Pediatric computed tomography doses in Germany from 2016 to 2018 based on large-scale data collection.

PURPOSE: Accumulating evidence from epidemiological studies that pediatric computed tomography (CT) examinations can be associated with a small but non-zero excess risk for developing leukemia or brain tumor highlights the need to optimize doses of pediatric CT procedures. Mandatory dose reference levels (DRL) can support reduction of collective dose from CT imaging. Regular surveys of applied dose-related parameters are instrumental to decide when technological advances and optimized protocol design allow lower doses without sacrificing image quality. Our aim was to collect dosimetric data to support adapting current DRL to changing clinical practice. METHOD: Dosimetric data and technical scan parameters from common pediatric CT examinations were retrospectively collected directly from Picture Archiving and Communication Systems (PACS), Dose Management Systems (DMS), and Radiological Information Systems (RIS). RESULTS: We collected data from 17 institutions on 7746 CT series from the years 2016 to 2018 from examinations of the head, thorax, abdomen, cervical spine, temporal bone, paranasal sinuses and knee in patients below 18 years of age. Most of the age-stratified parameter distributions were lower than distributions from previously-analyzed data from before 2010. Most of the third quartiles were lower than German DRL at the time of the survey. CONCLUSIONS: Directly interfacing PACS, DMS, and RIS installations allows large-scale data collection but relies on high data-quality at the documentation stage. Data should be validated by expert knowledge or guided questionnaires. Observed clinical practice in pediatric CT imaging suggests lowering some DRL in Germany is reasonable.

Evaluation of the New DIN Standard for Quality Assurance of Diagnostic Displays - Technical Review DIN 6868-157.

Acceptance and regular constancy tests are necessary to ensure the quality of diagnostic displays. In November 2014, a new standard (DIN 6868-157) was published which defines the test procedure and limiting values. There are several substantial changes compared with the previous standard DIN V 6868-57, i. e. considering the complete image display system including workstation and application software instead of only the displays. Since its publication, the new standard has raised many questions. This technical review aims to show the strengths and weaknesses of the new standard. Positive aspects are the introduction of a limiting value for the illuminance and the extension of the interval for constancy tests from 3 to 6 six months. The daily constancy test on the other hand, raises several problems and should be replaced by a randomized test. Additionally, the medical relevance is critically questioned and an overview of software for the quality assurance will be given. KEY POINTS: · Acceptance and constancy tests for diagnostic displays are defined in DIN 6868-157.. · The new standards has positive and negative aspects.. · Randomized tests should be introduced.. CITATION FORMAT: · Entz K, Sommer A, Lenzen H. DIN 6868-157: Image Quality Assurance in Diagnostic X-ray Departments - X-ray Ordinance Acceptance and Constancy Test of Image Display Systems in their Environment - Technical Review -. Fortschr Röntgenstr 2018; 190: 51 - 60.