Radiation protection is of utmost importance in our hospital, having as consequence our recognition as a Eurosafe 5-star hospital by the European Society of Radiology.  For this reason, the Medical Physics department in collaboration with the Radiology Department put a lot of effort in order to continuously improve the staff’s skills and knowledge in terms of radiation protection. Though paediatric patients are not routinely admitted in our hospital, still actions have been undertaken in order to increase the awareness of the healthcare professionals on paediatric radiation protection related issues.

For this purpose, our initial action was the conduction of a literature review on the radiation doses that children receive during radiological examinations such as radiography, fluoroscopy and CT examinations. This review helped in understanding the important issues that need to be considered in justification as well as in optimization.

A. Regarding optimization we reviewed the existing guidelines and data regarding the establishment of paediatric DRLs. This review helped us in identifying the challenges and the existing limitations in this important topic. This effort contributed to deeply understand:

• The necessity for establishing DRLs in paediatric diagnostic and interventional radiology and cardiology

• That systematic excess of DRLs indicates wrong practices and lack of experienced and trained staff.

• That the establishment of paediatric DRLs is a challenge, as the number of patients is usually small and has to be further subdivided in different age/weight groups. 

• That most of the studies have been performed before the recent recommendations, without using a single methodology, leading to an incapability of comparing the dose data between different centers or countries.

• That the recently published recommendations propose the establishment of DRLs based on clinical indication.

The result of this review was the creation of two articles relevant to this issue, the one already published in a national paediatric journal [5] and the other currently being under review by a national radiology journal.

B. Regarding justification, we performed a literature review in order to identify the main clinical indications that lead to high CT radiation doses in children.

This effort contributed to deeply understand:

• Which are the main clinical indications that lead to high radiation doses to children

• The importance of justification, as nowadays children with cancer or genetic disorders undergo many CT examinations during their lifetime. Taking into account that life expectancy is continuously growing, the high radiation doses from radiological examinations could possibly lead to high effective doses and therefore to a probably high radiation-induced cancer risk.

The result of this effort was the presentation of two studies, the one in a National and the other in a European Conference [6,7]. The presentation in the European Conference was selected as one of the best 40 presentations and was afterwards published as an article in a European journal [8].

C. One additional action regarding paediatric radiation protection, in terms of optimization, was the participation of the Head of the Medical physics department of the Hospital to the piDRL project; a project intending, not only to propose a common methodology, but also to establish European Paediatric DRLS.