{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T15:14:08Z","timestamp":1774019648486,"version":"3.50.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T00:00:00Z","timestamp":1673222400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T00:00:00Z","timestamp":1673222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Addis Ababa University, the Vice President for research and Technology Transfer","award":["Funded under grant number: AR\/028\/2021"],"award-info":[{"award-number":["Funded under grant number: AR\/028\/2021"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Imaging"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>In medical imaging, a computed tomography (CT) scanner is a major source of ionizing radiation. All medical radiation exposures should be justified and optimized to meet the clinical diagnosis. Thus, to avoid unnecessary radiation doses for patients, diagnostic reference levels (DRLs) have been used. The DRLs are used to identify unusually high radiation doses during CT procedures, which are not appropriate for the clinical diagnosis. It has been successfully implemented in Europe, Canada, Australia, the United States, several industrialized countries, and a few underdeveloped countries. The present study aimed to establish DRLs for the head, chest, and abdominopelvic (AP) CT procedures in Addis Ababa, Ethiopia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A pilot study identified the most frequent CT examinations in the city. At the time of the pilot, eighteen CT scan facilities were identified as having functioning CT scanners. Then, on nine CT facilities (50% of functional CT scanners), a prospective analysis of volume CT dose index (CTDI<jats:sub>vol<\/jats:sub>) and dose length product (DLP) was performed. We collected data for 838 adult patients\u2019 head, chest, and AP CT examinations. SPSS version 25 was used to compute the median values of the DLP and CTDI<jats:sub>vol<\/jats:sub> dose indicators. The rounded 75th percentile of CTDI<jats:sub>vol<\/jats:sub> and DLP median values were used to define the DRLs. The results are compared to DRL data from the local, regional, and international levels.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Result<\/jats:title>\n                <jats:p>The proposed DRLs using CTDI<jats:sub>vol<\/jats:sub> (mGy) are 53, 13, and 16 for the head, chest, and AP examinations respectively, while the DLP (mGy.cm) for the respective examinations were 1210, 635, and 822\u00a0mGy.cm.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Baseline CT DRLs figures for the most frequently performed in Addis Ababa were provided. The discrepancies in dose between CT facilities and as well as between identical scanners suggests a large potential for dose optimization of examinations. This can be actually achieved through appropriate training of CT technologists and continuous dose audits.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12880-023-00963-1","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T15:05:22Z","timestamp":1673276722000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Establishment of local diagnostic reference levels for common adult CT examinations: a multicenter survey in Addis Ababa"],"prefix":"10.1186","volume":"23","author":[{"given":"Marema Jebessa","family":"Kumsa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teklehaimanot Mezgebe","family":"Nguse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haleluya Biredaw","family":"Ambessa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tesfaye Tefera","family":"Gele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wondemu Geteye","family":"Fantaye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seife Teferi","family":"Dellie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,1,9]]},"reference":[{"issue":"2","key":"963_CR1","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1148\/radiol.2532090494","volume":"253","author":"DA Schauer","year":"2009","unstructured":"Schauer DA, Linton OW. National Council on Radiation Protection and Measurements report shows substantial medical exposure increase. Radiology. 