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Establishment of Local Diagnostic Reference Levels of Pediatric Abdominopelvic and Chest CT Examinations Based on the Body Weight and Size in Korea

  • Jae-Yeon Hwang (Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University) ;
  • Young Hun Choi (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hee Mang Yoon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Young Jin Ryu (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hyun Joo Shin (Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Hyun Gi Kim (Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • So Mi Lee (Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Sun Kyung You (Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Ji Eun Park (Department of Radiology, Ajou University Hospital, School of Medicine, Ajou University)
  • 투고 : 2020.07.13
  • 심사 : 2020.09.16
  • 발행 : 2021.07.01

초록

Objective: The purposes of this study were to analyze the radiation doses for pediatric abdominopelvic and chest CT examinations from university hospitals in Korea and to establish the local diagnostic reference levels (DRLs) based on the body weight and size. Materials and Methods: At seven university hospitals in Korea, 2494 CT examinations of patients aged 15 years or younger (1625 abdominopelvic and 869 chest CT examinations) between January and December 2017 were analyzed in this study. CT scans were transferred to commercial automated dose management software for the analysis after being de-identified. DRLs were calculated after grouping the patients according to the body weight and effective diameter. DRLs were set at the 75th percentile of the distribution of each institution's typical values. Results: For body weights of 5, 15, 30, 50, and 80 kg, DRLs (volume CT dose index [CTDIvol]) were 1.4, 2.2, 2.7, 4.0, and 4.7 mGy, respectively, for abdominopelvic CT and 1.2, 1.5, 2.3, 3.7, and 5.8 mGy, respectively, for chest CT. For effective diameters of < 13 cm, 14-16 cm, 17-20 cm, 21-24 cm, and > 24 cm, DRLs (size-specific dose estimates [SSDE]) were 4.1, 5.0, 5.7, 7.1, and 7.2 mGy, respectively, for abdominopelvic CT and 2.8, 4.6, 4.3, 5.3, and 7.5 mGy, respectively, for chest CT. SSDE was greater than CTDIvol in all age groups. Overall, the local DRL was lower than DRLs in previously conducted dose surveys and other countries. Conclusion: Our study set local DRLs in pediatric abdominopelvic and chest CT examinations for the body weight and size. Further research involving more facilities and CT examinations is required to develop national DRLs and update the current DRLs.

키워드

과제정보

We thanks Mr. JongWon Lee from Bayer Korea Ltd. for supporting set up an automated dose management software.

