a contrast agent concentration of 100% was 9% higher than that of SECT at 80% concentration. This study confirms that 40 keV VMIs are more useful than SECT images for vascular diagnosis with contrast in pediatric abdominal CT examinations and that a 20% reduction in contrast agent concentration can reduce the risk of contrast agent concentration-induced nephrotoxicity in pediatric patients by increasing the subjective acceptability of image quality for diagnosis.

Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead.

We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (inArgentina, Bolivia,Brazil, Chile,Colombia, Ecuador, Hondurasand Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sexand weight, scan factors (tube current and potential), volumeCT dose index (CTDIvol) and dose lengthproduct (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data toimprove scan protocols and perform a follow-up CTstudy to establish DRLs and ADs based on clinical indications.

Usefulness of the superior orbitomeatal line without the lens included in the scan range at different tube voltage during pediatric head CT

Introduction and objectivesTo compare the real time skin dosimeter values at lens between with the lens included in the scan range (orbitomeatal base line [OML]) or without the lens included in the scan range (superior orbitomeatal line [SOML]) at different tube voltages. Materials and methodsWe used three pediatric anthropomorphic phantoms with a 64 detector-row computed tomography (CT) scanner with the OML- or SOML-protocol at different tube voltages during the head CT. A real time skin dosimeter was inserted into the phantom center of the head, and surfaces of the lens. We compared the real time skin dosimeter values at lens between the OML- and SOML-protocol. ResultsThere were no significant differences in the real time skin dosimeter values for the head in the scan area for each phantom at different tube voltages between the OML- and SOML-protocol (p > 0.05 for all phantom). Compared with the OML protocol, it is possible to reduce the real time skin dosimeter values at lens by approximately 80% by using the SOML protocol (p < 0.05) at all tube voltages. Compared with the OML protocol, it is possible to reduce the real time skin dosimeter values at mammary gland by approximately 20% by using the SOML protocol (p < 0.05) at all tube voltages. ConclusionsDuring the pediatric head CT examination, SOML protocol was possible to reduce the real time skin dosimeter values at lens by approximately 80% compared with OML protocol at all tube voltages.

Pediatric computed tomography doses in Germany from 2016 to 2018 based on large-scale data collection

PurposeAccumulating evidence from epidemiological studies that pediatric computed tomography (CT) examinations can be associated with a small but non-zero excess risk for developing leukemia or brain tumor highlights the need to optimize doses of pediatric CT procedures. Mandatory dose reference levels (DRL) can support reduction of collective dose from CT imaging. Regular surveys of applied dose-related parameters are instrumental to decide when technological advances and optimized protocol design allow lower doses without sacrificing image quality. Our aim was to collect dosimetric data to support adapting current DRL to changing clinical practice. MethodDosimetric data and technical scan parameters from common pediatric CT examinations were retrospectively collected directly from Picture Archiving and Communication Systems (PACS), Dose Management Systems (DMS), and Radiological Information Systems (RIS). ResultsWe collected data from 17 institutions on 7746 CT series from the years 2016 to 2018 from examinations of the head, thorax, abdomen, cervical spine, temporal bone, paranasal sinuses and knee in patients below 18 years of age. Most of the age-stratified parameter distributions were lower than distributions from previously-analyzed data from before 2010. Most of the third quartiles were lower than German DRL at the time of the survey. ConclusionsDirectly interfacing PACS, DMS, and RIS installations allows large-scale data collection but relies on high data-quality at the documentation stage. Data should be validated by expert knowledge or guided questionnaires. Observed clinical practice in pediatric CT imaging suggests lowering some DRL in Germany is reasonable.

Utilidad de la línea orbitomeatal superior sin incluir los cristalinos en la exploración con diferentes voltajes del tubo en la TC craneal pediátrica

Introduction and objectivesTo compare the real time skin dosimeter values at lens between with the lens included in the scan range (orbitomeatal base line [OML]) or without the lens included in the scan range (superior orbitomeatal line [SOML]) at different tube voltages. Materials and methodsWe used three pediatric anthropomorphic phantoms with a 64 detector-row computed tomography (CT) scanner with the OML- or SOML-protocol at different tube voltages during the head CT. A real time skin dosimeter was inserted into the phantom center of the head, and surfaces of the lens. We compared the real time skin dosimeter values at lens between the OML- and SOML-protocol. ResultsThere were no significant differences in the real time skin dosimeter values for the head in the scan area for each phantom at different tube voltages between the OML- and SOML-protocol (P>.05 for all phantom). Compared with the OML protocol, it is possible to reduce the real time skin dosimeter values at lens by approximately 80% by using the SOML protocol (P<.05) at all tube voltages. Compared with the OML protocol, it is possible to reduce the real time skin dosimeter values at mammary gland by approximately 20% by using the SOML protocol (P<.05) at all tube voltages. ConclusionsDuring the pediatric head CT examination, SOML protocol was possible to reduce the real time skin dosimeter values at lens by approximately 80% compared with OML protocol at all tube voltages.

