Establishment of national diagnostic reference levels as guidelines for computed tomography radiation in Jordan
Abstract
Computed tomography (CT) scan contributes to about 10% of the total medical radiographic examinations conducted worldwide. Noticeably, various studies have raised concern regarding the high radiation dose exposure of patients during this technique of imaging. The study assesses the dose of radiation to which patients undergoing different CT examinations in Jordanian hospitals are exposed and measures the national diagnostic reference levels (DRLs). This retrospective observational study of all CT examinations performed in almost 300 plus CT examination centers in Jordan. A random sample of the top 28 hospitals in Jordan was taken for the study, which was conducted between May 2019 and December 2020. We quantified the national DRL by calculating the 75th percentile and the percentage difference of volume CT dose index (CTDIv) and dose length product (DLP) for both pediatric and adult populations and different CT examinations, including brain, sinus, chest, abdomen & pelvis, knee, neck, lumbar‐spine, cervical‐spine, and shoulder. A total of 242 pediatric patients and 304 adult patients underwent various CT examinations during the study period. The national DRLs (the 75th percentiles of CTDIv and DLP) for the pediatric population were highest for the brain (81 mGy and 1425 mGy.cm, respectively) and lowest for the shoulder (7 mGy and 181 mGy.cm, respectively). Similarly, the 75th percentiles of CTDIv for the adults were highest for the brain examination (68 mGy) and lowest for the shoulder (8 mGy). The national DRLs for CT scans conducted in Jordan hospitals were found to be higher than those quantified in other countries, with larger CTDIv and DLP variations.
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In Jordan, an increasing emphasis on radiation protection and quality assurance in medical imaging has initiated endeavors to create and revise national CT diagnostic reference levels (DRLs).
“In Jordan, an increasing emphasis on radiation protection and quality assurance in medical imaging has initiated endeavors to create and revise national CT diagnostic reference levels (DRLs).6–8”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [6]
Cites
Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog
Mettler, F. A., Huda, W., Yoshizumi, T. T., & Mahesh, M. (2008) · Radiology · doi:10.1148/radiol.2481071451 · Cited by 2,007 · see citing works
Computed tomography and patient risk: Facts, perceptions and uncertainties
Power, S. P., Moloney, F., Twomey, ., James, K., O’Connor, O. J., & Maher, M. M. (2016) · World Journal of Radiology · doi:10.4329/wjr.v8.i12.902 · Cited by 337 · see citing works
Pediatric CT: Strategies to Lower Radiation Dose
Zacharias, C., Alessio, A. M., Otto, R. K., Iyer, R. S., Phillips, G. S., Swanson, J. O., & Thapa, M. M. (2013) · American Journal of Roentgenology · doi:10.2214/ajr.12.9026 · Cited by 148 · see citing works
Zhang, H., Zeng, D., Zhang, H., Wang, J., Liang, Z., & Ma, J. (2017) · Medical Physics · doi:10.1002/mp.12097 · Cited by 106 · see citing works
Establishing national diagnostic reference levels (DRLs) for computed tomography in Egypt
Salama, D. H., Vassileva, J., Mahdaly, G., Shawki, M., Salama, A., Gilley, D., & Rehani, M. M. (2017) · Physica Medica · doi:10.1016/j.ejmp.2017.05.050 · Cited by 98 · see citing works
Statistics Notes: Percentage differences, symmetry, and natural logarithms
Cole, T. J., & Altman, D. G. (2017) · BMJ · doi:10.1136/bmj.j3683 · Cited by 88 · see citing works
Crowhurst, J. A., Whitby, M., Thiele, D. L., et al. (2014) · Journal of Medical Radiation Sciences · doi:10.1002/jmrs.67 · Cited by 45 · see citing works
Australian diagnostic reference levels for multi detector computed tomography
Hayton, A., Wallace, A. B., Marks, P., Edmonds, K., Tingey, D., & Johnston, P. N. (2013) · Australasian Physical & Engineering Sciences in Medicine · doi:10.1007/s13246-013-0180-6 · Cited by 42 · see citing works
Qurashi, A. A., Rainford, L. A., & Foley, S. J. (2014) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncu343 · Cited by 37 · see citing works
Dodge, C. T., Tamm, E. P., CODY, D. D., et al. (2016) · Journal of Applied Clinical Medical Physics · doi:10.1120/jacmp.v17i2.5709 · Cited by 35 · see citing works
Liang, C. R., Chen, P. X. H., Kapur, J., Ong, M. K. L., Quek, S. T., & Kapur, S. C. (2017) · Journal of Medical Radiation Sciences · doi:10.1002/jmrs.210 · Cited by 33 · cited 1× · see citing works
“For such issues, the International Commission of Radiation Protection (ICRP) 1996 introduced diagnostic reference levels (DRLs).(10) The main aim of introducing DRLs was to manage the dose required for imaging adequately for clinical purposes.”
BackgroundGovindarajan, K., Saravanakumar, A., Vaideki, K., et al. (2014) · Journal of Medical Physics · doi:10.4103/0971-6203.125509 · Cited by 32 · see citing works
Effective dose delivered by conventional radiology to Aosta Valley population between 2002 and 2009
Zenone, F., Aimonetto, S., Catuzzo, P., et al. (2012) · British Journal of Radiology · doi:10.1259/bjr/19099861 · Cited by 29 · see citing works
Toori, A. J., Monfared, A. S., Deevband, M. R., et al. (2015) · PubMed · Cited by 20 · see citing works
Fukuda, A., Ichikawa, N., Fujita, Y., et al. (2017) · Physica Medica · doi:10.1016/j.ejmp.2017.04.008 · Cited by 12 · see citing works
Livingstone, R. S., & Dinakaran, P. M. (2011) · Journal of Medical Physics · doi:10.4103/0971-6203.75471 · Cited by 11 · see citing works
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Oglat, A., Shdaifat, S., Sayah, M., Abukonna, A., & Khogali, W. (2026) · Drug, Healthcare and Patient Safety · doi:10.2147/dhps.s595721
- Authors
- Al Ewaidat, H., Balawi, S., Bataineh, Z., Al‐Dwairi, A., Al‐Khalily, M., Azez, K. A., & Almakhadmeh, A.
- Affiliations
- Department of Allied Medical Sciences‐Radiologic Technology, Faculty of Applied Medical Sciences Jordan University of Science and Technology Irbid Jordan
- Jordan University of Science and Technology (JO)
- The University of Queensland (AU)
- Venue
- International Journal of Imaging Systems and Technology
- Publisher
- Wiley
- Published
- 2023-01-29
- Volume
- 33
- Issue
- 4
- Pages
- 1223-1234
- ISSN
- 0899-9457 (ISSN-L)
- 1098-1098
- OpenAlex
- W4318465072
- Cited by
- 4
- References
- 16
- Citations by year
- 2026: 2 · 2025: 1 · 2023: 1
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Imaging Systems and Technology (publishedVersion)
- Funders
- Jordan University of Science and Technology (20200649)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Physical Sciences › Physics and Astronomy › Radiation › Advanced Radiotherapy Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Keywords
- computed tomography, diagnostic reference levels, patient radiation dose, volume CT dose index, dose-length product, pediatric CT, Jordan, radiation protection
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