Radiation levels due to medical use are relatively low in the Netherlands compared to other countries1.In a recent review2about dose reducing measures in children it appeared that Diagnostic Reference Levels (DRLs) for children were only used in about 50% of hospitals in the Netherlands. This low percentage is in clear contradiction with the fact that most health professionals consider DRLs as a powerful means to optimize radiation dose. So there seems to be opportunities for further optimization of the radiation dose in paediatric radiological practice....

Triggered by the 50% implementation rate we tried to find potential obstacles for implementing DRLs in general and especially in children. To that end we scrutinized relevant inventories executed by the National Instiute for Public Health and the Environment(RIVM) in the last 10 years. RIVM reports The RIVM conducts scientific research on behalf of government policy and the oversight exercised in the area of public health, the environment and nature. The institute is an independent branch of the Ministry of Health, Welfare and Sport (VWS)....

ALARA no longer stands for justification and optimization but for justification, optimization and cooperation Until recently radiation protection was based on justification and optimization or in one word: ALARA, as low as reasonable achievable. The introduction of DRLs and forthcoming obligation will give a boost to the ALARA-principle. It is no longer a local activity, but will be lifted to regional and national levels. However that will not be automatic. Our survey suggests that the process of justification and optimization concerning patient protocols is mostly...

Herman Pieterman MD, Radiological Society of the Netherlands, Vught and radiologist/head of patientcare Erasmus Medical Centre Rotterdam Rotterdam Netherlands correspondance adress: [email protected] -Harmen Bijwaard PhD, Project Manager Medical Radiation Applications RIVM (National Institute for Public Health and the Environment)and Medical Technology Research Group, Inholland University of Applied Sciences, VLH (Centre for Environmental Safety and Security) Bilthoven Netherlands Doreth Valk Msc, scientific staff RIVM (National Institute for Public Health and the Environment) VLH (Centre for Environmental Safety and Security) Netherlands Arjen Becht PhD, DutchSociety of Clinical...

1) M. van Bruggen, I.R. de Waard, H. Bijwaard: Inventory of high risk groups for radiodiagnostic imaging; RIVM report 610113001 (2013). 2) H. Bijwaard and D. Valk: Radiological examination in children -inventory of the Dutch practice with the focus on dose reducing measures;RIVM report 2014-0071(2014). 3) H. Bijwaard: Survey of the application of Diagnostic Reference Levels for X-rays in the Netherlands;RIVM report 080129001(2013). 4)I. R. de Waard, P. Stoop:Survey results on quality radiology departments; RIVM report 300080004(2010).