The International Commission on Radiological Protection (ICRP) first introduced the term ‘diagnostic reference level’ (DRL) in 1996 in Publication 73. The concept was subsequently developed further, and practical guidance was provided in 2001. The DRL has been proven to be an effective tool that aids in optimisation of protection in the medical exposure of patients for diagnostic and interventional procedures. However, with time, it has become evident that additional advice is needed. There are issues related to definitions of the terms used in previous guidance, determination of the values for DRLs, the appropriate interval for re-evaluating and updating these values, appropriate use of DRLs in clinical practice, methods for practical application of DRLs, and application of the DRL concept to newer imaging technologies. This publication is intended as a further source of information and guidance on these issues. Some terminology has been clarified. In addition, this publication recommends quantities for use as DRLs for various imaging modalities, and provides information on the use of DRLs for interventional procedures and in paediatric imaging. It suggests modifications in the conduct of DRL surveys that take advantage of automated reporting of radiation-dose-related quantities, and highlights the importance of including information on DRLs in training programmes for healthcare workers. The target audience for this publication is national, regional, and local authorities; professional societies; and facilities that use ionising radiation for medical purposes, and responsible staff within these facilities. A full set of the Commission’s recommendations is provided.

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The International Commission on Radiological Protection has published a report (Publication 147) on the use of dose quantities in radiological protection, under the same authorship as this Memorandum. Here, we present a brief and partial summary of the report. ICRP Publication 147 consolidates and clarifies the explanations provided in the 2007 ICRP Recommendations (Publication 103) but reaches conclusions that go beyond those presented in Publication 103. Further guidance is provided on the scientific basis for the control of radiation risks using dose quantities in occupational, public and medical applications. It is emphasised that best estimates of risk to individuals will use organ / tissue absorbed doses and specific dose-risk models. However, bearing in mind the uncertainties associated with risk projection to low doses or low dose rates, it is concluded that effective dose may be considered as an approximate indicator of possible risk, recognising also that lifetime cancer risks vary with age at exposure, sex and population group. A further conclusion is that equivalent dose is not required as a protection quantity. It will be more appropriate for limits for the avoidance of tissue reactions for the skin, hands and feet, and lens of the eye to be set in terms of absorbed dose rather than equivalent dose.

Patient dosimetry is performed in radiology and interventional radiology to assess whether deterministic injuries may occur and to establish the risk of stochastic effects. A fundamental problem for patient dosimetry is that no single quantity can be used to accurately assess both the risk of stochastic effects and whether deterministic injuries will occur following a specific examination or procedure. In cardiology and interventional radiology, two different approaches to patient dosimetry are commonly used. Effective dose is a quantity which correlates reasonably well with the risk of stochastic effects. Effective dose may be deduced from the dose-area product (DAP) for the procedure if sufficient information is known. DAP does not correlate with maximum skin dose, which may be used to predict whether deterministic injuries may occur. DAP meter readings may be used as a trigger level for the investigation of maximum skin entrance dose. Trigger levels for different procedures are proposed.