title: Pediatric Chest CT Diagnostic Reference Ranges: Development and Application.
abstract: Purpose To determine diagnostic reference ranges on the basis of the size of a pediatric patient's chest and to develop a method to estimate computed tomographic (CT) scanner-specific mean size-specific dose estimates (SSDEs) as a function of patient size and the radiation output of each CT scanner at a site. Materials and Methods The institutional review boards of each center approved this retrospective, HIPAA-compliant, multicenter study; informed consent was waived. CT dose indexes (SSDE, volume CT dose index, and dose length product) of 518 pediatric patients (mean age, 9.6 years; male patients, 277 [53%]) who underwent CT between July 1, 2012, and June 30, 2013, according to the guidelines of the Quality Improvement Registry in CT Scans in Children were retrieved from a national dose data registry. Diagnostic reference ranges were developed after analysis of image quality of a subset of 111 CT examinations to validate image quality at the lower bound. Pediatric dose reduction factors were calculated on the basis of SSDEs for pediatric patients divided by SSDEs for adult patients. Results Diagnostic reference ranges (SSDEs) were 1.8-3.9, 2.2-4.5, 2.7-5.1, 3.6-6.6, and 5.5-8.4 mGy for effective diameter ranges of less than 15 cm, 15-19 cm, 20-24 cm, 25-29 cm, and greater than or equal to 30 cm, respectively. The fractions of adult doses (pediatric dose reduction factors) used within the consortium for patients with lateral dimensions of 8, 11, 14, 17, 20, 23, 26, 29, 32, 35, and 38 cm were 0.29, 0.33, 0.38, 0.44, 0.50, 0.58, 0.66, 0.76, 0.87, 1.0, and 1.15, respectively. Conclusion Diagnostic reference ranges developed in this study provided target ranges of pediatric dose indexes on the basis of patient size, while the pediatric dose reduction factors of this study allow calculation of unique reference dose indexes on the basis of patient size for each of a site's CT scanners.©RSNA, 2017 Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Strauss
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Goske
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Alexander J
authors.identifier: 0000-0003-1729-5071
authors.initials: AJ
authors.lastname: Towbin
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Debapriya
authors.initials: D
authors.lastname: Sengupta
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Callahan
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Kassa
authors.initials: K
authors.lastname: Darge
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Podberesky
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Donald P
authors.initials: DP
authors.lastname: Frush
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Charles
authors.initials: C
authors.lastname: Maxfield
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Sjirk J
authors.initials: SJ
authors.lastname: Westra
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Prince
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Huimin
authors.initials: H
authors.lastname: Wu
authors.affiliation: From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
authors.forename: Mythreyi
authors.initials: M
authors.lastname: Bhargavan-Chatfield
mesh_terms: D049628:Body Size; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011829:Radiation Dosage; D013902:Radiography, Thoracic / Q000592:standards*; D012016:Reference Values; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*