The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of ...computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.
This paper presents the summary reports of the session rapporteurs at the Workshop on Ethical Issues in Diagnostic Radiology. The summaries reflect the extent to which the topics discussed are well ...reflected in the papers presented in this proceedings.
This paper is based on general observation arising from many years experience in managing and delivering radiography services in the health service. In addition, it presents the results of a pilot ...qualitative study based on unstructured interviews. The interviews were undertaken with a view to identifying the reasons for radiography that may not be well justified. The study was undertaken in the public and private sectors and many of the reasons are shared by both. The reasons for poor justification include: inadequate radiation protection education for referrers; avoidance of medical litigation; defensive medicine attitude by referrers and, in the private sector, pursuit of profit. The study provides a starting point for further more quantitative investigations that are clearly required in the area.
General practitioners can play an important role in addressing smoking among pregnant women but studies suggest they rarely do so. The aim of this study was to explore general practitioners ...perceptions about the management of smoking in pregnancy, and what would enable them to provide better care.
Qualitative semi-structured interviews were conducted (Feb-July 2017), with 19 Australian general practitioners recruited from a sample that participated in a national survey on managing smoking during pregnancy; and through a national conference. The interview guide was structured using the theoretical domains framework, exploring previously reported barriers and two specific components of smoking cessation care - nicotine replacement therapy prescription and Quitline referral.
Participants reported high confidence and knowledge to provide pregnant patients adequate support for quitting. Nonetheless, participants reported lacking communication skills, focusing on providing information on smoking harm, accepting cutting down cigarettes as adequate, while following the 'Stages of Change' model and only providing treatment options to motivated patients. Lack of time, nicotine replacement therapy cost and safety concerns, and being unfamiliar with the Quitline (particularly for Aboriginal and Torres Strait Islander pregnant smokers) were perceived as challenges. Participants reported needing better communication skills, clear detailed nicotine replacement therapy guidelines for special populations, and visual resources they could use to discuss treatment options with patients.
Difficulty communicating with pregnant patients about smoking, using the 'Stages of Change' model to guide support provision and concerns regarding nicotine replacement therapy safety are barriers to providing cessation support to pregnant patients for general practitioners. Training on specific effective behaviour change techniques, clear guidance for nicotine replacement therapy use, and practical visual patient education tools may facilitate smoking cessation care provision to pregnant women.
A high precision traverse mechanism with micro-resolution was designed to capture accurately the velocity profile of the very thin turbulent attachment line on a swept body. To ensure that the ...traverse mechanism could position the hot wire reliably, a simple digital optical system was designed to check the performance of the traverse by measuring the displacement of the hot wire: a vertical displacement of 2.4 µm was achievable and this could be further reduced to 0.6 µm using micro-stepping. Due to the simplicity of the set-up it was equally useful for probe wall positioning and the velocity profiles captured clearly demonstrated that the optical set-up helped in resolving the near wall flow more accurately, regardless of the thinness of the boundary layer. The captured data compare well with the results from similar investigations, with arguably higher precision achieved.
Objective
To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries.
Methods
Under a project of the International Atomic Energy Agency, 146 CT ...facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses.
Results
Modern MDCT systems are available in 77 % of the facilities surveyed with dedicated paediatric CT protocols available in 94 %. However, protocols for some age groups were unavailable in around 50 % of the facilities surveyed. Indication-based protocols were used in 57 % of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDI
vol
values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49 % of sites.
Conclusion
There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA.
Key Points
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Paediatric computed tomography (CT) practice was audited in 40 less resourced countries.
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This audit revealed widespread (up to 100 times) variation in radiation dose.
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Specific CT protocols for certain age groups were frequently (ca. 50 %) unavailable.
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This survey demonstrates significant potential for improvement in paediatric CT practice.
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Multinational networking is an effective mechanism for quality improvement.
The purpose of this study was to assess the frequency of pediatric CT in 40 less-resourced countries and to determine the level of appropriateness in CT use.
Data on the increase in the number of CT ...examinations during 2007 and 2009 and appropriate use of CT examinations were collected, using standard forms, from 146 CT facilities at 126 hospitals.
The lowest frequency of pediatric CT examinations in 2009 was in European facilities (4.3%), and frequencies in Asia (12.2%) and Africa (7.8%) were twice as high. Head CT is the most common CT examination in children, amounting to nearly 75% of all pediatric CT examinations. Although regulations in many countries assign radiologists with the main responsibility of deciding whether a radiologic examination should be performed, in fact, radiologists alone were responsible for only 6.3% of situations. Written referral guidelines for imaging were not available in almost one half of the CT facilities. Appropriateness criteria for CT examinations in children did not always follow guidelines set by agencies, in particular, for patients with accidental head trauma, infants with congenital torticollis, children with possible ventriculoperitoneal shunt malfunction, and young children (< 5 years old) with acute sinusitis. In about one third of situations, nonavailability of previous images and records on previously received patient doses have the potential to lead to unnecessary examinations and radiation doses.
With increasing use of CT in children and a lack of use of appropriateness criteria, there is a strong need to implement guidelines to avoid unnecessary radiation doses to children.
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