Comment on “Diagnostic reference levels based on clinical indications for paediatric computed tomography examinations at the Mohammed VI University Hospital Center in Marrakech-Morocco”

Clinical indication–based diagnostic reference levels (DRL-CI) for paediatric CT are valuable for dose optimisation and benchmarking across institutions. We comment on a recent single-centre retrospective study that derived DRL-CI for paediatric head, chest, abdomen–pelvis, and chest–abdomen–pelvis CT using CTDIvol and DLP percentiles across multiple clinical indications. While the work addresses an important gap, we identify issues that warrant clarification before the findings are translated into practice. Key concerns include inconsistent reporting of age stratification between the methods and results, and discordant statements between the abstract and main text regarding statistical significance for CTDIvol versus DLP. In addition, the manuscript alternates between defining DRLs using medians and third quartiles while applying statistical tests framed around medians, which does not directly evaluate differences in the operational DRL metric (75th percentile). We suggest reconciling denominators and inclusion criteria, adopting a single consistent DRL definition, and reporting effect sizes with uncertainty. Additional analyses focusing on upper-tail dose metrics (e.g., quantile-based comparisons), and adjustment for scan length and multiphase acquisition would improve interpretability. Addressing these points would strengthen confidence in the proposed DRL-CI and facilitate safer, more generalisable implementation.