Emergency radiology · 2026
First nationwide clinical indication-based diagnostic reference levels incorporating size-specific dose estimates for adult chest CT in Morocco.
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Madkouri Youssef, Sekkat Hamza, Mouden Oussama El, Bentayeb Farida, Merabet Youssef El, Khallouqi Abdellah, Halimi Abdellah, Rhazouani Omar El
Аннотация
PURPOSE: To establish nationwide clinical indication-based multicenter diagnostic reference levels (DRLs) for adult chest CT examinations in Morocco.
METHODS: This retrospective multicenter study included 1,238 adult chest CT examinations grouped into four clinical indications: Lung nodule/follow-up, Infection/ILD/fibrosis, lung cancer staging/lymph node evaluation, and emergency/PE/trauma. For each indication, CTDIvol and dose-length product (DLP) were analyzed. Multicenter DRLs were defined as the 75th percentile of center-level median CTDIvol and DLP values. Differences between indication groups were assessed using the Kruskal-Wallis test, with results reported using medians and 95% confidence intervals.
RESULTS: Dose levels differed significantly between clinical indications for both CTDIvol and DLP (p < 0.001). Emergency/PE/trauma examinations showed the highest patient-level dose values, followed by lung cancer staging/lymph node evaluation, infection/ILD/fibrosis, and lung nodule/follow-up. Patient-level P75 values for CTDIvol were 10.11, 7.10, 5.00, and 4.80 mGy, respectively, while corresponding DLP P75 values were 439.78, 339.60, 250.00, and 214.60 mGy·cm.
CONCLUSION: Adult chest CT dose levels vary substantially according to clinical indication. Clinical indication-based multicenter DRLs provide a more appropriate optimization framework than a single anatomy-based chest CT DRL and should be used to guide protocol harmonization and dose optimization in Moroccan CT practice.
METHODS: This retrospective multicenter study included 1,238 adult chest CT examinations grouped into four clinical indications: Lung nodule/follow-up, Infection/ILD/fibrosis, lung cancer staging/lymph node evaluation, and emergency/PE/trauma. For each indication, CTDIvol and dose-length product (DLP) were analyzed. Multicenter DRLs were defined as the 75th percentile of center-level median CTDIvol and DLP values. Differences between indication groups were assessed using the Kruskal-Wallis test, with results reported using medians and 95% confidence intervals.
RESULTS: Dose levels differed significantly between clinical indications for both CTDIvol and DLP (p < 0.001). Emergency/PE/trauma examinations showed the highest patient-level dose values, followed by lung cancer staging/lymph node evaluation, infection/ILD/fibrosis, and lung nodule/follow-up. Patient-level P75 values for CTDIvol were 10.11, 7.10, 5.00, and 4.80 mGy, respectively, while corresponding DLP P75 values were 439.78, 339.60, 250.00, and 214.60 mGy·cm.
CONCLUSION: Adult chest CT dose levels vary substantially according to clinical indication. Clinical indication-based multicenter DRLs provide a more appropriate optimization framework than a single anatomy-based chest CT DRL and should be used to guide protocol harmonization and dose optimization in Moroccan CT practice.