Vassileva J, Rehani M, Kostova-Lefterova D, Al-Naemi H M, Al Suwaidi J S, Arandjic D, Bashier E H O, Kodlulovich Renha S, El-Nachef L, Aguilar J G, Gershan V, Gershkevitsh E, Gruppetta E, Hustuc A, Jauhari A, Kharita Mohammad Hassan, Khelassi-Toutaoui N, Khosravi H R, Khoury H, Kralik I, Mahere S, Mazuoliene J, Mora P, Muhogora W, Muthuvelu P, Nikodemova D, Novak L, Pallewatte A, Pekarovič D, Shaaban M, Shelly E, Stepanyan K, Thelsy N, Visrutaratna P, Zaman A
International Atomic Energy Agency, Vienna, Austria
Harvard Medical School and Massachusetts General Hospital, Boston, USA.
Radiat Prot Dosimetry. 2015 Jul;165(1-4):70-80. doi: 10.1093/rpd/ncv116. Epub 2015 Apr 1.
The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.
本文报道了在32个国家进行的最大规模的儿科计算机断层扫描（CT）国际剂量调查结果，并根据计算机断层扫描剂量指数（CTDI vol）和剂量长度乘积（DLP）提出了国际诊断参考水平（DRL）。它还评估了应使用各个机构的平均值还是中位数。在四个年龄组中总共记录了6115份个体患者数据：<1岁、>1 - 5岁、>5 - 10岁和>10 - 15岁。来自CT控制台的CTDIw、CTDI vol和DLP与患者数据及技术参数一起以专用表格形式记录。进行了统计分析，并在所有CT机构中位数分布的约第75百分位数处确定了国际DRL。该研究提供了证据，支持使用患者剂量指数的中位数而非平均值作为机构中典型局部剂量的代表，并支持将DRL确定为中位数的第三个四分位数。为四个年龄组的儿科CT常规头部、胸部和腹部检查建立了国际DRL。CTDI vol的DRL与其他已发表报告中的参考值相似，胸部和腹部CT存在一些差异。基于对整个多期检查的调查，DLP值之间观察到更高的变异性。需要注意的是，文献中的其他研究仅基于单相检查。本文报道的DRL可用于缺乏足够医学物理支持的国家，以识别未优化的做法。还提供了提高未来调查准确性和重要性的建议。
