الفهرس 
Chapter (1) Introduction 1 1. INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This study is a prospective study conducted from November 2018 to December 2021. The communication and data collection started by travelling and face to face meetings and then by teleconferences during the era of COVID 19. The survey was conducted by a highly collaborative team that consists of the project’s steering committee, the management of the university hospitals, Ministry of Health and the health professionals who were available on each site to fulfill the study requirements.
Pilot studies were conducted in the seven dedicated pediatric Hospitals such as Pediatric Radiology Hospital (H1) – PD (Ain Shams University Hospitals), Eldemerdash Hospital (H2) – DM (Ain Shams University Hospitals), Abou EL Rish Pediatric Hospital (H3) - (Cairo University Hospitals) , Children’s Cancer Hospital (H4) CCH – 57357, Tanta University Hospital (H5), Mansoura University Children Hospitals- MUCH (H6) and Assiout University Hospitals (H7) to identify the three most common examinations and they were as follows: CT of the head, chest and abdomen-pelvis. Our intension to establish National Diagnostic Reference Levels (NDRLs) based on indication, as recommended by the ICRP, could not be achieved due to the inexistence of proper referral system and information about the clinical indications of the CT studies within the centers.
As recommended by the European guidelines on pediatric DRLs, patients were classified according to age for head CT examinations and body weight for chest and abdomen-pelvis examinations. The patients were classified into four groups A : <1 year or <5 - 15 kg, B: >1-5 years or 15 - 30 kg , C: > 5-10 years or 30 - 50 kg and D: > 10-15 years or 50 - < 80 kg.
The volumetric CT dose index CTDIvol16,32 (mGy) and dose length product DLP16,32 (mGy.cm) for the head, chest and abdomen-pelvis scans of pediatric patients were retrieved from Picture Archiving and Communication Systems (P.A.C.S) which were available in the seven hospitals.
Patients’ data and CT dose Indices were recorded on an excel worksheet and analyzed by using SPSS software version 23.0. The median CTDIvol and DLP data from each facility were used to estimate the typical doses. The national pediatric DRLs for Egypt were based on the third quartile values of distributions of medians for the DLP and CTDIvol values. The results were compared to the international pediatric DRLs data to assess the situation and practice in Egypt.
Children are at greater risk of radiation exposure than adults because the rapidly dividing cells of children tend to be more radiosensitive and they have a longer expected life time in which to develop potential radiation injury. Although the CTDIvol and DLP were generally lower than those seen in earlier surveys, except in certain age groups, this survey showed some variability regarding the protocols and radiation exposure of the pediatric CT scanning. Therefore, a protocol was suggested to describe the different physical parameters of pediatrics CT scan of the head, chest and abdomen that achieve the highest imaging quality and the lowest radiation exposure dose.
The main aim of this first national survey to establish pediatric NDRLs is to promote their use and advance the optimization of radiation protection among children in Egypt. The release of CT NDRLs for adults triggered our motivation to go further and assess the situation among the pediatric age groups and compare it with the international levels.