참고문헌

  1. OECD. Health at a glance. Oecd-ilibrary.org Web site. https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2019_4dd50c09-en. Published 2019. Accessed February 23, 2020 
  2. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000-2005. Emerg Radiol 2006;13:25-30 
  3. Brody AS, Frush DP, Huda W, Brent RL; American Academy of Pediatrics Section on Radiology. Radiation risk to children from computed tomography. Pediatrics 2007;120:677-682 
  4. Bosch de Basea M, Salotti JA, Pearce MS, Muchart J, Riera L, Barber I, et al. Trends and patterns in the use of computed tomography in children and young adults in Catalonia - results from the EPI-CT study. Pediatr Radiol 2016;46:119-129 
  5. Wildman-Tobriner B, Strauss KJ, Bhargavan-Chatfield M, Kadom N, Vock P, Applegate KE, et al. Using the American College of Radiology Dose Index Registry to evaluate practice patterns and radiation dose estimates of pediatric body CT. AJR Am J Roentgenol 2018;210:641-647 
  6. Chodick G, Ronckers C, Ron E, Shalev V. The utilization of pediatric computed tomography in a large Israeli Health Maintenance Organization. Pediatr Radiol 2006;36:485-490 
  7. Linet MS, Kim KP, Rajaraman P. Children's exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol 2009;39 Suppl 1:S4-26 
  8. Anonymous. Radiological protection and safety in medicine. Annals of the ICRP 1996;26:1-31 
  9. European Comission. European guidelines on diagnostic reference levels for paediatric imaging. Luxembourg: EU Publications, 2018 
  10. Vano E, Miller DL, Martin CJ, Rehani MM, Kang K, Rosenstein M, et al. ICRP publication 135: diagnostic reference levels in medical imaging. Ann ICRP 2017;46:1-144 
  11. Vassileva J, Rehani M. Patient grouping for dose surveys and establishment of diagnostic reference levels in paediatric computed tomography. Radiat Prot Dosimetry 2015;165:81-85 
  12. The 2007 recommendations of the international commission on radiological protection. Icrp.org Web site. https://www.icrp.org/publication.asp?id=ICRP%20Publication%20103. Published 2007. Accessed February 23, 2020 
  13. Granata C, Sorantin E, Seuri R, Owens CM. European Society of Paediatric Radiology Computed Tomography and Dose Task Force: European guidelines on diagnostic reference levels for paediatric imaging. Pediatr Radiol 2019;49:702-705 
  14. Jackson D, Atkin K, Bettenay F, Clark J, Ditchfield MR, Grimm JE, et al. Paediatric CT dose: a multicentre audit of subspecialty practice in Australia and New Zealand. Eur Radiol 2015;25:3109-3122 
  15. Goske MJ, Strauss KJ, Coombs LP, Mandel KE, Towbin AJ, Larson DB, et al. Diagnostic reference ranges for pediatric abdominal CT. Radiology 2013;268:208-218 
  16. Strauss KJ, Goske MJ, Towbin AJ, Sengupta D, Callahan MJ, Darge K, et al. Pediatric chest CT diagnostic reference ranges: development and application. Radiology 2017;284:219-227 
  17. Boone J, Strauss K, Cody D, McCollough C, McNitt-Gray M, Toth T. The Report of AAPM Task Group 204: size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. Alexandria: American Association of Physicists in Medicine, 2011 
  18. Wallace A, Hayton A, Thomas P, Beveridge T. The 2011-2013 national diagnostic reference level service report. ARPANSA Technical Report No. 171. Victoria: Australian Radiation Protection and Nuclear Safety Agency, 2015 
  19. Schegerer A, Loose R, Heuser LJ, Brix G. Diagnostic reference levels for diagnostic and interventional X-ray procedures in Germany: update and handling. Rofo 2019;191:739-751 
  20. Imai R, Miyazaki O, Horiuchi T, Kurosawa H, Nosaka S. Local diagnostic reference level based on size-specific dose estimates: assessment of pediatric abdominal/pelvic computed tomography at a Japanese national children's hospital. Pediatr Radiol 2015;45:345-353 
  21. Hwang JY, Do KH, Yang DH, Cho YA, Yoon HK, Lee JS, et al. A survey of pediatric CT protocols and radiation doses in South Korean hospitals to optimize the radiation dose for pediatric CT scanning. Medicine (Baltimore) 2015;94:e2146 
  22. Kubo T. Vendor free basics of radiation dose reduction techniques for CT. Eur J Radiol 2019;110:14-21 
  23. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006;450:76-85 
  24. Kleinman PL, Strauss KJ, Zurakowski D, Buckley KS, Taylor GA. Patient size measured on CT images as a function of age at a tertiary care children's hospital. AJR Am J Roentgenol 2010;194:1611-1619 
  25. McCollough CH, Bruesewitz MR, Kofler JM Jr. CT dose reduction and dose management tools: overview of available options. Radiographics 2006;26:503-512 
  26. Kalra MK, Maher MM, Toth TL, Schmidt B, Westerman BL, Morgan HT, et al. Techniques and applications of automatic tube current modulation for CT. Radiology 2004;233:649-657 
  27. Khawaja RD, Singh S, Vettiyil B, Lim R, Gee M, Westra S, et al. Simplifying size-specific radiation dose estimates in pediatric CT. AJR Am J Roentgenol 2015;204:167-176 
  28. Iriuchijima A, Fukushima Y, Nakajima T, Tsushima Y, Ogura A. Simple method of size-specific dose estimates calculation from patient weight on computed tomography. Radiat Prot Dosimetry 2018;178:208-212