Local diagnostic reference levels for Common Paediatric Imaging Studies at a General Public Hospital in Malta

Abstract

Background: DRLs are advisory guidance levels that should be used by regional, national and local healthcare organizations. The establishment of NDRLs are a statutory obligation required by EU directive 97/43/Euratom and in Malta by legal Notice 44/2003. Objectives: a) To measure appropriate dose monitoring quantities for projection radiography of the chest, Micturating Cystourethrogram, Barium Swallow fluoroscopy and CT examinations of head and abdomen in a major public hospital in Malta, b) To establish paediatric local DRL (LDRL) for these examinations, c) To compare the LDRL with NDRL from European states and European DRLs (EDRL). Research Design: Dose data was collected and analysed for correlations with anthropomorphic data. LDRL were set as mean KAP for chest radiographs, mean CKAP for fluoroscopy and mean DLP and CTDIvol for CT . Results: a) For chest radiography, LDRL ranged between 10 and 26 mGycm2 for four different age groups. b) For fluoroscopy LDRL were established for one age group (mean CKAP = 158mGycm2). c) For CT head, DLP ranged between 177 and 418 mGycm, and for abdomen between 47 and 553 mGycm. CTDIvol ranged between 15mGy and 52mGy for head and 3 and 13mGy for abdomen respectively. LDRLs were established for four age groups. Conclusions and recommendations: LDRL were lower or matched NDRL from other European countries. This indicates good practice especially for MCUG and CT. However further optimization is essential for chest radiographs. The LDRL should be considered as provisional and the process should be repeated with a bigger sample of patients.