TOWARDS GOOD PRACTICE IN PATIENT DOSE MANAGEMENT IN PAEDIATRIC RADIOLOGY

Abstract

Introduction. Diagnostic and interventional X-rays represent a substantial portion of radiation exposure from artificial sources, with pediatric patients being particularly vulnerable due to their increased sensitivity to ionizing radiation. This study aimed at assessing radiation exposure in children undergoing interventional radiology (IR) procedures and computer tomography (CT) scans at Vilnius University Hospital Santaros Klinikos (VUHSK), Lithuania’s second-largest hospital, and to establish local Diagnostic Reference Levels (DRLs) to ensure optimized dose management.

Methods. Data from pediatric IR and CT procedures conducted between 2021 and 2023 were analyzed, with local DRLs set at the 75th percentile of dose-related parameters such as Dose Area Product (DAP), Dose Length Product (DLP), Entrance Surface Dose (ESD), and Fluoroscopy Time (FT).

Results. The findings reveal that pediatric CT doses at VUHSK are consistently below European DRLs, with reductions of up to 25 %, largely due to over a decade of ongoing patient exposure assessment and protocol optimization. Optimization efforts included adjustments to acquisition parameters. Despite the challenges of establishing separate local DRLs for each IR procedure due to limited sample sizes, age-based DRLs were developed to address the absence of routinely recorded patient weight.

Conclusions. This study highlights the importance of continuous research in dose optimization and the need for local DRLs, especially for pediatric interventional radiology. The findings demonstrate that individualized optimization is crucial for maintaining low radiation doses without compromising diagnostic quality, and that establishing local DRLs is an essential step in ensuring patient safety.

References

European Commission. (2018). European Guidelines on Diagnostic Reference Levels for Paediatric Imaging. Radiation Protection, 185. http://www.eurosafeimaging.org/wp/wpcontent/uploads/2018/09/rp_185.pdf

European Council Directive 2013/59/Euratom. (2013). On basic safety standards for protection against the dangers arising from exposure to ionizing radiation and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/ Euratom. OJ of the EU. 2014; L13; 57: 1–73.  

UNSCEAR 2020/2021. (2021). Sources, Effects and Risks of Ionizing Radiation. Report to gneral assembly, Vol. I.

Vañó, E., Miller, D.L., Martin, C.J. et al. (2017). ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging. Ann ICRP, 46(1), 1–144. https://doi.org/10.1177/0146645317717209