Multicentre survey on patient dose in paediatric imaging and proposal for updated diagnostic reference levels for France. Part 2: plain radiography and diagnostic fluoroscopy

Objectives To report on a dose survey conducted by the French societies of radiology and paediatric imaging (SFR and SFIPP) and the French public service expert in nuclear and radiological risks (IRSN), and to suggest new diagnostic reference levels (DRLs) for paediatric plain radiography and diagnostic fluoroscopy. Methods Dose reports concerning four radiography procedures and three diagnostic fluoroscopy procedures performed in 2015–2016 on children aged 0–15 years were collected from 16 imaging departments on a voluntary basis. Air kerma–area product (P KA ) was recorded for at least 10 patients per procedure, per centre and per age group. New DRLs were calculated as the 3rd quartiles of the distributions of the median values. Results Results from 2249 radiography examinations and 1235 diagnostic fluoroscopy procedures were obtained. A noticeable variability in patient exposure between facilities was observed in diagnostic fluoroscopy and to a lesser extent in plain radiography. DRLs are proposed for each procedure and each age group. Conclusions This study showed that the applicable national DRLs in plain radiography were obsolete and its results have been recently used by the French authorities to update them. In diagnostic fluoroscopy, large differences of doses were observed, even among departments accustomed to paediatric procedures. The new national DRLs will be useful for optimising diagnostic practice. Key Points • New national diagnostic reference levels (DRLs) are proposed for several paediatric procedures in plain radiography and diagnostic fluoroscopy. • Even between departments accustomed to paediatric procedures, substantial differences of practice were observed, especially in diagnostic fluoroscopy.