Establishment of local diagnostic reference levels for common adult CT examinations: a multicenter survey in Addis Ababa
Open accessAbstract
Abstract Background In medical imaging, a computed tomography (CT) scanner is a major source of ionizing radiation. All medical radiation exposures should be justified and optimized to meet the clinical diagnosis. Thus, to avoid unnecessary radiation doses for patients, diagnostic reference levels (DRLs) have been used. The DRLs are used to identify unusually high radiation doses during CT procedures, which are not appropriate for the clinical diagnosis. It has been successfully implemented in Europe, Canada, Australia, the United States, several industrialized countries, and a few underdeveloped countries. The present study aimed to establish DRLs for the head, chest, and abdominopelvic (AP) CT procedures in Addis Ababa, Ethiopia. Methods A pilot study identified the most frequent CT examinations in the city. At the time of the pilot, eighteen CT scan facilities were identified as having functioning CT scanners. Then, on nine CT facilities (50% of functional CT scanners), a prospective analysis of volume CT dose index (CTDIvol) and dose length product (DLP) was performed. We collected data for 838 adult patients’ head, chest, and AP CT examinations. SPSS version 25 was used to compute the median values of the DLP and CTDIvol dose indicators. The rounded 75th percentile of CTDIvol and DLP median values were used to define the DRLs. The results are compared to DRL data from the local, regional, and international levels. Result The proposed DRLs using CTDIvol (mGy) are 53, 13, and 16 for the head, chest, and AP examinations respectively, while the DLP (mGy.cm) for the respective examinations were 1210, 635, and 822 mGy.cm. Conclusion Baseline CT DRLs figures for the most frequently performed in Addis Ababa were provided. The discrepancies in dose between CT facilities and as well as between identical scanners suggests a large potential for dose optimization of examinations. This can be actually achieved through appropriate training of CT technologists and continuous dose audits.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The present DRL values are lower than those from Kerala and South India.
“Among Indian studies, the present DRL values are lower than those from Kerala (CTDIvol: 10.6 mGy, DLP: 509.3 mGy·cm) and South India (CTDIvol: 12 mGy, DLP: 550 mGy·cm). 10 12”
From Establishing Diagnostic Reference Level for Adult Abdomen and Pelvis CT Scans: A Benchmarking Study across BMI Groups (2026) · cites this paper as [12]
The Results and Discussion report DRLs for Addis Ababa and compare them with values from several other countries, but not Kerala or South India. Searches for Kerala, South India, and the quoted CTDIvol and DLP values found no passage addressing the cited comparison. The citing paper’s own “present DRL values” cannot be assessed from this source. (LLM, conf=0.76)
Experimental — accuracy not yet measuredA South India study reported CTDIvol 12 mGy and DLP 550 mGy·cm.
“Among Indian studies, the present DRL values are lower than those from Kerala (CTDIvol: 10.6 mGy, DLP: 509.3 mGy·cm) and South India (CTDIvol: 12 mGy, DLP: 550 mGy·cm). 10 12”
From Establishing Diagnostic Reference Level for Adult Abdomen and Pelvis CT Scans: A Benchmarking Study across BMI Groups (2026) · cites this paper as [12]
The Results and Discussion report CT dose values for Addis Ababa and compare them with values from several other countries (Tables 4–5; page unavailable). Searches for South India and the claimed 12 mGy CTDIvol and 550 mGy·cm DLP found no passage reporting those values for a South India study. (LLM, conf=0.77)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging
Vañó, E., Miller, D. L., Martin, C. J., Rehani, M. M., Kang, K., Rosenstein, M., Ortiz-López, P., Mattsson, S., Padovani, R., & Rogers, A. (2017) · Annals of the ICRP · doi:10.1177/0146645317717209 · Cited by 1,043 · see citing works
Cancer risks from diagnostic radiology
Hall, E. J., & Brenner, D. J. (2008) · British Journal of Radiology · doi:10.1259/bjr/01948454 · Cited by 916 · see citing works
Radiological protection and safety in medicine
(1996) · Annals of the ICRP · doi:10.1016/s0146-6453(00)89195-2 · Cited by 438 · see citing works
U.S. Diagnostic Reference Levels and Achievable Doses for 10 Adult CT Examinations
Kanal, K. M., Butler, P. F., Sengupta, D., Bhargavan, M., Coombs, L. P., & Morin, R. L. (2017) · Radiology · doi:10.1148/radiol.2017161911 · Cited by 397 · see citing works
Schauer, D. A., & Linton, O. (2009) · Radiology · doi:10.1148/radiol.2532090494 · Cited by 171 · see citing works
