Diagnostic reference levels for pediatric fluoroscopy procedures: A systematic review

Abstract

Aim: This study aims to provide a systematic review of the DRLs for pediatric diagnostic and interventional fluoroscopy procedures.

Methods: This systematic review included the published studies in pediatric diagnostic and interventional fluoroscopy procedures from June 2012 to December 2025 on the PubMed/MEDLINE, ScienceDirect, and Google Scholar websites. Fourteen articles have met this study's inclusion. The included data was divided into two groups, which were diagnostic and interventional procedures. Each group was divided into two categories, which were age-specific and weight-specific DRLs.

Results: The collected values for DRLs show high variation in both DAPs and FTs, and the I² test shows that there was no homogeneity between procedures of the same type. In addition, the results suggest that there was no consistency in the procedures performed between institutions. The magnitude and variation of DRL results for the interventional fluoroscopy procedures were significantly higher than that for the diagnostic procedures. The high DRLs were directly related to the high FTs required to perform the interventional procedures. The average FT required for the interventional fluoroscopy procedure was 9.75 min, whereas 2.3 min was required for the diagnostic fluoroscopy procedure.

Conclusions: There were significant differences in both DAPs and FTs between the results obtained from different medical institutions. The higher DRLs were strongly related to the higher FTs required to perform the interventional procedures.

Keywords: DRLs; Diagnostic; Fluoroscopy; Interventional; Pediatric.