Determination of Paediatric Diagnostic Reference Levels (DRLS) in Computed Tomography Scanners in Two Public Hospitals in Klang Valley
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Abstract
Introduction: Computed Tomography (CT) scanners have made significant contributions in health facilities around the world. However, CT scan examinations produce relatively higher radiation doses compared to other X-ray-based imaging modalities especially in paediatric. The International Commission on Radiological Protection (ICRP) have recommended Diagnostic Reference Levels (DRLs) to optimize dose received in paediatric patients. This study aims to determine paediatric CT DRLs values for four age groups in two Public Hospitals. Materials and Methods: A total of 958 CT scan examinations were conducted at were conducted at two public hospitals over a 12-month period. The retrospective analysis was divided into head, chest and abdominal examinations and categorized into four age groups: <1, 1-5, 6-10 and 11-15 years old. CTDIvol, DLP, and ED values were analysed. Results: The study found that the value of CTDIvol and DLP in Hospital A gave the lowest value for all age groups at head examination. The highest DLP were estimated in Hospital B for the group <1y and 5-10 y in head examination, and the 10-15 y group in abdomen examination. The estimated ED values were consistent with those reported in other studies which were 2.30 mSv (Hospital A) and 4.08 mSv (Hospital B). Conclusion: The CTDIvol, DLP and ED values in this study are in the optimal except for DLP values for the abdomen examinations in oldest group which gives the impression that there is room for an improvement.
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Kalender WA (2006) X-ray computed tomography. Phys Med Biol 51:R29–R43
Ginat DT, Gupta R (2014) Advances in Computed Tomography Imaging Technology. Annu Rev Biomed Eng 16:431–453
Chaves TO, Dovales ACM, Da Rosa LAR, Veiga LHS (2018) Patterns and trends of Computed Tomography usage among pediatric and young adult patients in a private hospital in Rio de Janeiro, 2005-2015. Brazilian Journal of Radiation Sciences. https://doi.org/10.15392/bjrs.v6i1.333
Brady Z, Cain TM, Johnston PN (2011) Paediatric CT imaging trends in Australia. J Med Imaging Radiat Oncol 55:132–142
Lewis MA, Pascoal A, Keevil SF, Lewis CA (2016) Selecting a CT scanner for cardiac imaging: the heart of the matter. Br J Radiol 89:20160376
Jung H (2021) Basic Physical Principles and Clinical Applications of Computed Tomography. Progress in Medical Physics 32:1–17
Valentin J (2005) ICRP Publication 99: Low-dose extrapolation of radiation-related cancer risk. Annals of the ICRP 35 (4)
National Research Council (2006) Health Risks from Exposure to Low Levels of Ionizing Radiation. The National Academies Press. https://doi.org/10.17226/11340
Karim MKA, Hashim S, Bakar KA, Bradley DA, Ang WC, Bahrudin NA, Mhareb MHA (2017) Estimation of radiation cancer risk in CT-KUB. Radiation Physics and Chemistry 137:130–134
Kesminiene A, Cardis E (2018) Cancer risk from paediatric computed tomography scanning: implications for radiation protection in medicine. Ann ICRP 47:113–114
Woo JKH, Chiu RYW, Thakur Y, Mayo JR (2012) Risk-benefit analysis of pulmonary CT angiography in patients with suspected pulmonary embolus. ajronline.org 198:1332–1339
Berrington De González A, Kim KP, Knudsen AB, et al (2011) Radiation-related cancer risks from CT colonography screening: a risk-benefit analysis. ajronline.org 196:816–823
Passiglia F, Cinquini M, Bertolaccini L, et al (2021) Benefits and harms of lung cancer screening by chest computed tomography: a systematic review and meta-analysis. ascopubs.org 39:2574–2585
MOH Malaysia (2013) Malaysia Diagnostic Reference Level (DRLs) in Medical Imaging (Radiology). Medical Radiation Surveillance Division. Ministry of Health.
MOH Malaysia (2013) Medical Radiation Exposure Study in Malaysia. Medical Radiation Surveillance Division. Ministry of Health.
ICRP (2017) Diagnostic Reference Levels in Medical Imaging. ICRP Publication 135. International Commission on Radiological Protection. https://doi.org/10.1177/0146645317717209
ICRP (2007) The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. International Commission on Radiological Protection 37:1–291
Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 257:158–166
Khursheed A, Hillier MC, Shrimpton PC, Wall BF (2002) Influence of patient age on normalized effective doses calculated for CT examinations. Br J Radiol 75:819–830
Inoue Y, Itoh H, Waga A, Sasa R, Mitsui K (2022) Radiation Dose Management in Pediatric Brain CT According to Age and Weight as Continuous Variables. Tomography 8:985–998
Galanski M, Nagel H, Stamm G, Michael Galanski med, nat Georg Stamm rer, nat Hans Dieter Nagel rer (2005) Paediatric CT exposure practice in the Federal Republic of Germany.
Shrimpton P, Hillier M, Lewis M, Dunn M (2005) Doses from computed tomography (CT) examinations in the UK-2003 review.
Gao Y, Quinn B, Pandit-Taskar N, Behr G, Mahmood U, Long D, Xu XG, St. Germain J, Dauer LT (2018) Patient-specific organ and effective dose estimates in pediatric oncology computed tomography. Physica Medica 45:146–155
Hwang JY, Choi YH, Yoon HM, Ryu YJ, Shin HJ, Kim HG, Lee SM, You SK, Park JE (2021) Establishment of Local Diagnostic Reference Levels of Pediatric Abdominopelvic and Chest CT Examinations Based on the Body Weight and Size in Korea. Korean J Radiol 22:1172–1184
Abulail A, Rahman AA, Noor Azman NZ, Hassan J (2023) Monitoring Pediatric Head CT Scan Dose Levels: A Retrospective Study of Diagnostic Reference Levels in a Single Hospital in Abu Dhabi, UAE. Applied Sciences (Switzerland). https://doi.org/10.3390/app13084662
Meinel FG, Graef A, Sommer WH, Thierfelder KM, Reiser MF, Johnson TRC (2013) Influence of vascular enhancement, age and gender on pulmonary perfused blood volume quantified by dual-energy-CTPA. Eur J Radiol 82:1565–1570
Boos J, Lanzman RS, Heusch P, Aissa J, Schleich C, Thomas C, Sawicki LM, Antoch G, Kröpil P (2016) Does body mass index outperform body weight as a surrogate parameter in the calculation of size-specific dose estimates in adult body CT? British Journal of Radiology. https://doi.org/10.1259/BJR.20150734
Christner JA, Kofler JM, McCollough CH (2010) Estimating effective dose for ct using dose-length product compared with using organ doses: Consequences of adopting international commission on radiological protection publication 103 or dual-energy scanning. American Journal of Roentgenology 194:881–889
Van Der Molen AJ, Veldkamp WJH, Geleijns J (2007) 16-slice CT: achievable effective doses of common protocols in comparison with recent CT dose surveys. Br J Radiol 80:248–255
Chu PW, Kofler C, Mahendra M, et al (2023) Dose length product to effective dose coefficients in children. Pediatr Radiol 53:1659–1668
Murat H, Kechik MMA, Said MA, Saufi SI, Zaid MHM, Karim MKA (2025) Assessment of typical values for establishing institutional DRL of adult whole-body Fluorine-18 Fluorodeoxyglucose (FDG) PET/CT scans in Malaysia cancer centre. Radiation Physics and Chemistry 237:112986