Expansion of Typical Values for Paediatric Patients in Ireland and Comparison with Published DRLs - Experiences of a Single Institution

Andrew Lyons; Ali Mohammed Ali; Andrew England; Niamh Moore; Rena Young; Brid Leamy; Winnie Tam; Paul Bezzina; Napapong Pongnapang; Mark F McEntee

doi:10.1016/j.jmir.2024.04.014

Expansion of Typical Values for Paediatric Patients in Ireland and Comparison with Published DRLs - Experiences of a Single Institution

J Med Imaging Radiat Sci. 2024 May 11:101421. doi: 10.1016/j.jmir.2024.04.014. Online ahead of print.

Authors

Affiliations

¹ Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland.
² Department of Medical Physics, College of Applied Medical Sciences, University of Kerbala, Karbala, Iraq.
³ Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland. Electronic address: aengland@ucc.ie.
⁴ Department of Radiology, Cork University Hospital, Cork, Ireland.
⁵ Department of Radiography, City, University of London, London, UK.
⁶ Department of Radiography, University of Malta, Msida, Malta.
⁷ Department of Radiological Technology, Mahidol University, Bangkok, Thailand.

PMID: 38735771
DOI: 10.1016/j.jmir.2024.04.014

Abstract

Introduction: To reduce the risks involved with ionising radiation exposure, typical values (TVs) and diagnostic reference levels (DRLs) have been established to help keep radiation doses 'as low as reasonably practicable. TVs/DRLs provide standardised radiation dose metrics that can be used for comparative purposes. However, for paediatrics, such values should consider the size of the child instead of their age. This study aimed to establish and compare paediatric TVs for chest, abdomen and pelvis radiography.

Methods: Study methods followed processes for establishing paediatric DRLs as outlined by the Health Information and Quality Authority (HIQA). Kerma-area product (KAP) values, excluding rejected images, were retrospectively acquired from the study institution's Picture Archiving and Communications System (PACS). Paediatric patients were categorised into the following weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg) and stratified based on the examination that was performed (chest, abdomen, and pelvis), and where it was performed (the different X-ray rooms). Anonymised data were inputted into Microsoft Excel for analysis. Median and 3rd quartile KAP values were reported together with graphical illustrations.

Results: Data from 407 X-ray examinations were analysed. For the previously identified weight categories (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg), TVs for the chest were 0.10, 0.19, 0.37 and 0.53 dGy.cm², respectively. For the abdomen 0.39, 1.04, 3.51 and 4.05 dGy.cm² and for the pelvis 0.43, 0.87, 3.50 and 7.58 dGy.cm². Between X-ray rooms TVs varied against the institutional TVs by -60 to 119 % (chest), -50 to 103 % (abdomen) and -14 and 24 %% (pelvis).

Conclusion: TVs in this study follow established trends with patient weight and examination type and are comparable with published literature. Variations do exist between individual examination rooms and reasons are multifactorial. Given that age and size do not perfectly correlate further work should be undertaken around weight-based TVs/DRLs in the paediatric setting.

Keywords: ALARA; Diagnostic reference levels; Dose area product; Paediatric; Radiation protection.