Challenges and solutions in establishing paediatric DRLs for scoliosis radiography

Congress:

EuroSafe Imaging 2019

Poster Number:

ESI-0037

Type:

EuroSafe Imaging

Keywords:

Action 2 - Clinical diagnostic reference levels (DRLs), Action 6 - Clinical audit tool for imaging, Action 7 - Radiation protection of children, Paediatric, Plain radiographic studies, Radiation safety, Quality assurance

Authors:

R. Seuri, A. Rintala, M. Kortesniemi, A. Lajunen, S. Savolainen

DOI:

10.26044/esi2019/ESI-0037

DOI-Link:

https://dx.doi.org/10.26044/esi2019/ESI-0037

Fig. 1: Whole spine radiography for scoliosis.

Fig. 2: Wide variation was observed in dose levels between institutions, but in some...

Fig. 3: There was no significant variation with the use of either patient weight,...

Fig. 4: Example of the Exel table of DRL-curve for paediatric body CT. stuk.fi.

Background/introduction

Scoliosis Scoliosis is usually diagnosed and followed by measuring the Cobb angle form whole spine radiography Repeated radiographies during the growth are frequent in the follow-up Scoliosis and Diagnostic Refrence Levels (DRLs) No DRLs published for scoliosis radiography Patient weight is the recommended quantity for patient size (EC, ICRP), though also BMI and body thickness have been used Small overall numver of paediatric patients is a challenge for the use of DRLs: *When weight/age groups are used, minimum of 10 patients need to be collected...

Description of activity and work performed

Dose collection frominstitutions in Finland 5 university hospitals (UH), 7 central hospitals (CH) All patients under 17 years of age with scoliosis radiography PA or PA+LAT Results Alltogether 305 patients with scliosis PA radiography Only 64 patients also had a LAT image 9 units with DR, 1 with CR, 1 with fluoroscopy technique Variation in dose levels Up to 10 fold variation between institutions Lower doses mostly in the university hospitals *larger number of patients (helps optimization) *dedicated paediatric radiology units with paediatric radiology specialists...

Conclusion and recommendations

Challenges in establishing DRLs for scoliosis Variation of patient sizes: weight, thickness ... Great variation in dose levels *different techniques (DR, CR, fluoroscopy) *variation in the use of grid *variation in the use of AEC / fixed parameters by age or weight Solution: DRL-curve model To overcome problems concerning traditional DRL values in paediatric examinations (low number of patients in different size groups) a DRL curve was calculated An exponential DRL curve was fitted so that approximately 75% of the data points were below the...

Personal/organisational information

Raija Seuri, Paediatric radiologist, HUS Medical Imaging, New Children´s Hospital, Helsinki, Finland Anna Rintala, Medical physicist, Helsinki University, Finland Mika Kortesniemi, Chief medical physicist, HUS Medical Imaging, Helsinki, Finland Atte Lajunen, Inspector, Radiation and Nuclear Safety Authority STUK, Finland Sauli Savolainen, Prof, Helsinki University, Finland

References

European guidelines on diagnostic reference levels for paediatric imaging; EC Publications 2018 Diagnostic reference Levels in Medical Imaigng; ICRP Publication 135 2017 Patient doses in paediatric CT: feasibility of setting diagnostic reference levels; Rad Prot Med 2011 Diagnsotic reference levels for thorax x-ray examinations of paediatric patients; BJR 2006