Diagnostic reference levels in paediatric fluoroscopy: how does a secondary referral centre compare with 2018 European guidelines?

2021 ◽  
pp. 20201269
Author(s):  
Emily Ashworth ◽  
Liam Woods ◽  
J Valmai Cook
Keyword(s):  
Age Groups ◽  
Ionising Radiation ◽  
Low Doses ◽  
Age Group ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Referral Centre ◽  
European Guidelines

Objectives: To compare diagnostic reference levels (DRLs) in paediatric fluoroscopy at a secondary referral centre with 2018 European guidelines. Secondly, to compare secondary referral centre DRLs for paediatric fluoroscopy examinations not included in European guidelines with 2010 national UK DRLs. Methods: Paediatric fluoroscopy studies were grouped by age (groups: 0, 1, 5, 10, 15 years) for examination type and analysed retrospectively, over a period of 14 years. DRLs were compared with European DRLs (micturating cystourethrograms (MCUs)) and 2010 UK national DRLs (contrast swallows and meals). Results: 1,586 studies were performed (49% MCUs; 31% meals; 9% swallows). For all age groups, DRLs for MCUs were lower than European DRLs by up to a factor 58 x (1 year age group: secondary referral centre DRL 12 mGycm2 vs European DRL 700 mGycm2). For contrast swallows and meals, 75th percentile doses were lower than 2010 UK national 25th percentile doses in all age groups. Conclusion: Maintaining low doses of ionising radiation is particularly important in paediatrics, and our study has found that it is possible to achieve low paediatric fluoroscopy doses in a secondary referral centre setting. Advances in knowledge: Our data may prove useful to other centres and could contribute towards future European DRLs.

scholarly journals Paediatric diagnostic reference levels for common radiological examinations using the European guidelines

2021 ◽  
Author(s):  
Anja Almén ◽  
Jónína Guðjónsdóttir ◽  
Nils Heimland ◽  
Britta Højgaard ◽  
Hanne Waltenburg ◽  
...  
Keyword(s):  
Data Collection ◽  
Age Groups ◽  
Age Group ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Actual Weight ◽  
European Guidelines ◽  
Number Of Patients ◽  
Weight Groups ◽  
Radiological Examinations

Objective: The purpose of this study was to explore the feasibility to determine regional diagnostic reference levels (RDRLs) for paediatric conventional and CT examinations using the European guidelines and to compare RDRLs derived from weight and age groups, respectively. Methods: Data were collected from 31 hospitals in 4 countries, for 7 examination types for a total of 2978 patients. RDRLs were derived for each weight and age group, respectively, when the total number of patients exceeded 15. Results: It was possible to derive RDRLs for most, but not all, weight-based and age-based groups for the seven examinations. The result using weight-based and age-based groups differed substantially. The RDRLs were lower than or equal to the European and recently published national DRLs. Conclusion: It is feasible to derive RDRLs. However, a thorough review of the clinical indications and methodologies has to be performed previous to data collection. This study does not support the notion that DRLs derived using age and weight groups are exchangeable. Advances in knowledge: Paediatric DRLs should be derived using weight-based groups with access to the actual weight of the patients. DRLs developed using weight differ markedly from those developed with the use of age. There is still a need to harmonize the method to derive solid DRLs for paediatric radiological examinations.

scholarly journals Local Diagnostic Reference Levels for Paediatric Head CT Procedures

2021 ◽  
Vol 28 (2) ◽  
pp. 13
Author(s):  
Birutė Gricienė ◽  
Monika Šiukšterytė
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Age Groups ◽  
Ionising Radiation ◽  
Dose Assessment ◽  
Published Data ◽  
Publication Date ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Head Ct

 Background. Patients, especially children, are exposed to substantially high doses of ionising radiation during computed tomography (CT) procedures. Children are several times more susceptible to ionising radiation than adults. Diagnostic reference levels (DRLs) are an important tool for monitoring and optimising patient radiation exposure from radiological procedures. The aim of this study is to estimate the ionising radiation exposure doses and set local DRLs for head CT examinations according to age and to compare local DRLs with national and European DRLs and with literature data in other countries.Materials and methods. Scan parameters of single-phase head CT examinations were collected. Patients were grouped by age in the following intervals: <1, 1−5, 5−10, 10−15 and 15−18 years. Local age-based DRLs set as the 3rd quartile of the median dose-length product (DLP) were calculated. Literature analysis was performed on PubMed search engine on inclusion criteria: publication date 2015–2020, used keywords paediatric computed tomography, paediatric CT, diagnostic reference levels (DRLs). The 23 articles discussing paediatric DRLs were further analysed.Results. Data was collected from 194 paediatric head CT examinations performed in 2019. The median DLP values for head CT were 144.3, 233.7, 246.4, 288.9, 315.5 for <1, 1−5, 5−10, 10−15 and 15−18 years old groups. Estimated local DRLs for head CT examinations are 170, 300, 310, 320, 360 mGy*cm for <1, 1−5, 5−10, 10−15 and 15−18 years age groups respectively and 130, 210, 275, 320 mGy*cm for 0−3 months, 3 months−1 year, 1−6 years and ≥ 6 years age groups respectively.Conclusions. Results of this study showed that settled new local DRLs of head CT examinations were 2–4 times lower than national DRLs and about 2 times lower than European DRLs. Moreover, the study indicated that paediatric head CT doses are significantly lower in comparison with those indicated in the majority of published data from other hospitals over the last 6 years. Patient dose assessment and local DRLs establishment plays important role in future exposure optimisation.

