Paediatric CT dose: a multicentre audit of subspecialty practice in Australia and New Zealand

Abstract

Objectives

To evaluate paediatric CT dosimetry in Australia and New Zealand and calculate size-specific dose estimates (SSDEs) for chest and abdominal examinations.

Methods

Eight hospitals provided data from 12 CT systems for 1462 CTs in children aged 0–15. Imaging data were recorded for eight examinations: head (trauma, shunt), temporal bone, paranasal sinuses, chest (mass) and chest HRCT (high-resolution CT), and abdomen/pelvis (mass/inflammation). Dose data for cranial examinations were categorised by age and SSDEs by lateral dimension. Diagnostic reference ranges (DRRs) were defined by the 25th and 75th percentiles. Centralised image quality assessment was not undertaken.

Results

DRRs for 201 abdominopelvic SSDEs were: 2.8–4.7, 3.6–11.5, 8.5–15.0, 7.6–15, and 10.6–16.2 for the <15 cm, 15–19 cm, 20–24 cm, 25–29 cm and >30 cm groups, respectively. For 147 chest examinations using these body width categories, SSDE DRRs were 2.0–4.4, 3.3–7.9, 4.0–9.4, 4.5–12, and 6.5–12. Kilovoltage peak (kVp), but not AEC or IR, was associated with SSDE (parameter estimate [standard error]: 0.12 (0.03); p < 0.0001).

Conclusions

Australian and New Zealand paediatric CT DRRs and abdominal SSDEs are comparable to international data. SSDEs for chest examinations are proposed. Dose variations could be reduced by adjusting kVp.

Key Points

SSDEs can be calculated for all patients, CT systems, and practices

Kilovoltage peak (kVp) has the greatest association with dose in similar-sized patients

Paediatric DRRs for CT are now available for use internationally

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Abbreviations

AEC:

Automatic exposure control

CTDIvol :

Computed tomography dose index

DRR:

Diagnostic reference range

DLP:

Dose-length product

IAEA:

International Atomic Energy Agency

IR:

Iterative reconstruction

SSDE:

Size-specific dose estimate

DRL:

Diagnostic reference level

SPR:

Scan projection radiograph

BW:

Body width

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Acknowledgments

The authors wish to acknowledge Nancy Kennelly, Nicki Hamilton, Sasko Kadiev, Matthew Ng, Genevieve Howlett, Scott Brown, Deana Maddison, Debbie Watson, Tom Tiang, Michael Saide, Aishwarya Rajan and Shane Handley, who assisted with data collection at all participating sites.

The scientific guarantor of this publication is Adj. Clin. Prof. Stacy Goergen. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the Australian Government Department of Health under the Diagnostic Imaging Quality Program. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was not required for this study, as it was a quality assurance activity to monitor, improve and evaluate the quality of health services. Methodology: retrospective, diagnostic or prognostic, multicenter study.

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Correspondence to S. K. Goergen.

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Jackson, D., Atkin, K., Bettenay, F. et al. Paediatric CT dose: a multicentre audit of subspecialty practice in Australia and New Zealand. Eur Radiol 25, 3109–3122 (2015). https://doi.org/10.1007/s00330-015-3727-y

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Keywords

  • Paediatrics
  • Radiation dose
  • CT, CT dose optimization
  • Diagnostic reference levels
  • Size-specific dose estimates (SSDEs)