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Our aim is to establish diagnostic reference levels (DRLs) for CT categories based on clinical indications in pediatric patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      We analyzed CT data from an international dose registry retrospectively, including scans performed in children under 18 years at 143 facilities between January 2016 and January 2021. DRLs were calculated for volumetric CT dose index (CTDI\n                      <jats:sub>vol<\/jats:sub>\n                      ), dose-length product (DLP), and size-specific dose estimate (SSDE) across 14 CT categories, which reflect both the anatomic areas and radiation dose levels (low, routine, high dose) required by imaging indications within the anatomic areas. We compared the routine dose categories for head, chest, and abdomen\/pelvis scans between facilities in the United States (U.S.) and Europe.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 95,047 CT scans (mean age, 10.4\u2009\u00b1\u20095.6 years, 54% male), including 41 different indications, were included. DRLs increased with increasing age group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05 for trend). For the head and the abdomen\/pelvis body regions, there was greater variation between the CT categories than between the indications within the categories, suggesting these categories are valid. For example, in 10- to 15-year-old children, the DRLs for the DLP increased from 362 mGy\u00b7cm for head low dose to 2058\u2009mGy\u00b7cm for head high dose. The U.S. DRLs were similar to the European for head categories, but were around twice as high for routine dose chest, and abdomen\/pelvis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We have established DRLs for indication-based CT category age groups to help standardize practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>CT categories are needed to reflect body regions and clinical indications with similar radiation dose requirements in pediatric patients<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Doses varied more between CT categories than within. DRLs for chest and abdomen\/pelvis were about twice as high in the U.S. as in Europe<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>DRLs as a function of patient age were developed for 14 broad anatomy- and indication-based CT categories in children using registry data<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11724-9","type":"journal-article","created":{"date-parts":[[2025,6,14]],"date-time":"2025-06-14T06:00:04Z","timestamp":1749880804000},"page":"7985-7999","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Diagnostic reference levels for indication-based CT categories in pediatric CT: data from an international registry"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9585-9787","authenticated-orcid":false,"given":"Denise","family":"Bos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip W.","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Luong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Haubold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Schr\u00f6er","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Zensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phuong-Anh T.","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Schindera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile R. 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R.S.-B. founder of Alara Imaging. A.J.E. reports receiving a speaker\u2019s fee from Ionetix, consulting fees from W. L. Gore & Associates, authorship fees from Wolters Kluwer Healthcare\u2014UpToDate, and serving on a scientific advisory board for Canon Medical Systems USA; his institution has grants\/grants pending from Attralus, Canon Medical Systems USA, Eidos Therapeutics, GE HealthCare, Intellia Therapeutics, Ionis Pharmaceuticals, Neovasc, Pfizer, Roche Medical Systems, and W. L. Gore & Associates.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The institutional review boards at the UCSF (and the collaborating institutions) approved the study or relied on the university\u2019s approval.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Some study subjects or cohorts have been previously reported in: (1) Chu et al [\n                      \n                      ];\n                      \n                      . (2) Chu et al (2023) Correction to: dose length product to effective dose coefficients in children. Pediatr Radiol 53:2165.\n                      \n                      . Erratum for: Pediatr Radiol 2023 53:1659\u20131668.\n                      \n                      . Paper (1) focuses on the selection of reference phantoms, which served as the basis for the phantom selection in this paper. Paper (2) deals with the development of pediatric effective dose coefficients. The effective dose was not reported in this paper. The current study reports a new analysis using a different time frame and total patient cohort from the registry than these previously published works, and for the first time, we have established DRLs for indication-based CT categories in children.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}