With increasing use of CT in children and a lack of use of appropriateness criteria, there is a strong need to implement guidelines to avoid unnecessary radiation doses to children.
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.
Objectives: Cone beam CT (CBCT) in dentistry and maxillofacial surgery is a widely used imaging method for the assessment of various maxillofacial and dental pathological conditions. The objective of this study was to summarize the results of a multinational retrospective–prospective study that focused on patient exposure in this modality. Methods: The study included 27 CBCT units and 325 adult and paediatric patients, in total. Data on patients, clinical indications, technical parameters of exposure, patient dose indicator, or, alternatively, dose to phantom were collected. The dose indicator used was air kerma–area product, PKA. Results: In most scanners operators are offered with a variety of options regarding technical parameters, especially the field of view size. The median and the third quartile value of PKA for adult patients in 14 different facilities were 820 mGy cm² and 1000 mGy cm² (interquartile range = 1058 mGy cm²), and 653 mGy cm² and 740 mGy cm² (interquartile range = 1179 mGy cm²) for children, as reported by four different institutions. Phantom dose data were reported from 15 institutions, and median PKA ranged from 125 mGy cm² to 1951 mGy cm². Median PKA values varied by more than a 10-fold between institutions, mainly due to differences in imaging protocol used, in particular field of view and tube current-exposure time product. Conclusions: The results emphasize the need for a cautious approach to using dental CBCT. Imaging only when the clinical indications are clear, accompanied with the appropriate radiographic techniques and the optimum imaging protocol, will help reduce radiation dose to patients.
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