A review of current local dose-area product levels for paediatric fluoroscopy in a tertiary referral centre compared with national standards. Why are they so different?

A prospective single centre study has been performed to assess dose-area product (DAP) values in children having fluoroscopic examinations and to revise local diagnostic reference levels (DRLs). DAP measurements for 2658 examinations performed in a dedicated fluoroscopy room over a period of 21 months were analysed. Data for the eight most commonly performed examinations (2215 cases) are presented. DAPs (75th centile) for upper gastrointestinal studies and micturating cystograms are substantially lower (by a factor of between x 5 and x 25) than the current national reference doses (NRDs), with some of the median values being 50 times lower. The small DAP values in all examinations demonstrate the substantial reduction in dose and consequent risk that can be achieved when both equipment performance and operator technique are optimized. Whilst we recognize that different institutions will have differing practices, it is important that practitioners are aware of the range of DAPs achievable and that NRDs do not necessarily represent best practice, and may falsely reassure.