Low dose pediatric chest computed tomography on a photon counting detector system – initial clinical experience

BackgroundWith the clinical release of a photon counting detector-based computed tomography (CT) system, the potential benefits of this new technology need to be evaluated clinically. Literature concerning this new generation of detector is sparse, especially in the field of pediatric radiology. Therefore, this study outlines our initial experience with ultra-low dose chest CT imaging on the new photon counting CT system.Materials and methodsA pediatric phantom (1-year old, CIRS ATOM phantom, model 704 [CIRS-computerized imaging reference system, Norfolk, VA]) was scanned at different dose levels and different image quality levels to define a protocol for clinical examinations. Next, 20 consecutive pediatric non-contrast ultra-low dose chest CT examinations were evaluated for radiation dose and diagnostic image quality using a 4-point Likert-scale—1 = excellent, 4 = bad image quality—by two radiologists in a consensus reading. This retrospective analysis was approved by the local research ethics committee.ResultsChest CT examinations performed at ultra-low radiation dose (effective dose 0.19 ± 0.07 mSv; size-specific dose estimate 0.45 ± 0.14 mGy) in pediatric patients ages (2.6 ± 1.8 years) show good to excellent image quality for lung structures (1.4 ± 0.4) and moderate image quality for soft tissue structures (2.8 ± 0.2).ConclusionPediatric ultra-low dose chest CT examinations are feasible with the new generation photon counting detector-based CT system. The benefits of this technology must be evaluated for pediatric patients from the outset.

Sample Size and Estimation of Standard Radiation Doses for Pediatric Brain CT.

Estimation of the standard radiation dose at each imaging facility is required for radiation dose management, including establishment and utilization of the diagnostic reference levels. We investigated methods to estimate the standard dose for pediatric brain computed tomography (CT) using a small number of data. From 980 pediatric brain CT examinations, 25, 50, and 100 examinations were randomly extracted to create small, medium, and large datasets, respectively. The standard dose was estimated by applying grouping and curve-fitting methods for 20 datasets of each sample size. For the grouping method, data were divided into groups according to age or body weight, and the standard dose was defined as a median value in each group. For the curve-fitting methods, logarithmic, power, and bilinear functions were fitted to plots of radiation dose against age or weight, and the standard dose was calculated at the designated age or weight using the derived equation. When the sample size was smaller, the random variations of the estimated standard dose were larger. Better estimation of the standard dose was achieved with the curve-fitting methods than with the grouping method. Power fitting appeared to be more effective than logarithmic and bilinear fittings for suppressing random variation. Determination of the standard dose for pediatric brain CT by the curve-fitting method is recommended to improve radiation dose optimization at facilities performing the imaging procedure infrequently.

Radiation Dose Management in Pediatric Brain CT According to Age and Weight as Continuous Variables.

The diagnostic reference levels (DRLs) for pediatric brain computed tomography (CT) are provided for groups divided according to age. We investigated the relationships of radiation dose indices (volume CT dose index and dose length product) with age and weight, as continuous variables, in pediatric brain CT. In a retrospective analysis, 980 pediatric brain CT examinations were analyzed. Curve fitting was performed for plots of the CT dose indices versus age and weight, and equations to estimate age- and weight-dependent standard dose indices were derived. Standard dose indices were estimated using the equations, and the errors were calculated. The results showed a biphasic increase in dose indices with increasing age and weight, characterized by a rapid initial and subsequent slow increase. Logarithmic, power, and bilinear functions were well fitted to the plots, allowing estimation of standard dose indices at an arbitrary age or weight. Error analysis suggested that weight was mildly better than age and that the best results were obtained with the bilinear function. Curve fitting of the relationship between CT dose indices and age or weight facilitates the determination of standard dose indices in pediatric brain CT at each facility and is expected to aid the establishment and application of the DRLs.

Scientific Research Group Report: Nationwide Survey on Radiation Exposure of Pediatric CT Examination in Japan (2018)

To understand the latest pediatric computed tomography (CT) exposure required for the revision of national DRLs. A questionnaire was sent to 409 facilities where the members of the Japanese Society of Radiological Technology and the Japanese Society of Pediatric Radiology are enrolled. We investigated the imaging conditions, CTDIvol, and DLP of the pediatric head, chest, and abdominal CT examinations. In all, 43 facilities (11%) responded to our survey. multi detector-row CT (MDCT) systems were available in all surveyed facilities. More than 98% of the MDCT systems had more than 64 detector rows. The CTDIvol of all CT protocols was lower than the NDRL due to the progress of updating to MDCTs with radiation exposure reduction functions such as an iterative reconstruction, but the DLP of head and abdominal CT protocols of some age group were higher than NDRL. It is necessary to review the imaging protocol with the attending physician and radiologist and consider further optimization of medical exposure.

