Establishment of Local Diagnostic Reference Levels for Pediatric Head CT at a South African Tertiary Hospital

Authors

  • Mpumelelo Nyathi Sefako Makgatho Health Sciences University image/svg+xml
    • Autherlia Dimpho Rinkie Mosiame Sefako Makgatho Health Sciences University image/svg+xml

      DOI:

      https://doi.org/10.15392/2319-0612.2026.3059

      Keywords:

      pediatric CT, radiation dose optimization, dose length product (DLP), computed tomography

      Abstract

      Computed tomography (CT) provides rapid, high-resolution 3D imaging, reducing motion artifacts and the need for sedation in pediatric patients. However, children are highly sensitive to ionizing radiation due to their developing tissues and longer life expectancy. This study proposed local diagnostic reference levels (LDRLs)) for pediatric head CT examinations at a South African (SA) tertiary hospital. A retrospective review was conducted for pediatric head CT dose length product (DLP) and volume computed tomography dose index (CTDIvol) data acquired between January 2023 and March 2024. Examinations were stratified into four age groups: <1 year, 1 – <5 years, 5 – < 10 years, and 10 – 15 years. For each group, median DLP and CTDIvol values were calculated as LDRLs and then compared with international values. Proposed LDRLs in terms of DLP (mGy.cm) were 242.6; 405.5;715.5 and 899.3 while in terms of CTDIvol (mGy) were: 13.8; 15.8; 26.0 and 38.7 respectively for <1 year; 1 – <5 years; 5 – <10 years and 10 – 15 years age groups. The DLP for SA (242.6) exceeded Brazilian (143.8) but was lower than Nigerian (1040.0) for <1-year group. For 1 – <5 years, the DLP for SA (405.5) was lower than Nigerian (988.0), yet higher than Iranian (216.9). For 5 – <10-year group, the DLP for SA (715.5) exceeded Iranian (232.8) but remained lower than Nigerian (1493.0). For 10 – 15-year group, the DLP for SA (899.3) surpassed Omani (391.0) and Brazilain (531.7) but remained lower than Nigeriain (1824.0). In case of CTDIvol (mGy) for <1-year group, SA (13.8) value exceeded Brazilian (8.8) and Omani (13.0) values. For 1 – <5 years, SA (15.8) value remained lower than Saudi Arabian (22.0) value. For 5 – < 10 years, the SA (26.0) value exceeded the Omani (19.0) value but remained lower than Saudi Arabian (29.0). For the 10 – 15 years the SA (38.7) value exceeded the Brazilian (26.9) and Omani (21.0) values but remained lower than the Irish (52.1) value. Pediatric CT doses at the proposed South African tertiary hospital fall within global ranges. However, higher values in the <1, 5 – <10, and 10 – 15-year groups compared to some international values indicate room for possible optimization.

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      References

      [1] IMPACTSCAN. CT History. [S. l.]: Impactscan, [s. d.]. Disponível em: http://www.impactscan.org/CThistory.htm. Acesso em: 6 ago. 2023.

      [2] GRICIENE, B. B.; SIUKSTERYTE, M. Local Diagnostic Reference Levels for Paediatric Head CT Procedures. Acta Medica Lituanica, Lithuania, v. 28, n. 2, p. 253-261, 2021. DOI: https://doi.org/10.15388/Amed.2021.28.2.13

      [3] MAHARJAN, S. et al. Knowledge of Radiation Protection among Radiology Professionals and Students: A medical college-based study. European Journal of Radiology Open, Netherlands, v. 7, p. 100287, 2020. DOI: https://doi.org/10.1016/j.ejro.2020.100287

      [4] CÉLIER, D. et al. Multicentre survey on patient dose in paediatric imaging and proposal for updated diagnostic reference levels for France. Part 1: Computed Tomography. European Radiology, Austria, v. 30, n. 2, p. 1156–1165, 2020. DOI: https://doi.org/10.1007/s00330-019-06405-3