scholarly journals Pediatric Diagnostic Reference Levels for Diagnostic and Therapeutic Cardiac Catheterization in Japan

2021 ◽  
Author(s):  
Toru Ishibashi ◽  
Yasutaka Takei ◽  
Mamoru Kato ◽  
Yukari Yamashita ◽  
Atsuko Tsukamoto ◽  
...  
Keyword(s):  
Cardiac Catheterization ◽  
Pediatric Patients ◽  
Age Groups ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Air Kerma ◽  
Cardiac Angiography ◽  
Pediatric Cardiac Catheterization ◽  
One Year ◽  
Area Product

Abstract To propose Japanese national DRLs for air-kerma at the reference point (Ka,r), air-kerma area product (PKA), fluoroscopy time (FT), and number of cine images (CI) for four age groups. We posted a nationwide questionnaire to 132 facilities. Questions focused on identifying the procedure, age, weight, height, Ka,r, PKA, FT, and CI during diagnostic and therapeutic pediatric cardiac catheterization. For diagnostic cardiac angiography, the 75th percentile values were as follows; Ka,r: 103, 127, 194, and 351 mGy; PKA: 7.0, 12.3, 14.3, and 47.2 Gy.cm2; FT: 36.8, 30.7, 33.4, and 35.7 min; and CI: 2018, 2313, 2408, and 2016 images for less than one year, 1–5 years, 6–10 years, and 11–15 years respectively. For therapeutic cardiac angiography, the 75th percentile values were as follows: Ka,r: 146, 209, 130, and 501 mGy; PKA: 7.54, 16.0, 8.35, and 46.0 Gy.cm2; FT: 56.5, 52.0, 49.4, and 52.0 min; and CI: 4075, 4514, 3576, and 5984 images for less than one year, 1–5 years, 6–10 years, and 11–15 years respectively. Our survey of diagnostic and therapeutic cardiac catheterization in Japanese pediatric patients showed that all age-based Japanese 75th percentiles for the Ka,r, PKA, FT, and CI were higher than in other surveys. Based on the result of our study, it is necessary to establish DRLs for pediatric cardiac catheterization examinations in Japan, in order to optimize the safety of pediatric protocols for diagnostic and therapeutic cardiac catheterization.

AVERAGE GLANDULAR DOSES AND NATIONAL DIAGNOSTIC REFERENCE LEVELS IN MAMMOGRAPHY EXAMINATIONS IN TURKEY

2020 ◽  
Vol 190 (1) ◽  
pp. 100-107
Author(s):  
Aydın Parmaksız ◽  
Gökçe K Ataç ◽  
Emine Bulur ◽  
Tolga İnal ◽  
Aslıhan Alhan
Keyword(s):  
Age Groups ◽  
Skin Dose ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
The Third ◽  
Air Kerma ◽  
Entrance Skin Dose ◽  
Breast Thickness

Abstract In order to establish national diagnostic reference levels for mammography examinations, entrance skin air kerma, entrance skin dose and average glandular doses (AGDs) were calculated for a total of 25 624 cranio-caudal (CC) and mediolateral oblique (MLO) projections of 6309 patients for 40–49 and 50–64 age groups. The average entrance skin air kerma and entrance skin dose values for both age groups were found to be higher in MLO projections compared with CC projections. The minimum and maximum values of AGDs were determined as 0.4 and 7.9 mGy for both projections. The maximum numbers of AGDs for CC and MLO projections were calculated in the range of 1.1–1.5 and 1.6–2.0 mGy, respectively. The third quartile values of AGDs were calculated for each compressed breast thickness between 20 and 99 mm. The first national diagnostic reference levels of the country were established for each 10-mm compressed breast thickness in mammography examinations.

