Radioprotection 2025, 60( 4), 297 – 305 © A. Boulanouar et al., Published by EDP Sciences, 2025 https:// doi. org / 10.1051 / radiopro / 2025008
Available online at: www. radioprotection. org ARTICLE
Diagnostic reference levels based on clinical indications for paediatric computed tomography examinations at the Mohammed VI University Hospital Center in Marrakech-Morocco
A. Boulanouar 1, 2, H. Khajmi 1,*, H. Jalal 3, 4 and A. Tounsi 2
1 Higher Institute of Nursing Professions and Health Technics, Marrakech, Morocco. 2 Environmental, Ecological and Agro-Industrial Engineering Laboratory, University Sultan Moulay Sliman, Béni Mellal, Morocco. 3 Faculty of Medicine and Pharmacy- Marrakech, Morocco. 4 Radiology Department of the Mother and Child Hospital of the Med VI UHC – Marrakech, Morocco.
Received: 4 September 2024 / Accepted: 7 March 2025
Abstract – The study aims to derive the diagnostic reference levels for children based on clinical indications( DRL CI) in the computed tomography( CT) unit of the mother and child hospital( MCH) at the Mohammed VI University Hospital Centre in Marrakech( Med VI UHC-M). We retrospectively collected dosimetric statistics from 1730 CTs of children across three age groups( 1 – 5 years, 5 – 10 years, and 10 – 15 years). Head, chest, abdomen-pelvis, and chest-abdomen-pelvis( CAP) CTs were the examinations studied. We have established 14 distinct clinical indications. For each indication, DRLs were defined as the median and third quartile values of the dose index CTDI vol and dose-length product DLP distributions. We analysed the calculated dose distributions between indications for each age group, using a non-parametric test to assess differences in DRLs. Statistical significance was defined at p < 0.01. We also compared our DRL CI with the published international standards. For head CT, the variability of CTDI vol and DLP was statistically significant between indications( p < 0.01). However, for chest, abdomen-pelvis, and CAP CTs, the difference was significant for CTDI vol( p < 0.01) and not significant for DLP( p > 0.01). DRL CI in terms of CTDI vol are in good agreement with the literature. The DRLs for the head trauma indication were lower than the results from Europe and Africa, but for the other indications, the DRLs CI were higher than the results from Europe and lower than the ones of Africa.
Keywords: CT / CTDIvol / DLP / DRL-Clinical indications( CI) / Paediatric
1 Introduction
In recent years, the increased use of multidetector CT( MDCT) in medical imaging has raised concerns within the scientific community. CT scans account for 71.3 % of the medical radiation dose( IRSN, 2014). MDCT exams may elevate the risk of developing cancer in children, who are more fragile and sensitive to radiation than adults( Pearce et al., 2012). In the United States, approximately 500 out of every 600,000 children may develop cancer as a result of CT scans( Brenner et al., 2001). Likewise, a large cohort study in Australia( Mathews et al., 2013) found that undergoing CT scans during childhood can lead to various types of cancer, including leukemia and brain tumors, and increases the overall cancer incidence by 24 %.
* Corresponding author: khajmi. hassan @ gmail. com
To minimize the risk of radiation exposure, the International Commission on Radiological Protection( ICRP) established three fundamental principles of radiation protection in its publication N ° 60: justification, limitation, and optimization( ICRP, 1991). Additionally, in publication N °. 73( ICRP, 1996), ICRP proposed the development of diagnostic reference levels as a tool for optimization of radiation doses in medical imaging. This recommendation was subsequently adopted in France starting in 2004( Roch et al., 2018).
Determining Diagnostic Reference Levels for children is more complex than for adults due to the wide variety of sizes among paediatric patients. However, many studies worldwide on paediatric CT imaging( Brisse et al., 2009; Roch et al., 2013; Shrimpton et al., 2000; Rehani et al., 2012) have established DRLs based on anatomical regions and age groups, in accordance with the recommendations of the ICRP( Vañó et al., 2017). Furthermore, several experts have defined DRL values for paediatric CT using weight bands( Célier et al., 2020; Watson et al., 2010; Strauss et al., 2017; Vassileva et al., 2015).
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