Pediatric Radiology

, Volume 44, Supplement 3, pp 506–510 | Cite as

Diagnostic reference ranges and the American College of Radiology Dose Index Registry: the pediatric experience

  • Marilyn J. Goske
Image Gently ALARA CT summit: How to Use New CT Technologies for Children


CT scans are powerful tools used in the care of pediatric patients daily. Yet the increased use of CT warrants careful monitoring. This article defines diagnostic reference levels and how they can be used to guide practice. Once a facility has adapted its techniques and protocols to fall within diagnostic reference levels or target values, the facility can expand its quality-improvement efforts to include a new concept, diagnostic reference ranges (DRRs). DRRs take into account the subjective image quality of the examination and provide a minimum estimated patient dose, below which accurate interpretation of an image might be difficult, and an upper estimated dose, above which the patient dose may be higher than necessary. This paper also describes how the American College of Radiology Dose Index Registry can be used by a facility as a continuous quality improvement tool to monitor and manage appropriate patient dose.


Diagnostic reference levels Diagnostic reference ranges Dose index registry Quality improvement Computed tomography Pediatric 


Conflicts of interest

Dr. Goske has no financial interests, investigational or off-label uses to disclose.


  1. 1.
    Foley SJ, McEntee MF, Rainford LA (2012) Establishment of CT diagnostic reference levels in Ireland. Br J Radiol 85:1390–1397PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Schauer DA, Linton OW (2009) National council on radiation protection and measurements report shows substantial medical exposure increase. Radiology 253:293–296PubMedCrossRefGoogle Scholar
  3. 3.
    Miglioretti DL, Johnson E, Williams A et al (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 167:700–707PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Brenner DJ, Hall EJ (2007) Computed tomography — an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar
  5. 5.
    ICRP (1991) 1990 Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann. ICRP 21 (1–3)Google Scholar
  6. 6.
    Teunen D (1998) The European directive on health protection of individuals against the dangers of ionising radiation in relation to medical exposures (97/43/EURATOM). J Radiol Prot 18:133–137PubMedCrossRefGoogle Scholar
  7. 7.
    Kiljunen T, Jarvinen H, Savolainen S (2007) Diagnostic reference levels for thorax X-ray examinations of pediatric patients. Br J Radiol 80:452–459PubMedCrossRefGoogle Scholar
  8. 8.
    Goske MJ, Strauss KJ, Coombs LP et al (2013) Diagnostic reference ranges for pediatric abdominal CT. Radiology 268:208–218PubMedCrossRefGoogle Scholar
  9. 9.
    ICRP (1996) Radiological Protection and Safety in Medicine. ICRP Publication 73. Ann. ICRP 26 (2)Google Scholar
  10. 10.
    Gray JE, Archer BR, Butler PF et al (2005) Reference values for diagnostic radiology: application and impact. Radiology 235:354–358PubMedCrossRefGoogle Scholar
  11. 11.
    Smith-Bindman R, Lipson J, Marcus R et al (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086PubMedCrossRefGoogle Scholar
  12. 12.
    Shrimpton PC, Wall BF (2000) Reference doses for paediatric computed tomography. Radiat Prot Dosimetry 90:249–252CrossRefGoogle Scholar
  13. 13.
    Boone JM, Strauss KJ, Cody D et al (2011) Size specific dose estimates (SSDE) in pediatric and adult body CT examinations. Report of AAPM Task Group 204. American Association of Physicists in Medicine, College Park, MDGoogle Scholar
  14. 14.
    Li X, Samei E, Segars WP et al (2011) Patient-specific radiation dose and cancer risk for pediatric chest CT. Radiology 259:862–874PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Muhogora WE, Ahmed NA, Alsuwaidi JS et al (2010) Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiat Prot Dosimetry 140:49–58PubMedCrossRefGoogle Scholar
  16. 16.
    Committee H-4 on the Nationwide Evaluation of X-Ray Trends (NEXT) of the Conference of Radiation Control Program Directors (CRCPD) (2000) Protocol for survey of computed tomography (CT). Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH), Rockville, MDGoogle Scholar
  17. 17.
    McCollough C, Branham T, Herlihy V et al (2011) Diagnostic reference levels from the ACR CT accreditation program. J Am Coll Radiol 8:795–803PubMedCrossRefGoogle Scholar
  18. 18.
    American College of Radiology (2013) CT accreditation program requirements. Accessed 29 April 2014
  19. 19.
    Linet MS, Kim KP, Rajaraman P (2009) Children's exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol 39:S4–26PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Hricak H, Brenner DJ, Adelstein SJ et al (2011) Managing radiation use in medical imaging: a multifaceted challenge. Radiology 258:889–905PubMedCrossRefGoogle Scholar
  21. 21.
    Golding SJ (2010) Radiation exposure in CT: what is the professionally responsible approach? Radiology 255:683–686Google Scholar
  22. 22.
    Coombs LP (2008) Powerpoint presentation ACR Dose Index Registry. American Board of Radiology Radiation Safety Summit. Accessed 18 Dec 2013
  23. 23.
    American College of Radiology (2011) ACR launches dose index registry. Accessed 18 Dec 2013
  24. 24.
    The American Board of Radiology (2013) MOC: maintenance of certification: what is MOC? Accessed 18 Dec 2013
  25. 25.
    American College of Radiology (2012) ACR Dose Index Registry: ABR PQI project description. Accessed 18 Dec 2013

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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