NATIONAL DIAGNOSTIC REFERENCE LEVELS AND ACHIEVABLE DOSES FOR 13 ADULT CT PROTOCOLS AND A PAEDIATRIC HEAD CT PROTOCOL: NATIONAL SURVEY OF KOREAN HOSPITALS

2019 ◽  
Vol 187 (2) ◽  
pp. 220-229
Author(s):  
Jung Su Kim ◽  
Sang Kyung Lee ◽  
Sun-Ki Kim ◽  
Seung-Min Yoo ◽  
Jung Min Kim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
National Survey ◽  
Age Group ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Head Ct ◽  
Brain Ct ◽  
Ct Protocol

Abstract To develop a second set of diagnostic reference levels (DRLs) and achievable doses (ADs) for 13 adult computed tomography (CT) protocols and a paediatric head CT protocol in Korea. A survey of 13,625 CT examinations was performed based on 13 adult CT protocols and a paediatric non-contrast brain CT protocol using 369 CT systems, with patients grouped according to age. Most CT protocols in this survey had DRLs similar to those reported in other countries. However, chest and abdomen-pelvic CT had lower DRLs than those reported in the first Korean national survey and those from other countries. Paediatric non-contrast brain CT in each age group, with the exception of the 11–15-year age group, had lower DRLs than those reported in other countries. The DRLs presented here are similar to (or lower than for some protocols) those reported in the first Korean national survey and those from other countries.

scholarly journals Diagnostic reference levels for paediatric computed tomography

2015 ◽  
Vol 19 (2) ◽  
Author(s):  
Zakariya Vawda ◽  
Richard Pitcher ◽  
John Akudugu ◽  
Willem Groenewald
Keyword(s):  
Computed Tomography ◽  
Age Groups ◽  
Ct Scanning ◽  
Ct Scans ◽  
Tertiary Level ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Dose Length Product ◽  
Head Ct ◽  
Institutional Review

Objectives: To establish local diagnostic reference levels (LDRLs) for emergency paediatric head computed tomography (CT) scans performed at a South African (SA) tertiary-level hospital and to compare these with published data.Materials and methods: A retrospective analysis was conducted of volume-based CT dose index (CTDIvol) and dose length product (DLP) data from uncontrasted paediatric head CT scans performed in the Trauma and Emergency Unit of a tertiary-level SA hospital from January to June 2013. A random sample of 30 patients in each of 3 age groups (0–2, >2–5 and >5–10 years) was used. LDRL values were compared with several national DRLs from Europe and Australia. Results: Mean CTDIvol and DLP values were: 30 mGy and 488 mGy.cm for the 0–2 years age group; 31 mGy and 508 mGy.cm for the >2–5 years group, and 32 mGy and 563 mGy.cm for the >5–10 years group, respectively. The mean DLP for 0–2 year-olds was the only parameter outside the range of corresponding published reference data. Stratification into narrower age groupings showed an increase in DLP values with age. Conclusion: An institutional review of the head CT scanning technique for emergency studies performed on children less than 2 years of age is recommended. The current study highlights the role of LDRLs in establishing institutional dosimetry baselines, in refining local imaging practice, and in enhancing patient safety. Standard age stratification for DRL and LDRL reporting is recommended.

Local diagnostic reference levels in children’s CT examinations according to the new european guidelines

2016 ◽  
Vol 32 ◽  
pp. 261
Author(s):  
Makri Triantafyllia ◽  
Tsilimidou Artemis ◽  
Syrgiamiotis Vasilis ◽  
Xatzigiorgi Christiana
Keyword(s):  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
European Guidelines

The Effect of Collagen Mediated Platelet Release on Plasma Prekallikrein Activation

1984 ◽  
Vol 51 (01) ◽  
pp. 037-041 ◽  
Author(s):  
K M Weerasinghe ◽  
M F Scully ◽  
V V Kakkar
Keyword(s):  
Platelet Aggregation ◽  
Healthy Volunteers ◽  
Platelet Rich Plasma ◽  
Age Groups ◽  
Inhibitory Effect ◽  
Age Group ◽  
Platelet Factor ◽  
Activated Platelets ◽  
Platelet Release ◽  
Collagen Treatment

SummaryCollagen mediated platelet aggregation caused -5.6 ± 6.7% inhibition and +39.1 ± 15.2% potentiation of prekallikrein activation in plasma from normal healthy volunteers between 20–40 and 50–65 years of age, respectively (n = 15, p <0.01). The amouns of platelet factor-four (PF4) released in the two groups were not significantly different. Collagen treatment in the presence of indomethacin caused +11.5 ± 3.6% and +59.6 ± 19.5% potentiation in the 20–40 and 50–65 age groups respectively (p <0.02). Adrenaline mediated platelet aggregation caused -55.2 ± 7.1% and -35.2 ± 8.3% inhibition in the 20–40 and 50–65 age groups, respectively. Collagen treatment of platelet-deficient-plasma and platelet-rich-plasma in EDTA also caused potentiation of prekallikrein activation.The results indicate that the observed degree of prekallikrein activation after platelet aggregation is a net result of the inhibitory effect of PF4 and the potentiatory effect of activated platelets. The potentiatory effect was greater after collagen treatment as compared to adrenaline treatment, and in the 50–65 age group as compared to the 20–40 age group.

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