Introduction: Computed tomography contributes the largest share to the exposure of patients to ionizing radiation in medicine, which is why it is important to consistently follow the principles of justification and optimization. Special care is needed when performing computed tomography scans on children, as they are more susceptible to the harmful effects of radiation. Diagnostic reference levels are used to monitor patient exposure and identify suboptimal clinical practice. For adults, the levels are determined for a patient of standard size, while for children, we encounter a wide range of sizes and body mass, which is why it is recommended to determine the levels based on age groups for head examinations and based on body mass for trunk examinations. Purpose: The purpose of the master's thesis is to research and present diagnostic reference levels in pediatric computed tomography examinations used worldwide through a systematic literature review. The aim is to determine which dosimetric quantities are most suitable for establishing diagnostic reference levels. Methods: The master's thesis was written using a descriptive method with a systematic literature review. The literature search was conducted using the PRISMA method, on international databases PubMed (NCBI), Scopus, ScienceDirect and IOP Science, using various combinations of selected keywords. We included fully accessible scientific articles written in English that are no older than ten years. Results: We included 39 studies in the final analysis that met the inclusion criteria and addressed the topic of the master's thesis. The analyzed studies revealed discrepancies in the proposed diagnostic reference levels among countries worldwide, and differences in the methodology for determining reference levels also occurred among studies. The authors reported various statistical measures, dosimetric quantities, and parameters for classifying patients into groups, such as age, body weight, or body diameter. Discussion and conclusion: A literature review showed that diagnostic reference levels are an important tool for optimizing protocols. There are significant differences in the proposed values and methodology of determination between studies. The most frequently reported method of grouping patients is based on age, despite current guidelines recommending the use of body weight. Standardizing the methodology for determining reference levels would enable better comparability of values between countries and more effective optimization of protocols.
|
