European Radiology

, Volume 20, Issue 7, pp 1572–1579 | Cite as

Diagnostic reference levels in pediatric radiology in Austria




Because of the higher sensitivity to radiation in children, optimization plays an essential role in pediatric radiology. Diagnostic reference levels are a helpful tool to optimize patient dose for standard radiographic procedures.


A nationwide survey was conducted to determine doses and variation in average dose applied to children for standard X-ray examinations. Dose values for chest, skull and abdomen X-ray procedures were determined for newborns, 1, 5, 10 and 15 year olds.


Third quartiles of patient doses are provided and compared to European, British and German reference values. Variation in average doses between hospitals (i.e., ratio of maximal to minimal applied average dose) for the same age and examination was found to be typically a factor of eight. Ratios of maximal to minimal applied doses to individual patients were found to be approximately a factor of six higher than variations of average doses between clinics.


While average patient doses indicate the use of good radiological practice in general, variance in average doses applied by different hospitals indicate that audit of dose with respect to reference values will provide guidance for optimization. Such practice should result in lowering doses for pediatric examinations.


Pediatric radiology Diagnostic reference levels Radiation protection Patient dose DRL 



The authors wish to express their gratitude to all clinical partner hospitals that supplied the data on which this work is based, to Mr. Antti Kosunen and Ms. Katja Nieminen from the Finnish radiation and nuclear safety authority (STUK) for assistance and calibration of the reference KAP meter, and to Mr. Manfred Ditto from the Austrian Federal Ministry of Health, Family and Youth for helpful discussions. The project was founded by the Austrian Federal Ministry of Health, Family and Youth.


  1. 1.
    International Commission on Radiological Protection (1991) 1990 recommendations of the International Commission on Radiological Protection. ICRP publication no. 60, Annals of ICRP, 21. Pergamon, OxfordGoogle Scholar
  2. 2.
    International Commission on Radiological Protection (1996) Radiological protection and safety in medicine. ICRP publication no 73. Annals of ICRP, 26. Pergamon, OxfordGoogle Scholar
  3. 3.
    Teunen D (1998) The European directive on health protection of individuals against the dangers of ionizing radiation in relation to medical exposures (97/43/Euratom). J Radiol Prot 18:133–137CrossRefPubMedGoogle Scholar
  4. 4.
    Wall BF (2004) Diagnostic reference levels in the x–ray department. Eur Radiol Suppl 14:66–73CrossRefGoogle Scholar
  5. 5.
    Gray JE, Archer BR, Butler PF, Hobbs BB, Mettler FA, Pizzutiello RJ, Schueler BA, Strauss KJ, Suleiman OH, Yaffe MJ (2005) Reference values for diagnostic radiology: application and impact. Radiology 235:354–358CrossRefPubMedGoogle Scholar
  6. 6.
    Kiljunen T, Järvinen H, Savolainen S (2007) Diagnostic reference levels for thorax x-ray examinations of paediatric patients. Br J Radiol 80:452–459CrossRefPubMedGoogle Scholar
  7. 7.
    Hart D, Wall BF, Shrimpton PC, Dance DR (2000) The establishment of reference doses in paediatric radiology as a function of patient size. Rad Prot Dosim 90:235–238Google Scholar
  8. 8.
    Montgomery A, Martin CJ (2000) A study of the application of paediatric reference levels. Br J Radiol 73:1083–1090PubMedGoogle Scholar
  9. 9.
    Hart D, Wall BF, Shrimpton PC, Bungay DR, Dance DR (2000) NRPB- R318-Reference doses and patient size in paediatric radiology. NRPB-R318, NRPB, ChiltonGoogle Scholar
  10. 10.
    IAEA (International Atomic Energy Agency) (2008) Dosimetry in diagnostic radiology: an international code of practice. IAEA, ViennaGoogle Scholar
  11. 11.
    Petoussi-Henss N, Zankl M, Drexler G, Panzer W, Regulla D (1998) Calculation of backscatter factors for diagnostic radiology using Monte Carlo methods. Phys Med Biol 43:2237–2250CrossRefPubMedGoogle Scholar
  12. 12.
    Harrison RM (1983) Tissue-air ratios and scatter-air ratios for diagnostic radiology (1–4 mm al hvl). Phys Med Biol 28:1–18CrossRefPubMedGoogle Scholar
  13. 13.
    Grosswendt B (1990) Dependence of the photon backscatter factor for water on source-to-phantom distance and irradiation field size. Phys Med Biol 35:1233–1245CrossRefGoogle Scholar
  14. 14.
    Kohn MM (1996) European guidelines on quality criteria for diagnostic radiographic images in paediatrics. Report EUR 16261. Office for Official Publications of the European Communities, LuxembourgGoogle Scholar
  15. 15.
    Bundesamt für Strahlenschutz (2003) Bekanntmachung der diagnostischen Referenzwerte für radiologische und nuklearmedizinische Untersuchungen. Bundesanzeiger 143:17503–17504Google Scholar
  16. 16.
    Bakawski C, Stein E, Kohn M, Kellner M, Schweighofer K, Cartagena G, Padovani R, Panzer W, Scheurer C, Schneider K, Fendel H, Wall B (1992) Results of a dosimetry study in the European community on frequent x-ray examination in infants. Rad Prot Dosim 43:31–36Google Scholar
  17. 17.
    Endemann B, Ernst G, Panzer W, Padovani R, Schneider K, Kohn MM, Wall B (1995) Variation in radiation dose and image quality of common x-rays of the 5-year-old child. A European wide survey in children’s clinics. Eur Radiol Suppl 5:192Google Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Jochen Billinger
    • 1
  • Robert Nowotny
    • 1
  • Peter Homolka
    • 1
  1. 1.Center for Biomedical Engineering and PhysicsMedical University of ViennaViennaAustria

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