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Establishment of Pediatric CT Diagnostic Reference Levels in the United States

27 April 2022

Recording →

Moderator: Jenia Vassileva (IAEA)

Presenters: Kalpana M. Kanal (United States of America)


The webinar will present the recently developed diagnostic reference levels (DRLs) and achievable doses (ADs) for the 10 most commonly performed pediatric computed tomography (CT) examinations in the United States. Data from these examinations acquired between 2016 and 2020 from 1637 facilities were analysed, using the American College of Radiology (ACR) CT Dose Index Registry. For the head, neck and extremity examinations, doses were analysed based on a patient age. For body examinations, doses were analysed based on both patient age and patient effective diameter calculated from the images to represent patient size. Data from over 1.5 million pediatric examinations were used to propose DRL and AD values for the computed tomography dose index (CTDIvol), dose length product (DLP) and size-specific dose estimate (SSDE).

ADs and DRLs for both CTDIvol and DLP for all examinations generally increased as a function of age and a patient effective diameter. Although international pediatric DRL methodology and results vary, the US results fall within the ranges reported across other countries. These determinations can serve as practical benchmarks for accountability and for improvement in pediatric CT practice.

Learning objectives

  • To understand the concept of DRLs and ADs
  • To be aware of DRLs and ADs for the 10 most common pediatric CT exams in the USA
  • To learn how to use published DRLs to help optimize dose at local level


Dr Kalpana M. Kanal received her MS degree from the University of Texas at Arlington, and her PhD in Radiological Sciences from the University of Texas Health Science Center in San Antonio, USA. After completing the Medical Physics Residency Program at Mayo Clinic, she joined the Department of Radiology at University of Minnesota in 1998.

In 1999, Dr. Kanal was certified by the American Board of Radiology (ACR) in Diagnostic Radiological Physics. She has been working in the Department of Radiology at the University of Washington since 2000 and is currently Professor and Director of the Diagnostic Physics Section. She is also Chair of the Radiation Safety Committee at University of Washington and is active professionally in the American Association of Physicists in Medicine (AAPM), ACR and American Board of Radiology (ABR) and recently became a medical physics trustee in ABR. She has also served as the Chair of the ACR CT Dose Index Registry. She has published more than 60 papers in peer-reviewed journals and has made several scientific presentations throughout her career. Dr Kanal has also been recognized as a fellow by the AAPM, ACR and SABI.

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