Pediatric Effective Doses In Diagnostic Radiology by xeg10270



                      Walter Huda1, Nikolaos A Gkanatsios2, Robert J Botash1 and Ann S Botash3
                   Department of Radiology, SUNY Health Science Center at Syracuse, NY, USA
                         Department of Radiology, University of Florida, Gainesville, FL, USA
                    Department of Pediatrics, SUNY Health Science Center at Syracuse, NY, USA


Pediatric effective doses can be obtained for any radiologic examination using the selected radiographic technique factors
(kV/mAs), the exposure geometry and the patient mass. The energy imparted ε to the patient may be computed from the
exposure area product, x-ray tube voltage, half-value layer and patient thickness. Values of energy imparted may be
subsequently converted to an effective dose E using published radiographic projection specific E/ε ratios determined using
Monte Carlo techniques applied to anthropomorphic phantoms, with a correction applied for the patient mass. Pediatric
effective doses (head, chest, abdomen and extremity) were computed for representative adult patients, as well as for pediatric
patients ranging from new born to 15 year old youths. Values of patient effective dose were dependent on body size, selected
technique factors as well as the type of radiographic imaging equipment used, with no clear trends for effective dose with
patient age.


The effective dose quantifies the radiation risk to a patient undergoing any diagnostic x-ray examination.1,2 Benefits of the
effective dose include the ease of comparing doses associated with diverse types of radiographic examination, as well as the
ability to compare patient doses with natural background and regulatory dose limits.3,4 In this study, effective doses to
patients ranging from newborns to adults were determined for representative x-ray examinations of major body regions (i.e.,
head, chest, abdomen and extremities).


Technique factors. For examinations of the head, chest and abdomen, radiographic techniques (i.e., kVp/mAs) were
obtained from technique charts for dedicated pediatric room which uses a 600 speed screen-film combination. Pediatric
radiographs, ranging from newborns to 15 year olds, are all performed without the use of a scatter removal grid.
Corresponding adult technique factors were obtained for conventional radiographic rooms which all use scatter removal
grids. Radiographic techniques for the extremity examinations were taken from charts for (non-grid) fine screen and single
emulsion film combination, with a nominal speed value of 80. Representative x-ray field sizes for each age and examination
were taken from the published literature,5 with an estimate was made of the (water equivalent) patient thickness based on
the body part and typical patient thickness.

Dosimetry. The entrance skin exposure, and x-ray beam half-value layer (HVL), were theoretically calculated using
computed x-ray spectra at each kVp. The predictions of the theoretical model were compared to measurements made on a
Philips Classic C-850 three-phase generator with a Eureka ROT-350 x-ray tube, and the total x-ray beam filtration adjusted
to ensure a good fit between theory and measurement. Relative and absolute values of x-ray tube output and HVL were
generally found to agree within about 5%.

Energy imparted, ε, was computed from the exposure-area product, EAP, at the entrance plane of the patient and a
conversion factor ω(z) using the expression

                                     ε =ω(z)×EAP                  J                  (1)

where z is the patient thickness.6 For a given x-ray tube voltage, the conversion factor ω(z) is given by

                                  ω(z)=α×HVL+β               J/R-cm2             (2)
were α and β are constants. Values of energy imparted were converted to the corresponding patient effective dose E using
the expression
                                              E  70.9
                                      E = ε ×  ×               mSv                  (3)
                                              ε i M

where (E/ε)i is the body/projection specific ratios of effective dose per unit energy imparted for examination i, and M is the
patient mass.8


Technique factors. Table 1 lists the technique factors used for performing radiographic examinations of the head (AP),
chest (PA), abdomen (AP) and extremity (AP view of forearm). As the patient size increases, the kVp generally increases.
Also depicted in Table 1 are the corresponding values of x-ray beam cross-sectional area and the estimated patient thickness
in terms of water equivalence. As expected, both the x-ray beam cross-section and patient thickness monotonically increase
with increasing patient age.

