Poor practice and governance in Lebanese national diagnostic reference levels of adult head and body computed tomography: A nationwide study

Lebanon has one of the highest number of computed tomography (CT) scanners per capita in the world which could likely be one of the causative factors of its high cancer incidence. In this study, we aimed to establish a national diagnostic reference level (NDRL) in adult CT examinations of the head and body in Lebanon. Dose Length Product (DLP) (n = 2730) were recorded in 91 hospitals/centers in Lebanon for head, chest, and abdomen-pelvis CT. Data was obtained from adult patients (>= 18 years) with a weight range of 75-80 kg, from January 2018 until December 2019. Then, the median, mean and 75th percentile of the DLP was calculated for each anatomical region. NDRL was reported as the 75th percentile. Then, the established NDRL was bench-marked with international countries as the USA, UK, and Australia. In our study, data were collected from im-aging departments (n = 91), with a response rate of 65% of the national total. All CT scanners ranged from 1 to 256 slices. The 75th percentile for the DLP of the head, chest, and abdomen-pelvis CT scan in Lebanon was 1426, 646, and 967 mGy cm respectively. A significant difference in mean DLP of the chest and abdomen-pelvis CT in different governorates was noted with north Lebanon having the highest levels (604 and 882 mGy cm respec-tively) (p < 0.05). When benchmarked with 18 different countries, Lebanon ranked 2nd, 3rd, and 4th highest in 75th percentile DLP for head, chest, and abdomen-pelvis CT scans respectively. In conclusion, the established Lebanese NDRL for adult routine CT scans of head, chest, and abdomen-pelvis were significantly higher than the reported international radiation dose thresholds. This demonstrates a great scope for radiation dose reduction and the need for urgent intervention of DRL to optimize CT scanning procedures and protocols in Lebanon.