Exposure to Tomographic Scans and Cancer Risks
Shao, Y. J., Tsai, K. W., Kim, S., Wu, Y., & Demissie, K. (2019) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkz072 · Cited by 130 · see citing works
(1996) · PubMed · Cited by 127 · 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
Tsapaki, V. (2020) · Physica Medica · doi:10.1016/j.ejmp.2020.09.015 · Cited by 92 · see citing works
Reducing Radiation Dose in Body CT: A Primer on Dose Metrics and Key CT Technical Parameters
Maldjian, P. D., & Goldman, A. R. (2013) · American Journal of Roentgenology · doi:10.2214/ajr.12.9768 · Cited by 76 · see citing works
Updated Australian diagnostic reference levels for adult CT
Lee, K. L., Beveridge, T., Sanagou, M., & Thomas, P. (2020) · Journal of Medical Radiation Sciences · doi:10.1002/jmrs.372 · Cited by 75 · see citing works
Callahan, M. J. (2011) · Pediatric Radiology · doi:10.1007/s00247-011-2099-y · Cited by 64 · see citing works
Ekpo, E. U., Adejoh, T., Akwo, J. D., Emeka, O. C., Modu, A. A., Abba, M., Adesina, K. A., Omiyi, D. O., & Chiegwu, U. H. (2018) · Journal of Radiological Protection · doi:10.1088/1361-6498/aaaaf8 · Cited by 61 · see citing works
Developing diagnostic reference levels in Japan
Kanda, R., Akahane, M., Koba, Y., Chang, W., Akahane, K., Okuda, Y., & Hosono, M. (2021) · Japanese Journal of Radiology · doi:10.1007/s11604-020-01066-5 · Cited by 56 · see citing works
Muhammad, N. A., Karim, M. K. A., Hassan, H. A., et al. (2020) · Diagnostics · doi:10.3390/diagnostics10080591 · Cited by 53 · see citing works
NATIONAL DIAGNOSTIC REFERENCE LEVEL INITIATIVE FOR COMPUTED TOMOGRAPHY EXAMINATIONS IN KENYA
Korir, G. K., Wambani, J. S., Korir, I. K., Tries, M. A., & Boen, P. K. (2015) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncv020 · Cited by 52 · see citing works
Establishing local diagnostic reference levels for adult computed tomography in Morocco
Mansouri, M. E., Talbi, M., Choukri, A., et al. (2022) · Radioprotection · doi:10.1051/radiopro/2021035 · Cited by 27 · see citing works
Assessment of diagnostic reference levels awareness and knowledge amongst CT radiographers
Abdulkadir, M. K., Piersson, A. D., Musa, G. M., et al. (2021) · The Egyptian Journal of Radiology and Nuclear Medicine · doi:10.1186/s43055-021-00444-x · Cited by 23 · see citing works
Erem, G., Ameda, F., Otike, C., Olwit, W., Mubuuke, A. G., Schandorf, C., Kisolo, A., & Kawooya, M. G. (2022) · BMC Medical Imaging · doi:10.1186/s12880-022-00838-x · Cited by 22 · cited 1× · see citing works
“9 714 Nigeria (2018) [21] 61 1310 17 735 20 1486 Kenya (2016) [22] 61 1612 19 895 20 1845 Egypt (2017) [17] 30 1360 22 420 31 1325 Uganda (2022) [23] 56 1260 7.”
Uushona, V., Boadu, M., Nyabanda, R., et al. (2022) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncac074 · Cited by 15 · see citing works
Intraindividual variation of dose parameters in oncologic CT imaging
Lange, I., Alikhani, B., Wacker, F. K., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0250490 · Cited by 11 · see citing works
Zewdu, M., Kadir, E., Eshete, M. T., & Berhane, M. (2021) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncab028 · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [13]UKHSA-RCE-1: Doses from computed tomography (CT) exams in the UK 2019 review. 2019.
Cited by
Sorted by citations
M., J. M., U., R., U., S. K., Shetty, L., Dabholkar, A., & Ramachandraiah, C. (2026) · Indian Journal of Radiology and Imaging · doi:10.1055/s-0045-1806868 · Cited by 2 · see citing works
- Authors
- Kumsa, M. J., Nguse, T. M., Ambessa, H. B., Gele, T. T., Fantaye, W. G., & Dellie, S. T.
- Affiliations
- Addis Ababa University (ET)
- Tikur Anbessa Hospital (ET)
- Corresponding author
- Kumsa, Marema Jebessa
- Venue
- BMC Medical Imaging
- Published
- 2023-01-09
- Volume
- 23
- Issue
- 1
- Pages
- 6-6
- ISSN
- 1471-2342 (ISSN-L)
- PMC
- PMC9830915
- OpenAlex
- W4313888688
- Cited by
- 18
- References
- 22
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 5 · 2023: 2
- FWCI
- 2.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medical Imaging (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Addis Ababa University, the Vice President for research and Technology Transfer (Funded under grant number: AR/028/2021)
- 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
- diagnostic reference levels, CT radiation dose, volume CT dose index, dose-length product, head CT, chest CT, abdominopelvic CT, dose optimization, dose audit, Addis Ababa, Ethiopia
- MeSH terms
- Diagnostic Reference Levels, Adult, Ethiopia, Humans, Pilot Projects, Radiation Dosage, Reference Values, Tomography, X-Ray Computed
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
