Establishing Local Diagnostic Reference Levels for Pediatric Radiography: An In-depth Analysis of Radiation Dose Variation Using Computed Radiography Systems in Morocco

Purpose: The Diagnostic Reference Levels (DRLs), first introduced by the International Commission on Radiological Protection (ICRP), function as a significant tool for evaluating medical imaging procedures and optimizing the doses of radiation administered to patients. Within this framework, this study aims to establish and analyze DRLs specific to pediatric radiography in the eastern region of Morocco. Materials and Methods: The X-ray beam output and the standard backscatter factor value were utilized to estimate the entrance surface dose (ESD) for each patient, Data were collected on patient-specific parameters (age, height, weight, and BMI) and machine-specific parameters (kV, mAs, distance, and field sizes) for 200 patients. The control of the X-ray tube machine and the calculation of output parameters (mGy) were performed using the Piranha radiation dosimeter. Results: For all data presented in the whisker box plot, their five-number summary was calculated. This provided the statistical distribution for the data. From the collected data, thorax, upper extremity, and lower extremity were the most conducted categories each contributing about 29.65%, 24.14%, and 22.07%. The lowest contribution was from the crane category at around 4.14%. The highest ESD for this LDRL was 0.028 mGy for the crane category and the lowest was 0.0067 mGy in the Lower Extremity category. Conclusion: The third quartile ESD values have been set as the institutional DRLs, highlighting the need to adjust radiographic practices to minimize patient exposure and enhance safety.