Establishing Pediatric Thoracic Diagnostic Reference Levels Using CALDOSE_X: A Data-Driven Approach to Optimizing Radiation Safety

Ikbal Bouadel; Morad El Kafhali; Soukaina Mefrah; Marziyeh Tahmasbi; Rajaa Sebihi

Establishing Pediatric Thoracic Diagnostic Reference Levels Using CALDOSE_X: A Data-Driven Approach to Optimizing Radiation Safety

Abstract

Objective: In Morocco, significant disparities exist in observing national radiation protection standards, particularly in conventional radiology for pediatric patients. This cross-sectional study aims to establish Moroccan diagnostic reference levels (DRLs) for pediatric thorax radiography.

Methods: Thorax radiography examinations of 208 pediatric patients (newborns up to 18 years old) from four public hospitals in Morocco were evaluated. Patient demographics (age, gender, weight), and scan parameters were recorded to calculate radiation doses using CALDOSE_X 5.0 software, quantifying entrance surface air kerma (ESAK) in mGy. The study samples were divided into five age groups (age <1 month, 1 month ≤ age< 4 years, 4 years ≤ age< 10 years, 10 years ≤ age< 14 years, and 14 years ≤ age < 18 years). The third quartile (P75) of calculated ESAK in mGy and kinetic energy released per unit mass (KERMA)-area product (KAP), in mGy.cm² for each group were analyzed. Statistical analysis was performed using SPSS version 21.

Results: The P75 values for ESAK (mGy) and KAP (mGy.cm²) diagnostic reference levels across age groups were: 0.61, 0.69, 0.68, 0.82, and 1.29 for ESAK, and 350.25, 566.07, 499.14, 950.62, and 1816.06 for KAP. The calculated regional DRLs for pediatric thorax radiography exceeded the published values for thorax protocols in some European countries. The irradiated surfaces significantly impacted the received doses of patients up to 10 years old (p-values of 0.004, 0.000, and 0.001).

Conclusions: Adapting the irradiation surface to patient morphology is crucial, requiring precise control over exposure factors, radiation field size, and protocol selection.

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Pediatrics Healthcare Radiation Protection Thoracic Radiography Monte Carlo Method Diagnostic Reference Levels.

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Bouadel I, Kafhali ME, Mefrah S, Tahmasbi M, Sebihi R. Establishing Pediatric Thoracic Diagnostic Reference Levels Using CALDOSE_X: A Data-Driven Approach to Optimizing Radiation Safety. Frontiers Biomed Technol. 2025;.

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