      [5] DORFMAN, A. L.; FAZEL, R.; EINSTEIN, A. J. [Artigo sem título impresso]. Archives of Pediatrics & Adolescent Medicine, Chicago, IL, v. 165, n. 5, p. 458-464, 2011. DOI: https://doi.org/10.1001/archpediatrics.2010.270

      [6] YOSHIDA, K. et al. Changes in radiological imaging frequencies in children before and after the accident at the Fukushima Daiichi Nuclear Power Plant in Fukushima Prefecture, Japan. Japanese Journal of Radiology, Japan, v. 33, n. 10, p. 619–626, 2015. DOI: https://doi.org/10.1007/s11604-015-0464-8

      [7] ICRP. International Commission on Radiological Protection. Radiological Protection and Safety in Medicine: ICRP publication 73. Annals of the ICRP, Oxford, v. 26, n. 2, p. 1–4, 1996. DOI: https://doi.org/10.1016/S0146-6453(00)89195-2

      [8] ALREHILY, F. Diagnostic reference levels in radiographic and CT examinations in Saudi Arabia: A systematic Review. Radiation Protection Dosimetry, Oxford, v. 198, n. 19, p. 1451-1461, 2022. DOI: https://doi.org/10.1093/rpd/ncac183

      [9] AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE. The measurement, reporting, and management of radiation dose in CT: Report no. 96. College Park: AAPM, 2008. p. 1-96.

      [10] AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE. Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations: Report no. 204. College Park (MD): AAPM, 2011.

      [11] AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE. Use of water equivalent diameter for calculating patient size and size-specific dose estimates (SSDE) in CT: Report no. 220. College Park (MD): AAPM, 2014.

      [12] AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE. The use of size-specific dose estimate (SSDE) for CT dose optimization and monitoring: Report no. 293. College Park (MD): AAPM, 2019.

      [13] ABDOU, S. E. et al. National Diagnostic reference levels for pediatric computed tomography in Egypt. Radiation Protection Dosimetry, United Kingdom, v. 198, n. 70, p. 423-433, 2022. DOI: https://doi.org/10.1093/rpd/ncac069

      [14] ICRP. International Commission on Radiological Protection. Diagnostic reference levels of medical imaging: ICRP publication 135. Annals of the ICRP, Oxford, v. 46, n. 1, p. 1–144, 2017. DOI: https://doi.org/10.1177/0146645317717209

      [15] TREIER, R. et al. Patient Doses in CT Examinations in Switzerland: Implementation of National Diagnostic Reference Levels. Radiation Protection Dosimetry, United Kingdom, v. 142, n. 2-4, p. 244-254, 2010. DOI: https://doi.org/10.1093/rpd/ncq279

      [16] PLOUSSI, A. et al. Local diagnostic reference levels in pediatric CT examinations: a survey at the largest children’s hospital in Greece. The British Journal of Radiology, United Kingdom, v. 1116, n. 93, p. 20190358, 2019. DOI: doi.org. DOI: https://doi.org/10.1259/bjr.20190358

      [17] VASSILEVA, J.; REHANI, M. Diagnostic reference levels. AJR. American Journal of Roentgenology, v. 204, n. 1, p. W1–W3, 2015. DOI: https://doi.org/10.2214/AJR.14.12794

      [18] VAN DER MERWE, C. M.; MAHOMED, N. An audit of radiation doses received by pediatric patients undergoing computed tomography investigations at academic hospitals in South Africa. SA Journal of Radiology, Africa, v. 24, n. 1, p. 1823, 2020. DOI: https://doi.org/10.4102/sajr.v24i1.1823

      [19] MOHAMMADBEIGI, A. et al. Local DRLs for pediatric CT examinations based on size-specific dose estimates in Kermanshah, Iran. Radiation Protection Dosimetry, United Kingdom, p. 1-11, 2019. DOI: https://doi.org/10.1093/rpd/ncz056