2009;253(2):293\u20136.","journal-title":"Radiology"},{"key":"963_CR2","unstructured":"FDA. Computed Tomography (CT). [cited 2022 Aug 8]. Available from: https:\/\/www.fda.gov\/radiation-emitting-products\/medical-x-ray-imaging\/computed-tomography-ct"},{"issue":"1","key":"963_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/jncics\/pkz072","volume":"4","author":"YH Shao","year":"2020","unstructured":"Shao YH, Tsai K, Kim S, Wu YJ, Demissie K. Exposure to tomographic scans and cancer risks. JNCI Cancer Spectr. 2020;4(1):1\u20137.","journal-title":"JNCI Cancer Spectr"},{"key":"963_CR4","unstructured":"UNEP. Radiation effects and sources: What is radiation? What does radiation do to us? Where does radiation come from? 2016. 1\u201368 p."},{"issue":"965","key":"963_CR5","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1259\/bjr\/01948454","volume":"81","author":"EJ Hall","year":"2008","unstructured":"Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol. 2008;81(965):362\u201378.","journal-title":"Br J Radiol"},{"key":"963_CR6","doi-asserted-by":"crossref","unstructured":"ICRP, 2017. Diagnostic reference levels in medical imaging. ICRP Publication 135. Ann. ICRP 46(1)","DOI":"10.1177\/0146645317717209"},{"key":"963_CR7","doi-asserted-by":"publisher","unstructured":"Tsapaki V. Radiation dose optimization in diagnostic and interventional radiology: Current issues and future perspectives. Phys Medica. 2020;79(September):16\u201321. Available from: https:\/\/doi.org\/10.1016\/j.ejmp.2020.09.015","DOI":"10.1016\/j.ejmp.2020.09.015"},{"key":"963_CR8","doi-asserted-by":"crossref","unstructured":"ICRP. Radiological protection and safety in medicine. A report of International Commission on Radiological Protection. Ann ICRP. 1996;26:1\u201347.","DOI":"10.1016\/S0146-6453(00)89195-2"},{"key":"963_CR9","unstructured":"Cho PK. Diagnostic Reference Levels. Image Wisely. 2010."},{"key":"963_CR10","unstructured":"IAEA. Radiation protection and safety in medical uses of ionizing radiation: specific safety guide. 2018;340."},{"key":"963_CR11","unstructured":"European Comission. European guidelines on quality criteria for computed tomography European guidelines on quality criteria. Eur 16262 En. 1999;1\u201371."},{"issue":"8","key":"963_CR12","doi-asserted-by":"publisher","first-page":"591","DOI":"10.3390\/diagnostics10080591","volume":"10","author":"NA Muhammad","year":"2020","unstructured":"Muhammad NA, Abdul Karim MK, Abu Hassan H, Ahmad Kamarudin M, Ding Wong JH, Ng KH. Diagnostic reference level of radiation dose and image quality among paediatric CT examinations in a Tertiary Hospital in Malaysia. Diagnostics (Basel). 2020;10(8):591.","journal-title":"Diagnostics (Basel)"},{"key":"963_CR13","unstructured":"UKHSA-RCE-1: Doses from computed tomography (CT) exams in the UK 2019 review. 2019."},{"issue":"1","key":"963_CR14","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/jmrs.372","volume":"67","author":"KL Lee","year":"2020","unstructured":"Lee KL, Beveridge T, Sanagou M, Thomas P. Updated Australian diagnostic reference levels for adult CT. J Med Radiat Sci. 2020;67(1):5\u201315.","journal-title":"J Med Radiat Sci"},{"key":"963_CR15","unstructured":"Japan Medical Imaging and Radiological Systems Industries Association, National Institutes for Quantum and Radiological Science and Technology. National Diagnostic Reference Levels in Japan (2020). 2020;1\u201322."},{"key":"963_CR16","unstructured":"Canadian Computed Tomography Survey \u2013 National Diagnostic Reference Levels, by Graeme M Wardlaw, PhD and Narine Martel, MSc. Ottawa: Health Canada, May 2016. Pub. No. 160038."},{"key":"963_CR17","doi-asserted-by":"crossref","unstructured":"Salama DH, Vassileva J, Mahdaly G, Shawki M, Salama A, Gilley D, et al. Establishing national diagnostic reference levels (DRLs) for computed tomography in Egypt. Physica Medica, 39. Phys medica. 2017;39:16\u201324.","DOI":"10.1016\/j.ejmp.2017.05.050"},{"issue":"1","key":"963_CR18","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1051\/radiopro\/2021035","volume":"57","author":"M El Mansouri","year":"2022","unstructured":"El Mansouri M, Talbi M, Choukri A, Nhila O, Aabid M. Establishing local diagnostic reference levels for adult computed tomography in Morocco. Radioprotection. 