2nd Modification and Update of Diagnostic Reference Levels in Germany - Improvements and Consequences

Congress:

EuroSafe Imaging 2017

Poster Number:

ESI-0034

Type:

EuroSafe Imaging

Keywords:

Radiation safety, Audit and standards, Fluoroscopy, Digital radiography, CT, Radioprotection / Radiation dose, Radiation physics, Action 2 - Clinical diagnostic reference levels (DRLs), Action 3 - Optimisation, diagnostic reference levels, image quality, Quality assurance

Authors:

G. Stamm, H. Lenzen, M. Wucherer, G. Brix, A. Schegerer, A. Sommer

DOI:

10.1594/esi2017/ESI-0034

DOI-Link:

https://dx.doi.org/10.1594/esi2017/ESI-0034

Fig. 1: Relative changes in DRL for 1st and 2nd update of the DRL for plain radiography.

Fig. 2: Overview of the 20 Systems with the highest mean AGD, sorted in descending...

Fig. 3: DRL for CT of adult published in 2003, 2010 and 2016.

Fig. 4: DRL for fluoroscopy in adults published 2003, 2010 and 2016.

Background/Introduction

In July 2016, the 2nd update of diagnostic reference levels (DRL) in Germany was published by the Federal Office for Radiation Protection (BfS) [1]. The modifications made were based on different databases collected by either the “ärztliche Stellen” (a quality assurance board), the German society of interventional radiology (DeGIR), the AQUA institute, the reference centers mammography, and a nationwide survey on CT exposure conducted by the German Roentgen society in 2013-14 [2].

Description of activity and work performed

DRL for plain radiography Compared to the previous DRL, established in 2010 [3], dose-relevant parameters could be decreased by 20%, on average (see Fig. 1). Relative changes of the DRL for conventional plain X-ray radiography showed a decrease by about 40% between 2003 and 2010. The main reason for this rather big difference is that at the time of introducing DRL in 2003 [4] only a small database of dose values in terms of dose area products (DAP) was available. This changed substantially for the...

Conclusion and Recommendations

Future work and outlook for the 3rd update For the 3rd update of RDLs it is planned to use not only values for the DAP but also introduce some values for the number of images and total imaging time. Other countries have already successfully introduced RDLs for optimization. This will be also reported in an extended publication in Germany. Values of the 25 and 50 percentiles shall serve as resources for optimization processes as requested for example in the ICRP publication [5].

Personal/Organisational information

Contributing authors: Georg Stamm, Institute for Diagnostic and Interventional Radiology, Göttingen/DE Horst Lenzen, Institute of Clinical Radiology, Münster/DE Alexander Sommer, Reference Center, Münster/DE Michael Wucherer, Institute of Medical Physics, Nürnberg/DE Gunnar Brix, Federal Bureau of Radiation Protection, Neuherberg/DE Alexander Schegerer, Federal Bureau of Radiation Protection, Neuherberg/DE This poster was submitted on behalf of the German X-Ray Society (DRG) and the Working Group on Physics and Techniques in Imaging Diagnostics (APT).

References

[1] BfS, „Diagnostische Referenzwerte für diagnostische und interventionelle Röntgenanwendungen“ Bundesanzeiger BAnz AT 15.07.2016, B8 [2] A. Schegerer, H.-D. Nagel, G. Stamm, G. Adam, G. Brix: "Current CT Practice in Germany: Results and Implications of a Nationwide Survey", Eur. J. Radiol., submitted. [3] BfS, „Diagnostische Referenzwerte für diagnostische und interventionelle Röntgenanwendungen“ Bundesanzeiger BAnz ;111 28.07.2010, 2594 [4] BfS, Bekanntmachung der diagnostischen Referenzwerte für radiologische und nuklearmedizinische Untersuchungen vom 10. Juli 2003, Bundesanzeiger BAnz, 143 05.08.2003, 17503 [5] ICRP „Diagnostic Reference Levels in Medical Imaging“, 2017, pending...