Clinical Indication-Based Pediatric Diagnostic Reference Level Values for Abdominal Computed Tomography: A Descriptive Cross-Sectional Study

Abstract

Background and Aims

Computed tomography (CT) poses a concern in pediatric patients because of their higher sensitivity to radiation. At the time of the study, nephroblastoma was the most prevalent clinical indication for abdominal CT examinations in pediatric patients. Therefore, the aim of this study was to establish pediatric typical diagnostic reference levels (DRLs) for contrast-enhanced abdominal CT examinations of pediatric patients presenting with nephroblastoma.

Methods

The volume CT dose index (CTDI_vol), dose-length product (DLP) and patient weight of 121 patients with nephroblastoma were collected retrospectively. Size-specific dose estimates (SSDE), CTDI_vol and DLP were used to calculate DRL values. The SSDE was added as an additional parameter because dose estimates based on the patient's size are considered more precise. Patients were categorized into five weight groups for which DRL values were established per group. The pediatric DRL values in this study were set at the median of the data distribution.

Results

Diagnostic reference level values were only established for two weight groups that adhered to the International Commission on Radiological Protection (ICRP) guidelines. The DRL values for CTDI_vol ranged from 2.4 to 2.7 mGy, while the DLP ranged from 78.4 to 108 mGy.cm, and SSDE_sum ranged from 4.9 to 5.6 mGy. The DRL values of this study were lower than the European Commission (EC) DRL values and higher than those of other international studies. The lower DRL values of this study will be used to further tailor the radiation dose to be lower than usual for optimization of the radiation dose received by pediatric patients for CT abdomen examinations.

Conclusion

For efficient dose optimization, clinical indication, body weight, and SSDE should be considered when developing pediatric DRL values. Future optimization strategies will benefit from adapting patient size and clinical indication as suggested and supported by the findings of this study.