      [20] GUIMARAES, A. et al. In vivo measurements in pediatric computed tomography with TLD: A correlation between CDTI values. Radiation Measurements, England, v. 177, p. 107275, 2024. DOI: https://doi.org/10.1016/j.radmeas.2024.107275

      [21] BOUCHAREB, Y. et al. Establishing Diagnostic Reference Levels for Paediatric CT Imaging: A Multi-Centre Study. Healthcare, Basel, Switzerland, v. 13, p. 1728, 2025. Disponível em: doi.org. DOI: https://doi.org/10.3390/healthcare13141728

      [22] MUHAMMAND, N. A. et al. Diagnostic reference Levels of Radiation Dose and Image Quality among Pediatric CT Examinations in A Tertiary Hospital in Malaysia. Diagnostics, Basel, Switzerland, v. 10, p. 591, 2020. DOI: https://doi.org/10.3390/diagnostics10080591

      [23] RAWASHDEH, M. et al. Diagnostic reference levels for paediatric CT in Jordan. Journal of Radiological Protection, United Kingdom, v. 39, n. 4, p. 1060, 2019. DOI: https://doi.org/10.1088/1361-6498/ab3ee2

      [24] EKPO, E. U.; ADEJOH, T.; ERIM, A. E. Dose benchmarks for paediatric head computed tomography examination in Nigeria. Radiation Protection Dosimetry, v. 185, n. 4, p. 464-471, 2019. DOI: https://doi.org/10.1093/rpd/ncz036

      [25] ALHAILIY, A. et al. Reporting Diagnostic Reference Levels for Paediatric Patients Undergoing Brain Computed Tomography. Tomography, Basel, Switzerland, v. 9, n. 6, p. 2029-2038, 2023. DOI: https://doi.org/10.3390/tomography9060159

      [26] RAWASHDEH, M. et al. A new approach to dose reference levels in pediatric CT: Age and size-specific dose estimation. Radiation Physics and Chemistry, v. 205, p. 110698, 2022. DOI: doi.org. DOI: https://doi.org/10.1016/j.radphyschem.2022.110698

      [27] HAMAD, M. S. A. et al. Assessment of diagnostic reference levels for pediatric cardiac patients computed tomography in accordance with European guidelines. Radiation and Environmental Biophysics, Germany, v. 62, n. 2, p. 331-338, 2023. DOI: https://doi.org/10.1007/s00411-023-01031-6

      [28] KANAL, K. M. US Diagnostic Reference Levels and Achievable Doses for 10 Pediatric Examinations. Radiology, v. 300, n. 1, p. 1-11, 2021. DOI: https://doi.org/10.1148/radiol.2021211241

      [29] STRAUSS, K. J. et al. Radiation dose for pediatric CT versus adult imaging facility. Radiology, Netherlands, v. 291, n. 1, p. 158-167, 2019. DOI: https://doi.org/10.1148/radiol.2019181753

      [30] XU, H. et al. Results and analysis of examination doses for paediatric CT procedures based on a nationwide survey in China. European Radiology, Austria, v. 34, n. 3, p. 1659-1666, 2024. DOI: https://doi.org/10.1007/s00330-023-10005-7

      [31] ALMUQBIL, N. et al. Precision in Practice: Clinical Indication-Specific DRLs for Head CT for Advanced Personalised Dose Benchmarking. Diagnostics, Basel, Switzerland, v. 15, p. 1849, 2025. Disponível em: https://doi.org/10.3390/diagnostics15151849. DOI: https://doi.org/10.3390/diagnostics15151849

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      Published

      2026-06-19

      Data Availability Statement

      Raw data is available from the author at a reasonable request

      Issue

      Vol. 14 No. 2 (2026)

      Section

      Original Articles

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      Copyright (c) 2026 Mpumelelo Nyathi, Autherlia Dimpho Rinkie Mosiame

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