Congress:
EuroSafe Imaging 2016
Keywords:
Action 2 - Clinical diagnostic reference levels (DRLs), Action 3 - Optimisation, diagnostic reference levels, image quality
Authors:
J. Damilakis, H. Jarvinen, P. Vock, S. Evans, G. Paulo, E. Sorantin
DOI:
10.1594/esi2016/ESI-0011
Conclusion and Recommendations
A comprehensive European and worldwide review of DRLs for paediatric examinations has indicated that only a few countries have set DRLs for paediatric examinations and there is a complete lack of national DRLs for many examinations,
in particular for paediatric interventional fluoroscopically-guided procedures.
Furthermore,
the existing DRLs are often adopted from the old European Commission (EC) recommendations or from other countries,
and only a few countries have based their DRLs on their own national patient dose surveys.
In many countries,
the initial DRLs have never been updated.
There is a need to establish DRLs for radiologic examinations and procedures where DRLs are not available and provide guidance on what actions are needed in using DRLs to further enhance radiation protection of children.
PiDRL Guidelines provide an important tool for the establishment and use of paediatric DRLs for x-ray procedures.
These guidelines cover a wide spectrum of modalities including radiography,
computed tomography and fluoroscopy.
Based on the critical review of all paediatric national DRLs set by authoritative bodies in the European countries,
European DRLs have been suggested for radiography,
fluoroscopy and CT. The PiDRL project has also performed two limited surveys on non-cardiac fluoroscopically-guided procedures and cardiac fluoroscopically-guided procedures.
A European workshop was organized to discuss the results of the PiDRL project,
the need for further action on DRLs and the optimisation of radiation protection of paediatric patients.
All member states are encouraged to perform their own patient dose surveys to establish DRLs.
The physical quantity should be an easily measurable quantity,
usually directly obtainable from the x-ray equipment console,
obtained either by manual recording or preferably by automatic recording and analysis.
The values used for patient dose monitoring,
at the display unit and in the DICOM header should be regularly calibrated or checked for all beam qualities used in clinical practice.
The parameter to group the patients should be patient weight for all body examinations and patient age for all head examinations.
In some cases,
DRLs can also be given as a DRL curve by expressing the DRL quantity as a continuous function of the grouping parameter (e.g.
DLP as a function of patient weight) provided the collected data for setting of the DRLs indicates a clear relationship between patient doses and the grouping parameter.
National DRLs should be based on national patient dose surveys with a representative sample of all radiological institutions and all types of equipment and practices in the country when practical.
DRLs based on very limited surveys or on measurements only in phantoms,
as well as DRLs adopted from international recommendations,
should only be used as preliminary values until data from the relevant patient dose surveys are available.
In collecting the patient dose data for the DRLs,
likewise in daily imaging practices,
there should always be a system in place to judge whether image quality is adequate for the diagnosis according to the indication of the examination.
Due to the generally large amount of data needed and the large amount of potential errors when these data are to be collected during routine practice,
automatic data collection is recommended wherever possible.
The comparison of local patient dose levels of a hospital or a group of hospitals with local DRLs or national DRLs should be carried out at the minimum frequency of once per year.
National DRLs should be reviewed and updated at least every 5 years.
Local DRLs should be reviewed and updated at least every 3 years and when there are changes of the equipment or practices which have a potential impact on patient dose levels.
The national DRLs should be compared with available European DRLs whenever either of the values have been established or updated.
Radiation exposure is often high in fluoroscopically-guided procedures. However,
sufficient data are not available to provide DRLs for these procedures.
More data from several interventional centers should be collected in order to provide a better basis for setting paediatric DRLs for fluoroscopically-guided procedures.