Radiation dose of computed tomography in pediatric head trauma imaging

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PURPOSE: In emergency diagnostics, head CT and CT angiography (CTA) of craniocervical vasculature are indispensable for children, despite their increased radiation sensitivity. This study assesses the radiation dose metrics of head CT and CTA in pediatric patients managed in the trauma resuscitation unit (TRU). METHODS: All patients aged 0-<15 years who underwent head CT and CTA in the TRU between April 2020 and August 2023 were included. CT dose index volume (CTDIvol) and dose-length product (DLP) were extracted from the Radimetrics Enterprise Platform, which also provided organ doses estimated via Monte Carlo simulations and effective doses (ED) derived from these estimates. Dose metrics were compared with national diagnostic reference levels (DRLs), defined for three pediatric age groups: I (0-<5 years), II (5-<10 years), and III (10-<15 years). RESULTS: Of 212 pediatric TRU patients, 62.7% (133/212) underwent CT and 72.2% (96/133) received combined CT and CTA. Median CTDIvol and DLP increased with age, whereas ED decreased. For head CT, CTDIvol ranged from 18.9 mGy to 29.4 mGy, DLP from 282 to 460 mGycm, and ED from 1.6 to 1.3 mSv. For CTA, CTDIvol ranged from 1.4 to 2.2 mGy, DLP from 40 to 83 mGycm, and ED from 1.0 to 0.8 mSv. All doses remained below national DRLs. CONCLUSION: Head CT and CTA in pediatric trauma can be performed with radiation doses well below national DRLs. Careful dose management is important to reduce potential long-term cancer risks and deterministic effects such as lens cataract formation.

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