ABSTRACT
To propose a new method of reducing the scan length of head trauma while keeping the diagnostic efficiency of the examination in order to develop DRL in an African context. This is a retrospective single-center study including 145 patients who had cranial examinations on a 64-barettes scanner. All head trauma cases were selected. The interpretations of these CT scanners by the three radiologists of the service were noted to determine the acquisition limit. All patient acquisition lengths have been recorded. The acquisition limit for head trauma ended in clinical routine at cervical spine 4 (C4). The average scan length was 23.03 cm. Out of the CT scan results for 145 patients, only 2 (1.37%) had a C3 level cervical spine fracture and 2 (1.37%) at C4. By respecting the principles of radiation protection, this result has shown us that it is possible to limit the acquisition length of the CT scanners indicated for head trauma. The limit of the optimized scan length that we proposed is at cervical spine 2 (98.62%). Now, all head trauma are limited on cervical vertebra 2 in our hospital. The use of this new method is beneficial when the clinical indication of the examination and the type of trauma (multi-trauma) are taken into account. Based on the principles of radiation protection and the clinical indication for the examination, reducing the scan length from C4 to C2 is an effective way to reduce the dose absorbed by the patient.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Craniocerebral Trauma/diagnostic imaging , Multidetector Computed Tomography/methods , Neck Injuries/diagnostic imaging , Adolescent , Adult , Aged , Cameroon , Cervical Vertebrae/radiation effects , Child , Child, Preschool , Female , Hematoma, Epidural, Cranial/diagnostic imaging , Hematoma, Subdural/diagnostic imaging , Humans , Male , Middle Aged , Multidetector Computed Tomography/adverse effects , Multidetector Computed Tomography/ethics , Organs at Risk , Radiation Dosage , Radiation Injuries/etiology , Radiation Injuries/prevention & control , Radiation Protection/legislation & jurisprudence , Retrospective Studies , Skull Fractures/diagnostic imaging , Spinal Fractures/diagnostic imaging , Wounds, Nonpenetrating/diagnostic imaging , Young AdultABSTRACT
There is currently no Pediatric Regulatory Diagnostic Reference Level (DRL) in Cameroon to standardize protocols in hospitals. France, a European country, has DRL allowing them to optimize their examination protocol. For the sake of radiation protection, we have proposed to evaluate the dose and acquisition parameters delivered to our pediatric patients to optimize the protocols used. We also compared the 75th percentile values of dose parameters by acquisition between the three hospitals to Diagnostic Reference Level (DRL) of France. In this retrospective and evaluative multicenter study, a total of 320 patients who had at least one cranial CT scan were enrolled from three medical centers. The CT acquisition parameters including tube potential (kV), tube current (mA), slice Thickness (T), spiral or sequential scanning techniques, volume CT dose index (CTDIvol), and dose length product (DLP) were analyzed. CTDIvol values in our centers were found up to 17.42%, 46.01%, 21.56% respectively for children aged 1-4 higher than values of France's DRL. For those aged 5-9, we obtained 44.58%, 43.15%, 42.21% respectively. In addition, for children aged 10-14 there are also up to 47.73%, 44.11%, 46.39% respectively higher than values of France's DRL. It is similary for DLP values. The study showed a significant dosimetric overshoot compared to the France's DRL and prompted us to make corrections to the protocols used and to a more rigorous monitoring of the principles of radiation protection and optimization rules in pediatric computed tomography in our hospitals. Our results have led us to make changes to our protocols which are the subject of a new dosimetric evaluation. The development of DRL for improving the pediatric CT scan in our country is necessary to optimize our protocols. Our results have led us to make changes to our protocols which are the subject of a new dosimetric evaluation. It would be necessary to set up a quality control structure in Cameroon and their applications in current practice.
Subject(s)
Brain/diagnostic imaging , Radiation Dosage , Tomography, X-Ray Computed/methods , Adolescent , Child , Child, Preschool , Humans , InfantABSTRACT
BACKGROUND: The purpose of this study was to assess scan parameters and to propose strategies to optimize the examinations of children (from 0 to 15 years old) on adult scanners in developing countries. METHODS: A study was done in 2015 and 2018 on 312 pediatric patients to verify improved practices. The study of 2015 ended with proposed strategies. Dose and scan parameters were available for prospective dose analysis. These strategies were implemented in a study of 2018. RESULTS: Amount the CT examinations study in this paper, the common was head trauma (90 %). For every pediatric CT scan in 2015, a kV of 120 was used in the various hospitals. The mAs ranged from 57.75 to 283.33, slice thicknesses from 1.25 to 2.5 mm and pitch from 0.525 to 1.375 mm. In the study of 2018, implementing the strategy defined in the methodology and proposed in 2015: CTDIVol decreased by 21.27 % for children < 1 year, 31.97 % for children 1-4 years, 17 % for children 5-9 years. DLP also decreased by 25.14 %, 36.29 % and 19.85 % for children < 1 year, 1-4 years and 5-9 years respectively. Children were exposed to ionizing radiation on machines designed for adults, but now the doses received by children are reduced. CONCLUSIONS: The reduction of doses during the pediatric CT examination is possible with the introduction of new optimization protocols or the acquisition of a new machine with a pediatric protocol.
