Radioprotection 2026, 61( 2), 113 – 120 © A. El Khatib et al., Published by EDP Sciences 2026 https:// doi. org / 10.1051 / radiopro / 2025029
Available online at: www. radioprotection. org
ARTICLE Establishment of local diagnostic reference level for computed tomography angiography in Morocco
A. El Khatib 1, M. Tahiri 2, R. El Baydaoui 2, M. El Kafhali 3, I. Bouadel 4, T. Oubaddi 5, A. Halimi 1, A. Yassir 6 and M. Mkimel 2,*
1 Hassan First University of Settat, Laboratory health sciences and technologies, Higher Institute of Health Sciences, Settat, Morocco. 2 Sciences and Engineering of Biomedicals, Biophysics and Health Laboratory, Higher Institute of Health Sciences, Hassan First
University, Settat 26000, Morocco. 3 Physical Sciences and Engineering, Innovative Research and Applied Physics( IRAP), Faculty of Sciences, Moulay Ismail University, Meknes, Morocco. 4 LPHE-Modeling and Simulations, Faculty of Science, Mohammed V University in Rabat, Rabat, Morocco. 5 Emergency Radiology Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco. 6 LIS, Faculty of science Ain Chock, Casablanca 20100, Morocco.
Received: 22 December 2024 / Accepted: 18 August 2025
Abstract – Objective: To establish local diagnostic reference levels( LDRLs) for computed tomography angiography( CTA) examinations in Morocco. Methods: Data were collected from 2283 adult patients undergoing CTA scans across four hospitals in Morocco, covering examinations of the upper limb, brain, carotid arteries, pulmonary arteries, abdominal aorta, total aorta, and lower limb. CTDI vol and DLP were recorded and analyzed. The 75 th percentile values were determined as local DRLs. Results: For Hospital A, the LDRLs( CTDI vol and DLP) for upper limb, brain CTA, carotids, pulmonary arteries, abdominal aorta, total aorta, and lower limb were 16.05 mGy and 1059.81 mGy cm, 26.1 mGy and 1370.48 mGy cm, 13.95 mGy and 1303.85 mGy cm, 3.18 mGy and 321.38 mGy cm, 9.69 mGy and 1453.79 mGy cm, 5.12 mGy and 1346.47 mGy cm, and 7.49 mGy and 600.3 mGy cm, respectively. Hospital B had higher DRLs due to more scan phases. Hospital C’ s LDRLs for carotids, pulmonary arteries, abdominal aorta, total aorta, and lower limb were 9.07 mGy and 819.49 mGy cm, 11.52 mGy and 487.56 mGy cm, 9.41 mGy and 1018.17 mGy cm, 10.74 mGy and 1860.74 mGy cm, and 9.4 mGy and 860.98 mGy cm, respectively. Hospital D, the LDRLs for carotids, pulmonary arteries, and lower limb were 5.98 mGy and 596 mGy x cm, 3.87 mGy and 357 mGy cm, and 6.53 mGy and 724 mGy cm, respectively. Conclusion: Moroccan LDRLs generally have lower CTDI vol but higher DLP values, primarily due to more scan phases used. More efforts are needed to optimize radiation dose during vascular CT examinations.
Keywords: Dosimetry / Computed Tomography / Optimization / DLP / CTDI vol
1 Introduction
Computed tomography( CT) is a powerful diagnostic tool that provides high-quality 3D images, enabling fast and accurate diagnoses. As a specific technique, computed tomography angiography( CTA) uses an intravenous contrast medium to non-invasively produce detailed images of blood vessels, which are used to diagnose a wide range of vascular conditions, such as aneurysms, stenosis, and pulmonary embolism. It also aids interventional radiologists and surgeons during endovascular interventions or surgical procedures( Foley and Karcaaltincaba, 2003).
* Corresponding author: mounir. mkimel @ uhp. ac. ma
The technological advancements in CTA, such as enhanced spatial resolution and reduced scanning durations, have augmented its demand and broadened its clinical applications( Kumamaru et al., 2010), offering reduced invasiveness and potentially obviating the necessity for surgical intervention while providing accurate diagnostic results( Tins et al., 2001). Despite its advantages, the extensive use of this technology raises concerns about inappropriate applications and unwarranted patient radiation exposure( Hall and Brenner, 2012). The increased use of CT scans has raised concerns about patient dose and radiation exposure. While providing valuable diagnostic information, CT imaging contributes a substantial portion of the collective effective dose from medical procedures, with reports suggesting it may account for almost half of the total radiation exposure in the United
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