2022;57(1):61\u20136.","journal-title":"Radioprotection"},{"issue":"1","key":"963_CR19","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1148\/radiol.2017161911","volume":"284","author":"KM Kanal","year":"2017","unstructured":"Kanal KM, Butler PF, Sengupta D, Bhargavan-Chatfield M, Coombs LP, Morin RLUS. Diagnostic reference levels and achievable doses for 10 adult CT examinations. Radiology. 2017;284(1):120\u201333.","journal-title":"Radiology"},{"issue":"3","key":"963_CR20","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1093\/rpd\/ncab028","volume":"193","author":"M Zewdu","year":"2021","unstructured":"Zewdu M, Kadir E, Tesfaye M, Berhane M. establishing local diagnostic reference levels for routine computed tomography examinations in Jimma University Medical Center South West Ethiopia. Radiat Prot Dosimetry. 2021;193(3):200\u20136.","journal-title":"Radiat Prot Dosimetry"},{"issue":"2","key":"963_CR21","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1088\/1361-6498\/aaaaf8","volume":"38","author":"EU Ekpo","year":"2018","unstructured":"Ekpo EU, Adejoh T, Akwo JD, Emeka OC, Modu AA, Abba M, Adesina KA, Omiyi DO, Chiegwu UH. Diagnostic reference levels for common computed tomography (CT) examinations: results from the first Nigerian nationwide dose survey. J Radiol Prot. 2018;38(2):525\u201335.","journal-title":"J Radiol Prot"},{"issue":"2","key":"963_CR22","first-page":"253","volume":"168","author":"GK Korir","year":"2016","unstructured":"Korir GK, Wambani JS, Korir IK, Tries MA, Boen PK. National diagnostic reference level initiative for computed tomography examinations in Kenya. Radiat Prot Dosimetry. 2016;168(2):253\u201360.","journal-title":"Radiat Prot Dosimetry"},{"key":"963_CR23","doi-asserted-by":"publisher","unstructured":"Erem G, Ameda F, Otike C, Olwit W, Mubuuke AG, Schandorf C, et al. Adult computed tomography examinations in Uganda: towards determining the National Diagnostic Reference Levels. BMC Med Imaging. 2022;1\u201312. Available from: https:\/\/doi.org\/10.1186\/s12880-022-00838-x","DOI":"10.1186\/s12880-022-00838-x"},{"issue":"4","key":"963_CR24","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/s11604-020-01066-5","volume":"39","author":"R Kanda","year":"2021","unstructured":"Kanda R, Akahane M, Koba Y, Chang W, Akahane K, Okuda Y, Hosono M. Developing diagnostic reference levels in Japan. 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Assessment of diagnostic reference levels awareness and knowledge amongst CT radiographers. Egypt J Radiol Nucl Med. 2021;52(1).","DOI":"10.1186\/s43055-021-00444-x"}],"container-title":["BMC Medical Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12880-023-00963-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12880-023-00963-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12880-023-00963-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T15:09:07Z","timestamp":1673276947000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedimaging.biomedcentral.com\/articles\/10.1186\/s12880-023-00963-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,9]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["963"],"URL":"https:\/\/doi.org\/10.1186\/s12880-023-00963-1","relation":{},"ISSN":["1471-2342"],"issn-type":[{"value":"1471-2342","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,9]]},"assertion":[{"value":"20 August 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 January 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval to conduct the study was granted by the Department of Medical Radiologic Technology Ethics Committee of College of Health Sciences Addis Ababa University. The Department of Medical Radiologic Technology Research and Ethics Committee also approved the waiver of informed consent due to the lack of direct patient contact during data collection. The study was also carried out following relevant guidelines and regulations according to the Helsinki declaration.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"NA.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors do not have any conflicts of interest to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6"}}