The optimisation of paediatric CT examinations in Scotland: phase one; benchmarking current performance

To benchmark the dose from paediatric head and chest examinations on computed tomography (CT) scanners throughout Scotland, to identify scanners that may require optimisation and to provide optimisation advice based on the protocols from better performing scanners. Anthropomorphic phantoms corresponding to 1, 5 and 10 year olds were sent to 50 CT scanners around Scotland. Head and chest examinations were undertaken by local staff using local techniques on each scanner with each phantom, and details of the protocols used were recorded. Computed tomography dose index (CTDI)vol and dose length product (DLP) were recorded post-scan. There is a significant variation in performance throughout Scotland. For head examinations, the highest DLP is 13 times the lowest for an equivalent sized phantom. For chest examinations, the highest is 128 times the lowest for an equivalent sized phantom. The wide range of CT dose measurements indicates the potential for variation in image quality across Scotland. Feedback has been provided to all participating sites on their individual results compared to the national data set. Specific feedback was provided where relevant on potential considerations for optimisation. Scanners that may be undertaking paediatric CT head and chest examinations in a sub-optimal manner throughout Scotland have been identified along with those aspects of a scan protocol that are most likely to lead to sub-optimal performance.

Establishment of diagnostic reference level for computed tomography of head pediatrics in Morocco: A pilot study

Pediatric patients are well documented to be at higher risk of developing radiation-induced cancer than the average adult. This pilot study aims to estimate the radiation doses to pediatric patients during head Computed Tomography (CT), in order to establish local Diagnostic Reference Level (DRL).Data from 300 pediatric head CT examinations from 6 public hospitals were analyzed. The age group concerned is 5–10 years. The CT facilities were 64, 16, 4 and dual slice type. CT data included scanner acquisition parameters, the number of series, use of the contrast medium, rotation time, slice thickness, as well as the displayed CT Dose Index (CTDIvol) and the Dose Length Product (DLP). The effective dose and DRL were evaluated using the formalism and conversion factor of the International Commission on Radiological Protection (ICRP).The overall mean CT dose per procedure from different facilities was 44,97 mGy, 883,67 mGy.cm and 2,81 mSv for CTDIvol, DLP and effective dose, respectively. The mean third quartile dose per head CT procedure from all facilities was 40,94 mGy and 969,90 mGy.cm cm for CTDI and DLP, in that order. These results proved that pediatric patients are exposed to unnecessary doses of radiation during CT examination in public healthcare institution of Morocco.The DRL obtained was slightly higher than those established in some countries. Pediatric radiation dose per procedure indicated a wide variation between various hospitals and even in the same hospital for different patients. This pilot study showed the need for practices unification and radiation doses optimization during CT scan acquisition for pediatric patients in radiology departments.

Patient-level dose monitoring in computed tomography: tracking cumulative dose from multiple multi-sequence exams with tube current modulation in children.

In children exposed to multiple computed tomography (CT) exams, performed with varying z-axis coverage and often with tube current modulation, it is inaccurate to add volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) to obtain cumulative dose values. To introduce the patient-size-specific z-axis dose profile and its dose line integral (DLI) as new dose metrics, and to use them to compare cumulative dose calculations against conventional measures. In all children with 2 or more abdominal-pelvic CT scans performed from 2013 through 2019, we retrospectively recorded all series kV, z-axis tube current profile, CTDIvol, dose-length product (DLP) and calculated SSDE. We constructed dose profiles as a function of z-axis location for each series. One author identified the z-axis location of the superior mesenteric artery origin on each series obtained to align the dose profiles for construction of each patient's cumulative profile. We performed pair-wise comparisons between the peak dose of the cumulative patient dose profile and ΣSSDE, and between ΣDLI and ΣDLP. We recorded dose data in 143 series obtained in 48 children, ages 0-2years (n=15) and 8-16years (n=33): ΣSSDE 12.7±6.7 and peak dose 15.1±8.1mGy, ΣDLP 278±194 and ΣDLI 550±292mGy·cm. Peak dose exceeded ΣSSDE by 20.6% (interquartile range [IQR]: 9.9-26.4%, P<0.001), and ΣDLI exceeded ΣDLP by 114% (IQR: 86.5-147.0%, P<0.001). Our methodology represents a novel approach for evaluating radiation exposure in recurring pediatric abdominal CT examinations, both at the individual and population levels. Under a wide range of patient variables and acquisition conditions, graphic depiction of the cumulative z-axis dose profile across and beyond scan ranges, including the peak dose of the profile, provides a better tool for cumulative dose documentation than simple summations of SSDE. ΣDLI is advantageous in characterizing overall energy absorption over ΣDLP, which significantly underestimated this in all children.