The aims of this study were to investigate the frequency of computed tomography (CT) examinations for paediatric patients below 15 y of age in 128 CT facilities in 28 developing countries of Africa, Asia and Eastern Europe and to assess the magnitude of CT doses. Radiation dose data were available from 101 CT facilities in 19 countries. The dose assessment was performed in terms of weighted CT dose index (CTDI_w), volume CT index and dose length product (DLP) for chest, chest (high resolution), lumbar spine, abdomen and pelvis CT examinations using standard methods. The results show that on average the frequency of paediatric CT examinations was 20, 16 and 5 % of all CT examinations in participating centres in Africa, Asia and Eastern Europe, respectively. Eleven CT facilities in six countries were found to use adult CT exposure parameters for paediatric patients, thus indicating limited awareness and the need for optimisation. CT images were of adequate quality for diagnosis. The CTDI_w variations ranged up to a factor of 55 (Africa), 16.3 (Asia) and 6.6 (Eastern Europe). The corresponding DLP variations ranged by a factor of 10, 20 and 8, respectively. Generally, the CTDI_w and DLP values in Japan are lower than the corresponding values in the three regions in this study. The study has indicated a stronger need in many developing countries to justify CT examinations in children and their optimisation. Awareness, training and monitoring of radiation doses is needed as a way forwards.

The purpose of this prospective study at 73 facilities in 18 countries in Africa, Asia and Eastern Europe was to investigate if the CT doses to adult patients in developing countries are higher than international standards. The dose assessment was performed in terms of weighted computed tomography dose index (CTDIw) and dose length product (DLP) for chest, chest (high resolution), lumbar spine, abdomen and pelvis CT examinations using standard methods. Except in one case, the mean CTDIw values were below diagnostic reference level (DRL) while for DLP, 17 % of situations were above DRLs. The resulting CT images were of adequate quality for diagnosis. The CTDIw and DLP data presented herein are largely similar to those from two recent national surveys. The study has shown a stronger need to create awareness and training of radiology personnel as well as monitoring of radiation doses in many developing countries so as to conform to the ALARA principle.

Two cases of successful detection of inflammatory foci using Tc-99m exametazime (HMPAO)-labeled leukocyte scintigraphy in premature infants were reported. Necrotizing enterocolitis was detected in a child with a body weight of 1.6 kg. Scintigraphy confirmed a neonatal osteomyelitis in the distal part of the leg of another patient weighing 2.2 kg. These 2 cases indicate that it is feasible to perform Tc-99m HMPAO-labeled leukocyte scintigraphy even if the blood sample volume is lower than the minimal volumes required by the guidelines for pediatric patients.