Radiation Dose in Pediatric X-ray Exams

The radiation protection agencies of Iceland, Norway, Sweden, and Denmark have issued regional diagnostic reference levels for X-ray examinations and CT scans of children. The reference levels are based on radiation dose data collected in 2018 – 2019.

The regional diagnostic reference levels can be found in two articles:

In Paediatric diagnostic reference levels for common radiological examinations using the European guidelines, the regional diagnostic reference levels are presented in a standard format, in accordance with European guidelines (European guidelines on diagnostic reference levels for paediatric imaging). Regional diagnostic reference levels are presented for X-ray examinations of the lungs, abdomen, hips, and pelvis, as well for CT scans of the head, thorax, and abdomen.

It was also demonstrated that it is of considerable importance whether radiation dose reference levels are based on the weight of children or their age, but recent guidelines recommend basing it on the weight of the child rather than age when adapting research to the size of the child and also setting radiation dose reference levels for weight categories rather than age categories.

Radiation dose reference levels should be used to direct attention where improvements are most needed. They are set at the upper quartile of radiation doses, and where typical radiation doses exceed the reference level, appropriate measures should be taken (seeking explanations and reducing doses if possible).

In Establishing paediatric diagnostic reference levels using reference curves – A feasibility study including conventional and CT examinations, the same regional references are presented in line charts, which may be more suitable to use where there are few studies. In order to obtain a statistically significant comparison with radiation dose standards, at least 20 patients per study and weight category are needed, but if line charts are used, it should be sufficient to have 20 patients in total (children of all sizes) for each study.

Further info:

Anja Almén, Jónína Guðjónsdóttir, Nils Heimland, Britta Højgaard, Hanne Waltenburg, and Anders Widmark. Paediatric diagnostic reference levels for common radiological examinations using the European guidelines. The British Journal of Radiology. Published Online: 13 Dec 2021 https://doi.org/10.1259/bjr.20210700

Anja Almén, Jónína Guðjónsdóttir, Nils Heimland, Britta Højgaard, Hanne Waltenburg, Anders Widmark. Establishing paediatric diagnostic reference levels using reference curves – A feasibility study including conventional and CT examinations. Physica Medica, Volume 87, 2021, Pages 65-72, ISSN 1120-1797. https://doi.org/10.1016/j.ejmp.2021.05.035.

European Commission, Directorate-General for Energy, European guidelines on diagnostic reference levels for paediatric imaging, Publications Office, 2018, https://data.europa.eu/doi/10.2833/003998