Proposals for the Establishment of National Diagnostic Reference Levels for Radiography for Adult Patients Based on Regional Dose Surveys in Russian Federation

Abstract

In 2009-2014, dose surveys aimed to collect adult patient data and parameters of most common radiographic examinations were performed in six Russian regions. Typical patient doses were estimated for the selected examinations both in entrance surface dose and in effective dose. 75%-percentiles of typical patient effective dose distributions were proposed as preliminary regional diagnostic reference levels (DRLs) for radiography. Differences between the 75%-percentiles of regional typical patient dose distributions did not exceed 30-50% for the examinations with standardized clinical protocols (skull, chest and thoracic spine) and a factor of 1.5 for other examinations. Two different approaches for establishing national DRLs were evaluated: as a 75%-percentile of a pooled regional sample of patient typical doses (pooled method) and as a median of 75%-percentiles of regional typical patient dose distributions (median method). Differences between pooled and median methods for effective dose did not exceed 20%. It was proposed to establish Russian national DRLs in effective dose using a pooled method. In addition, the local authorities were granted an opportunity to establish regional DRLs if the local radiological practice and typical patient dose distributions are significantly different.

Entrance dose determination and effective dose calculation in chest and skull radiographies: an experimental and computational study

“…In this study, ESD measurements were performed experimentally using TLD, while some studies have calculated the ESD value using simulation software due to restricted access to dosimeters (25,26) . Some studies have also calculated ESD with specicformulas from other radiation parameters such as X-ray Output Device (27)(28)(29)(30) . Therefore, one of the possible reasons for the difference in measured dose values can be the difference in the method of ESD determination.…”

Patient doses from medical examinations in Russia: 2009–2015

“…MED was estimated for the whole sample of patients, without considering their anthropometric characteristics, or for the sample of standard patients, with body mass of 70±3 kg. Selective studies conducted in one of the St. Petersburg hospitals indicated a lack of statistically significant differences between two methods of patient data collection and dose assessment as above (whole sample of patients v/s standard patients, p<0.05) [8].…”

“…Data was obtained on 203 conventional x-ray units in 7 regions; 36 CT units in 3 regions; 19 interventional x-ray units in St. Petersburg; 44 nuclear medicine departments, 5 PET centers and 9 PET units in 16 regions. [3][4][5][6][7][8][9]. Mean values of the effective doses for adult patients (MED) based on ICRP Publication 60 [18], assessed from the examination parameters (see table 1), were used as a dose characteristic for single x-ray and nuclear medicine units and examination protocols.…”

“…Russian data is presented from two sources: the authors' dose surveys [3][4][5][7][8][9] and the statistical form 3-DOZ from the ESKID system for 2015 [12].…”

“…Such data is estimated annually by medical facilities in Russia within the federal dose collection system ESKID [10][11][12]. Details of the data collection and dose assessment have been partly published by the authors before [3][4][5][6][7][8][9] and are partly presented in this study.…”