Table 1: X-ray technique factors, exposure area and patient thickness for head, chest, abdomen and extremity examinations.
        Age                      Head                     Chest                   Abdomen
                           67 kVp/2.0 mAs           60 kVp/2.0 mAs            66 kVp/2.0 mAs
     Newborn                                                                                                  NA
                          (110 cm2/9.0 cm)          (140 cm2/8.0 cm)          (200 cm2/10 cm)
                           72 kVp/2.0 mAs           66 kVp/2.0 mAs            70 kVp/4.0 mAs           56 kVp/5.0 mAs
                           (160 cm2/12 cm)          (250 cm2/9.0 cm)          (300 cm2/13 cm)           (35 cm2/1.8 cm)
                           75 kVp/2.0 mAs           70 kVp/2.0 mAs            72 kVp/5.0 mAs           60 kVp/5.0 mAs
                           (210 cm2/14 cm)          (430 cm2/10 cm)           (540 cm2/15 cm)           (84 cm2/3.3 cm)
                           77 kVp/2.0 mAs           74 kVp/3.0 mAs            75 kVp/6.0 mAs             62 kVp/6 mAs
                           (240 cm2/15 cm)          (670 cm2/13 cm)           (820 cm2/17 cm)          (140 cm2/5.0 cm)
                           79 kVp/2.0 mAs           78 kVp/4.0 mAs            78 kVp/7.0 mAs           65 kVp/6.0 mAs
                           (270 cm2/16 cm)          (780 cm2/14 cm)           (900 cm2/20 cm)          (200 cm2/6.2 cm)
                           75 kVp/15 mAs           120 kVp/2.0 mAs            75 kVp/15 mAs            65 kVp/8.0 mAs
                           (320 cm2/20 cm)         (1300 cm2/15 cm)          (1200 cm2/22 cm)         (200 cm2/7.9 cm)

Dosimetry. Table 2 summarizes the key dosimetry parameters for the four types of radiographic examination for patients
ranging from newborn to the adult. In each cell, the first value is the entrance skin air kerma (free-in-air) in µGy. The second
term gives the energy imparted to the patient, expressed in µJ. In parentheses on the second line are the corresponding values
of patient effective dose in µSv.

As expected, values of the entrance skin exposure and energy imparted for the pediatric examinations all monotonically
increase with increasing patient age. Comparison of adult examinations with 15 year old patients is complicated by the
differences in radiographic technique, with 15 year old chests are performed at 78 kVp whereas adult chests are performed
at 120 kVp. An additional difficulty is the use of grids for the adult head/chest/abdomen examinations, which is expected
to have a large impact on the resultant values of entrance skin air kerma and energy imparted.

For pediatric head examinations, the effective dose increased as the patient age (size) was reduced, whereas for chest,
abdomens and extremity exams, the converse was generally true. Adult head and abdomen examinations have effective doses
much greater than pediatric effective doses. Effective doses for adult chest and extremity examinations were comparable to
those for 15 year old youths. Overall, there was no clear trend of patient effective doses with patient age; effective doses are
a (complex) function of body size, selected technique factors as well as the type of radiographic imaging equipment which
is used to perform these studies.
Table 2: Values of entrance skin air kerma ( µGy), energy imparted ( µJ) and the corresponding patient effective
doses( µSv) for the specified patient ages and type of radiographic examination.
         Age                      Head                     Chest                 Abdomen
                            100 µGy/78.2 µJ            77 µGy/66 µJ           100 µGy/140 µJ
      Newborn                                                                                       NA
                                (10 µSv)                  (19 µSv)                (62 µSv)
                            120 µGy/165 µJ            96 µGy/160 µJ           230 µGy/580 µJ  130 µGy/9.5 µJ
                               (7.3 µSv)                  (16 µSv)                (90 µSv)      (0.21 µSv)
                            140 µGy/260 µJ            110 µGy/340 µJ         320 µGy/1500 µJ  160 µGy/44 µJ
                               (5.9 µSv)                  (18 µSv)               (120 µSv)      (0.50 µSv)
                            150 µGy/320 µJ           190 µGy/1100 µJ         420 µGy/3300 µJ 200 µGy/130 µJ
                               (4.3 µSv)                  (33 µSv)               (160 µSv)      (0.87 µSv)
                            150 µGy/400 µJ           280 µGy/2100 µJ         550 µGy/5100 µJ 220 µGy/240 µJ
                               (3.1 µSv)                  (36 µSv)               (140 µSv)      (0.92 µSv)
                          1100 µGy/3200 µJ          150 µGy/2500 µJ       1100 µGy/13000 µJ  300 µGy/360 µJ
                                (19 µSv)                 (34 µSv)                (290 µSv)       (1.1 µSv)


1. Values of entrance skin exposure and energy imparted to patients generally increased with increasing patient age.

2. Values of patient effective dose were dependent on body size, selected technique factors as well as the type of radiographic
imaging equipment used.

3. There was no simple trend when comparing adult effective doses with those of infants and children.

4. There was no simple trend for the variation of pediatric patient effective dose with age.

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