Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France.
Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA.
Eur Radiol. 2018 Feb;28(2):630-641. doi: 10.1007/s00330-017-5001-y. Epub 2017 Aug 23.
To describe computed tomography (CT) scanning parameters, volume CT dose index (CTDIvol) and dose-length product (DLP) in paediatric practice and compare them to current diagnostic reference levels (DRLs).
The survey was conducted in radiology departments of six major university hospitals in France in 2010-2013. Data collection was automatised to extract and standardise information on scanning parameters from DICOM-header files. CTDIvol and DLP were estimated based on Monte Carlo transport simulation and computational reference phantoms.
CTDIvol and DLP were derived for 4,300 studies, four age groups and 18 protocols. CTDIvol was lower in younger patients for non-head scans, but did not vary with age for routine head scans. Ratios of 95th to 5th percentile CTDIvol values were 2-4 for most body parts, but 5-7 for abdominal examinations and 4-14 for mediastinum CT with contrast, depending on age. The 75th percentile CTDIvol values were below the national DRLs for chest (all ages) and head and abdominal scans (≥10 years).
The results suggest the need for a better optimisation of scanning parameters for routine head scans and infrequent protocols with patient age, enhanced standardisation of practices across departments and revision of current DRLs for children.
• CTDIvol varied little with age for routine head scans. • CTDIvol was lowest in youngest children for chest or abdominal scans. • Individual and inter-department variability warrant enhanced standardisation of practices. • Recent surveys support the need for revised diagnostic reference levels. • More attention should be given to specific protocols (sinuses, neck, spine, mediastinum).
描述儿童 CT 扫描参数、容积 CT 剂量指数（CTDIvol）和剂量长度乘积（DLP），并与当前的诊断参考水平（DRLs）进行比较。
该研究于 2010 年至 2013 年在法国六所主要大学医院的放射科进行。数据采集自动化，从 DICOM 头文件中提取和标准化扫描参数信息。基于蒙特卡罗输运模拟和计算参考体模来估计 CTDIvol 和 DLP。
对 4300 项研究、四个年龄组和 18 个协议进行了 CTDIvol 和 DLP 研究。对于非头部扫描，年龄较小的患者 CTDIvol 较低，但对于常规头部扫描，年龄与 CTDIvol 无关。大多数身体部位的 95%至 5%分位 CTDIvol 值的比值为 2-4，但腹部检查为 5-7，有对比剂的纵隔 CT 为 4-14，具体取决于年龄。75%分位 CTDIvol 值低于国家 DRLs 规定的胸部（所有年龄）、头部和腹部扫描（≥10 岁）。
结果表明，需要根据患者年龄更好地优化常规头部扫描和不频繁使用的协议的扫描参数，加强各部门之间的实践标准化，并修订当前儿童的 DRLs。
• 对于常规头部扫描，CTDIvol 随年龄变化不大。• 对于胸部或腹部扫描，年龄最小的儿童 CTDIvol 最低。• 个体和部门间的差异需要加强实践的标准化。• 最近的调查支持修订诊断参考水平的必要性。• 应更加关注特定的协议（鼻窦、颈部、脊柱、纵隔）。
