ABSTRACT Background and Aims The International Commission on Radiological Protection emphasizes dose optimization for pediatric patients due to their higher radiosensitivity. Establishing diagnostic reference levels (DRLs) supports this goal during radiological examinations. This study aimed to establish pediatric diagnostic reference levels (PiDRLs) for anteroposterior (AP) chest X‐rays across four hospitals in the Northern Cape Province, South Africa. Methods PiDRLs were calculated for 375 pediatric patients (birth to 12 years) categorized by weight bands and age groups. Image quality was assessed using an image quality assessment checklist. DRLs were determined as the 75th percentile of the dose distribution for fixed X‐ray units. An image quality assessment was performed to establish if the dose levels consistently produced images of acceptable diagnostic quality. Results Mean PiDRLs for weight groups < 5 kg, 5– < 15 kg, 15– < 30 kg, 30– < 50 kg were 0.2 mGy, 0.2 mGy, 0.2 mGy, and 0.3 mGy, respectively. Corresponding values for age groups < 1 year, 1– < 5 years, 5– < 10 years, and 10– < 12 years were 0.2 mGy, 0.2 mGy, 0.3 mGy, and 0.3 mGy, respectively. Image quality was consistently high, with the 75th percentile slightly exceeding international benchmarks. The image quality assessment confirmed that the dose levels produced images of acceptable image quality. Conclusion PiDRLs match select international benchmarks, offering a baseline for South African optimization. This study contributes valuable regional data to support radiation safety and dose optimization in pediatric medical imaging in South Africa.
Lackay et al. (2026) studied this question.