Practical implementation of the diagnostic reference levels concept for the common radiographic examinations

Background: The practical implementation of Diagnostic Reference Level in paediatric imaging is a complex task due to their unique individuality in terms of high sensitivity to radiation, varying body sizes and presenting pathology. Hence, good knowledge of medical technology, skill to perform patient dosimetry and to analyze mage quality is required. Purpose: To provide a guide on the methodological requirements for the establishment of Paediatric Diagnostic Reference Levels (PiDRLs) based on the revised and updated guidelines from the current ICRP publication 135 on Diagnostic Reference Levels (DRLs). Materials and method: An extensive review of the ICRP report Publication 135 on Diagnostic Reference levels in medical imaging with a focus on paediatric imaging and other related studies were undertaken. Results: The ICRP report 135 updates and refines the recommendations of 2001. It highlights that the application of DRLs in paediatrics alone is not sufficient for the optimization of protection. Image quality must be evaluated. Quantities used for DRLs should be appropriate to the imaging modality being evaluated, assess the amount of ionizing radiation applied to perform a medical imaging task, and be measured directly. For interventional procedures, the complexity of the procedure may be considered in setting DRLs. DRLs shall not be used for individual patients or as trigger (alert or alarm) levels for individual patients. Appropriate weight bands (generally with 5 or 10 kg intervals) are recommended for establishing paediatric DRLs and should be promoted. Conclusion: The amount of radiation used for examinations of children can vary tremendously due to great variation in patient size and weight from neonates to adult-sized adolescents. This variation in patient radiation dose is appropriate. However, variation in patient doses due to inappropriate technique or failure to child-size the imaging protocol is not appropriate. This forms the basis of the new ICRP guideline and should form the basis of developing PiDRLs.

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Diagnostic Reference Levels

Korean Society of Computed Tomographic Technology ◽

10.31320/jksct.2020.22.1.15 ◽

2020 ◽

Vol 22 (1) ◽

pp. 15-21

Author(s):

Pyong-Kon Cho

Keyword(s):

Diagnostic Reference Levels ◽

Reference Levels

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New french diagnostic reference levels: Let's take stock of our daily practices!

Journal of Neuroradiology ◽

10.1016/j.neurad.2019.08.001 ◽

2019 ◽

Vol 46 (6) ◽

pp. 341-342 ◽

Cited By ~ 3

Author(s):

Julien Ognard ◽

David Bourhis ◽

René Anxionnat ◽

Douraied Ben Salem

Keyword(s):

Diagnostic Reference Levels ◽

Reference Levels

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Diagnostic reference levels for adult’s abdominal computed tomography in a referral centre in Nigeria

IOP Conference Series Earth and Environmental Science ◽

10.1088/1755-1315/655/1/012064 ◽

2021 ◽

Vol 655 (1) ◽

pp. 012064

Author(s):

D.Z. Joseph ◽

I.S. Mansur ◽

I. Garba ◽

M.S. Umar ◽

F.B. Nkubli ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Referral Centre ◽

Abdominal Computed Tomography

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Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative mini C-arm Fluoroscopy

Hand ◽

10.1177/1558944721994257 ◽

2021 ◽

pp. 155894472199425

Author(s):

Kiran R. Madhvani ◽

Matthew J. R. Clark ◽

Alex A. J. Kocheta

Keyword(s):

Radiation Dose ◽

Fracture Fixation ◽

Wrist Fracture ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Audit Data ◽

Small Joint ◽

Open Fixation ◽

Phalangeal Fracture

Background: Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification. Methods: Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included. Results: The median radiation dose for wrist fracture open fixation was 2.73 cGycm2, Kirschner wiring (K-wiring) procedures was 2.36 cGycm2, small joint arthrodesis was 1.20 cGycm2, small joint injections was 0.58 cGycm2, and phalangeal fracture fixation was 1.05 cGycm2. Conclusions: Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.

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A comparison of age-dependent entrance skin doses in pediatric chest exams with diagnostic reference levels for the Antioquia region of Colombia

Radioprotection ◽

10.1051/radiopro/2012021 ◽

2012 ◽

Vol 47 (4) ◽

pp. 575-582 ◽

Cited By ~ 1

Author(s):

J. Morales ◽

W. Jaramillo ◽

J.A. Puerta ◽

A. Arrieta ◽

L. Moncada

Keyword(s):

Diagnostic Reference Levels ◽

Reference Levels ◽

Age Dependent ◽

Pediatric Chest ◽

Skin Doses

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NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR NUCLEAR MEDICINE IN KUWAIT

Journal of Nuclear Medicine Technology ◽

10.2967/jnmt.121.262175 ◽

2021 ◽

pp. jnmt.121.262175

Author(s):

Mashari Alnaaimi ◽

Mousa Alduaij ◽

Musab Algaily ◽

Fisal Shanawey ◽

Talal Mohammedzein ◽

...

Keyword(s):

Nuclear Medicine ◽

Diagnostic Reference Levels ◽

Reference Levels

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Towards the Establishment of Diagnostic Reference Levels in Saudi Arabia: Review and Opinion

Egyptian Journal of Radiation Sciences and Applications ◽

10.21608/ejrsa.2021.55201.1111 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Khalid M. Aloufi ◽

Fahad H. Alhazmi ◽

Osama M. Abdulaal ◽

Abdualaziz A. Qurashi

Keyword(s):

Saudi Arabia ◽

Diagnostic Reference Levels ◽

Reference Levels

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Establishing local diagnostic reference levels for adult computed tomography in Morocco

Radioprotection ◽

10.1051/radiopro/2021035 ◽

2022 ◽

Author(s):

M. El Mansouri ◽

M. Talbi ◽

A. Choukri ◽

O. Nhila ◽

M. Aabid

Keyword(s):

Computed Tomography ◽

Adult Patients ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Head Ct ◽

Ct Examination ◽

Japanese Studies ◽

The Uk

In Morocco, the radiation doses received by adult patients are increasing due to the number of CT examinations performed and the larger number of computed tomography (CT) scanners installed. The aim of this study was to evaluate the radiation doses received by patients for the most common adult CT examinations in order to establish local diagnostic reference levels (DRLs). Data from 1016 adult patients were collected during 3 months from four Moroccan hospitals. Dose length product (DLP) and volumetric computed tomography dose index (CTDIvol) were evaluated by determining the 75th percentile as diagnostic reference levels for the most common examinations including head, chest and abdomen. The DRL for each examination was compared with other studies. The established DRLs in Morocco in terms of CTDIvol were 57.4, 12.3 and 10.9 for CT examinations of the head, chest, abdomen, respectively. For DLP, they were 1020, 632 and 714, respectively. These established DRLs for CTDIvol were almost similar to the UK DRLs at all examinations, higher than the Egyptian DRLs and lower than the Japanese DRLs at the head CT examination, lower than the DRLs from Egypt and Japan at the CT abdomen examination. In terms of DLP, the DRLs were higher than those of the British studies, lower than those of the Egyptian and Japanese studies at the head CT examination were higher at chest CT and lower at abdominal CT than those of all selected studies. The higher level of established DRLs in our study demonstrates the requirement of an optimization process while keeping a good image quality for a reliable diagnosis.

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