The growing potential of diagnostic reference levels as a dynamic tool for dose optimization

Damilakis, John; Vassileva, J.

doi:10.1016/j.ejmp.2021.03.018

Cited by 15 publications

(8 citation statements)

References 25 publications

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“…D iagnostic reference level (DRL) benchmarks for radiation protection and optimization of patient imaging were first mentioned by the International Commission on Radiological Protection (ICRP) in 1990 (1) and clarified further in 1996 (2). The DRL is used for identifying situations where the levels of patient dose are unusually high (2,3). The use of DRLs is endorsed by professional, advisory, and regulatory organizations.…”

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confidence: 99%

U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations

et al. 2022

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Background: Diagnostic reference levels (DRLs) and achievable doses (ADs) were developed for the 10 most commonly performed pediatric CT examinations in the United States using the American College of Radiology Dose Index Registry.Purpose: To develop robust, current, national DRLs and ADs for the 10 most commonly performed pediatric CT examinations as a function of patient age and size.Materials and Methods: Data on 10 pediatric (ie, patients aged 18 years and younger) CT examinations performed between 2016 and 2020 at 1625 facilities were analyzed. For head and neck examinations, dose indexes were analyzed based on patient age; for body examinations, dose indexes were analyzed for patient age and effective diameter. Data from 1 543 535 examinations provided medians for AD and 75th percentiles for DRLs for volume CT dose index (CTDI vol ), dose-length product (DLP), and size-specific dose estimate (SSDE).Results: Of all facilities analyzed, 66% of the facilities (1068 of 1625) were community hospitals, 16% (264 of 1625) were freestanding centers, 9.5% (154 of 1625) were academic facilities, and 3.5% (57 of 1625) were dedicated children's hospitals. Fifty-two percent of the patients (798 577 of 1 543 535) were boys, and 48% (744 958 of 1 543 535) were girls. The median age of patients was 14 years (boys, 13 years; girls, 15 years). The head was the most frequent anatomy examined with CT (876 655 of 1 543 535 examinations [57%]). For head without contrast material CT examinations, the age-based CTDI vol AD ranged from 19 to 46 mGy, and DRL ranged from 23 to 55 mGy, with both AD and DRL increasing with age. For body examinations, DRLs and ADs for size-based CTDI vol , SSDE, and DLP increased consistently with the patient's effective diameter. Conclusion:Diagnostic reference levels and achievable doses as a function of patient age and effective diameter were developed for the 10 most commonly performed CT pediatric examinations using American College of Radiology Dose Index Registry data. These benchmarks can guide CT facilities in adjusting pediatric CT protocols and resultant doses for their patients.

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confidence: 99%

U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations

et al. 2022

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“…Optimisation follows the ALARA (as low as reasonably achievable) principle and requires the adequate image quality needed for the medical imaging procedure. Once the local DRLs have been established, their practical use should be included in a sustainable and continuous quality assurance program, performed by a local optimisation team, including at least a radiologist, a medical physicist, and a radiographer (2,5).…”

Section: How To Use Local Drlsmentioning

confidence: 99%

“…For example, non-contrast CT for ureteral stone detection can be performed by using lower doses than those used in other abdominal procedures such as CT for diagnosis of appendicitis because detection of stones is affected less by noise than low-contrast tissues. DRLs in Nuclear Medicine have not been determined in a standardised way [ 2 ]. There is a lack of national and regional DRLs for FGIP and paediatric imaging examinations.…”

Section: Introductionmentioning

confidence: 99%

How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement

et al. 2023

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Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging ‘Clinical DRLs’ working group formed with the purpose to produce scientific and educational material on DRLs and promote the concept of local DRLs. Guidelines on how to establish and how to use local DRLs presented herein can be implemented using a multidisciplinary team approach. Local DRLs are easy to determine and implement and they reflect local equipment performance and local clinical needs. They can be updated more frequently than the national DRLs, especially if a dose management system is available. To establish local DRLs, a practical approach could be to collect a reasonable set, i.e., at least 20–30 procedures, of data for well-defined clinical indications and calculate the 3rd quartile values. The median values of the distribution can be set to define the ‘typical values’. The International Commission of Radiological Protection (ICRP) suggests setting ‘typical values’ for newer technologies that enable decreased amounts of radiation exposure for a similar level of image quality. Local DRLs should be similar or lower to the national DRLs. They could be higher only if the clinical benefits for some medical indications are fully explained and reported. Local DRLs may be used as a quality benchmark to track outliers and can be also used as alert values. Key points Guidelines on how to establish and use local DRLs are presented. Local DRLs are easy to determine and implement and can be updated frequently Additionally, local DRLs can be used to track outliers.

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“…4 In 1996, the International Commission on Radiological Protection (ICRP) established diagnostic reference levels (DRLs) as benchmarks for identifying abnormally high radiation doses and optimizing radiation protection and image quality. 5,6 Experts, advisory bodies, and regulatory agencies recommend the use of DRLs for radiological imaging. 7 The ICRP emphasizes that DRLs are not intended for regulatory or commercial use, do not constitute dose limits, and are affected by variations in technology and clinical indications.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Data Management on the Achievable Dose and Efficiency of Mammography and Radiography During the COVID-19 Era: A Facility-Based Cohort Study

Hegazi¹,

Al-Sharydah²,

AlFawaz³

et al. 2023

RMHP

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To evaluate the impact of using computational data management resources and analytical software on radiation doses in mammography and radiography during the COVID-19 pandemic, develop departmental diagnostic reference levels (DRLs), and describe achievable doses (ADs) for mammography and radiography based on measured dose parameters. Patients and Methods: This ambispective cohort study enrolled 795 and 12,115 patients who underwent mammography and radiography, respectively, at the King Fahd Hospital of the University, Al-Khobar City, Saudi Arabia between May 25 and November 4, 2021. Demographic data were acquired from patients' electronic medical charts. Data on mammographic and radiographic dose determinants were acquired from the data management software. Based on the time when the data management software was operational in the institute, the study was divided into the pre-implementation and post-implementation phases. Continuous and categorical variables were compared between the two phases using an unpaired t-test and the chi-square test. Results: The median accumulated average glandular dose (AGD; a mammographic dose determinant) in the post-implementation phase was three-fold higher than that in the pre-implementation phase. The average mammographic exposure time in the postimplementation phase was 16.3 ms shorter than that in the pre-implementation phase. Furthermore, the median values of the dose area product ([DAP], a radiographic dose determinant) were 9.72 and 19.4 cGycm 2 in the pre-implementation and post-implementation phases, respectively. Conclusion: Although the data management software used in this study helped reduce the radiation exposure time by 16.3 ms in mammography, its impact on the mean accumulated AGD was unfavorable. Similarly, radiographic exposure indices, including DAP, tube voltage, tube current, and exposure time, were not significantly different after the data management software was implemented. Close monitoring of patient radiation doses in mammography and radiography, and dose reduction will become possible if imaging facilities use DRLs and ADs via automated systems.

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The growing potential of diagnostic reference levels as a dynamic tool for dose optimization

Cited by 15 publications

References 25 publications

U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations

U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations

How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement

The Impact of Data Management on the Achievable Dose and Efficiency of Mammography and Radiography During the COVID-19 Era: A Facility-Based Cohort Study

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