Diagnostic reference levels in paediatric fluoroscopy: a single-centre study in South Africa





DRL, ALARA/dose optimisation, Radiation protection, Radiation risks, fluoroscopy


Background. Establishment of diagnostic reference levels (DRLs) in medical imaging is recommended as a tool for dose optimisation. Currently, there are no published South African DRLs in paediatric fluoroscopy. This study proposes local DRLs for selected paediatric fluoroscopy studies, which may contribute to the establishment of national DRLs.

Objective. To establish single-centre local DRLs for air-kerma area product (KAP), cumulative air kerma at a reference point (Ka,r), and total fluoroscopy time in paediatric fluoroscopy.

Method. A retrospective analysis of archived data of fluoroscopy procedures was performed. The data were stratified into age and weight groups, and for each group and procedure, the mean, 25th, and 75th percentile values of KAP, Ka,r, and FT was determined. In this study, the local DRL was defined at the 75th percentile value. 

Results. The proposed local (DRLs) in terms of KAP, Ka,r and FT are: 87 mGy.cm2, 0.43mGy, 2.5 min for barium enema; 44.4 mGy.cm2, 1.10 mGy, 3.5 min for barium swallow; 28.7 mGy.cm2, 1.32 mGy, 3.5 min for modified swallow; 35.5 mGy.cm2, 3.83 mGy, 2.6 min for barium meal; 73.8 mGy.cm2, 1.35 mGy, 8.6 min for enema: air reduction; 23.0 mGy.cm2, 0.63 mGy, 1.9 min for contrast via peg; 33.8 mGy.cm2, 0.38 mGy, 1.2 min for urodynamics; and 40.0 mGy.cm2, 1.00 mGy, 3.1 min for micturating cystourethrography. 

Conclusion. The LDRLs in this study do not vary significantly from those found in cited references in the literature. However, there exists room for further optimisation.

Contribution. This study represents the first time that dose reference values for paediatric fluoroscopy have been published in South Africa.

Author Biography

J Mbewe, Division of Medical Physics, Groote Schuur Hospital

Division of Medical Physics

Groote Schuur Hospital






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