Abstract
CT scans are powerful tools used in the care of pediatric patients daily. Yet the increased use of CT warrants careful monitoring. This article defines diagnostic reference levels and how they can be used to guide practice. Once a facility has adapted its techniques and protocols to fall within diagnostic reference levels or target values, the facility can expand its quality-improvement efforts to include a new concept, diagnostic reference ranges (DRRs). DRRs take into account the subjective image quality of the examination and provide a minimum estimated patient dose, below which accurate interpretation of an image might be difficult, and an upper estimated dose, above which the patient dose may be higher than necessary. This paper also describes how the American College of Radiology Dose Index Registry can be used by a facility as a continuous quality improvement tool to monitor and manage appropriate patient dose.
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References
Foley SJ, McEntee MF, Rainford LA (2012) Establishment of CT diagnostic reference levels in Ireland. Br J Radiol 85:1390–1397
Schauer DA, Linton OW (2009) National council on radiation protection and measurements report shows substantial medical exposure increase. Radiology 253:293–296
Miglioretti DL, Johnson E, Williams A et al (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 167:700–707
Brenner DJ, Hall EJ (2007) Computed tomography — an increasing source of radiation exposure. N Engl J Med 357:2277–2284
ICRP (1991) 1990 Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann. ICRP 21 (1–3)
Teunen D (1998) The European directive on health protection of individuals against the dangers of ionising radiation in relation to medical exposures (97/43/EURATOM). J Radiol Prot 18:133–137
Kiljunen T, Jarvinen H, Savolainen S (2007) Diagnostic reference levels for thorax X-ray examinations of pediatric patients. Br J Radiol 80:452–459
Goske MJ, Strauss KJ, Coombs LP et al (2013) Diagnostic reference ranges for pediatric abdominal CT. Radiology 268:208–218
ICRP (1996) Radiological Protection and Safety in Medicine. ICRP Publication 73. Ann. ICRP 26 (2)
Gray JE, Archer BR, Butler PF et al (2005) Reference values for diagnostic radiology: application and impact. Radiology 235:354–358
Smith-Bindman R, Lipson J, Marcus R et al (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086
Shrimpton PC, Wall BF (2000) Reference doses for paediatric computed tomography. Radiat Prot Dosimetry 90:249–252
Boone JM, Strauss KJ, Cody D et al (2011) Size specific dose estimates (SSDE) in pediatric and adult body CT examinations. Report of AAPM Task Group 204. American Association of Physicists in Medicine, College Park, MD
Li X, Samei E, Segars WP et al (2011) Patient-specific radiation dose and cancer risk for pediatric chest CT. Radiology 259:862–874
Muhogora WE, Ahmed NA, Alsuwaidi JS et al (2010) Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiat Prot Dosimetry 140:49–58
Committee H-4 on the Nationwide Evaluation of X-Ray Trends (NEXT) of the Conference of Radiation Control Program Directors (CRCPD) (2000) Protocol for survey of computed tomography (CT). Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH), Rockville, MD
McCollough C, Branham T, Herlihy V et al (2011) Diagnostic reference levels from the ACR CT accreditation program. J Am Coll Radiol 8:795–803
American College of Radiology (2013) CT accreditation program requirements. http://www.acr.org/~/media/ACR/Documents/Accreditation/CT/Requirements.pdf%20Accessed%2017%20December%202013. Accessed 29 April 2014
Linet MS, Kim KP, Rajaraman P (2009) Children's exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol 39:S4–26
Hricak H, Brenner DJ, Adelstein SJ et al (2011) Managing radiation use in medical imaging: a multifaceted challenge. Radiology 258:889–905
Golding SJ (2010) Radiation exposure in CT: what is the professionally responsible approach? Radiology 255:683–686
Coombs LP (2008) Powerpoint presentation ACR Dose Index Registry. American Board of Radiology Radiation Safety Summit. http://www.theabr.org/the_abr/sites/all/themes/abr-media/pdf/coombs.pdf. Accessed 18 Dec 2013
American College of Radiology (2011) ACR launches dose index registry. http://www.eurekalert.org/pub_releases/2011-05/acor-ald051211.php. Accessed 18 Dec 2013
The American Board of Radiology (2013) MOC: maintenance of certification: what is MOC? http://www.theabr.org/moc-landing. Accessed 18 Dec 2013
American College of Radiology (2012) ACR Dose Index Registry: ABR PQI project description. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/NRDR/DIR/DIR_ABR_PQI_Description.pdf. Accessed 18 Dec 2013
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Dr. Goske has no financial interests, investigational or off-label uses to disclose.
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Goske, M.J. Diagnostic reference ranges and the American College of Radiology Dose Index Registry: the pediatric experience. Pediatr Radiol 44 (Suppl 3), 506–510 (2014). https://doi.org/10.1007/s00247-014-3030-0
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DOI: https://doi.org/10.1007/s00247-014-3030-0