The new ICRP Recommendations on Diagnostic Reference Levels for Medical Imaging

Congress:

EuroSafe Imaging 2018

Poster Number:

ESI-0018

Type:

EuroSafe Imaging

Keywords:

Audit and standards, Fluoroscopy, CT, Conventional radiography, Radioprotection / Radiation dose, Action 8 - Radiation protection training and learning material, Action 2 - Clinical diagnostic reference levels (DRLs), Action 6 - Education and training in medical radiation protection, Action 3 - Optimisation, diagnostic reference levels, image quality, Dosimetric comparison, Education and training

Authors:

E. Vano, D. L. Miller, C. J. Martin, M. M. Rehani, K. Kang, M. Rosenstein, P. Ortiz-Lopez, S. Mattsson, R. Padovani, A. T. Rogers

DOI:

10.1594/esi2018/ESI-0018

DOI-Link:

https://dx.doi.org/10.1594/esi2018/ESI-0018

Fig. 1: ICRP Publication 135 (Diagnostic Reference Levels in Medical Imaging)

Fig. 2: ICRP Publication 135 (Diagnostic Reference Levels in Medical Imaging). Authors...

Background/introduction

Beginning in the 1950s, national surveys of quantities related to patient dose for diagnostic x-ray examinations were performed e.g. in the USA and the UK [1-3]. The International Commission on Radiological Protection (ICRP) introduced the concept of Diagnostic Reference Levels (DRLs) in 1996 [4]. The European Commission included DRLs in a directive on medical exposures in 1997 [5]. In 2001, ICRP published supporting guidance expanding the use of DRLs to interventional radiology, and giving further advice on flexibility in their selection and implementation [6-7]. The...

Description of activity and work performed

In the ICRP P135 published in 2017 [8], the Commission recommends the use of different DRL terms: · DRL concept: A form of investigation level used as a tool to aid optimisation of protection in the medical exposure of patients for diagnostic and interventional procedures. · DRL quantity: A commonly and easily measured or determined radiation metric that assesses the amount of ionising radiation used to perform a medical imaging task. · DRL value: An arbitrary notional value of a DRL quantity, set at the...

Conclusion and recommendations

DRL concept 1. The Commission recommends setting DRL values based on surveys of the appropriate DRL quantities for procedures performed on an appropriate sample of patients. The use of phantoms is not sufficient in most cases, as the effects of operator performance are not considered when phantoms are used. 2. The numerical value of the DRL (the DRL value) should be tied to defined clinical and technical requirements for the selected medical imaging task. DRL quantity 3. A commonly and easily measured or determined radiation...

Personal/organisational information

Authors on behalf of ICRP (members of the Working Party): E. Vano, D.L. Miller, C.J. Martin, M.M. Rehani, K. Kang, M. Rosenstein, P. Ortiz-Lopez, S. Mattsson, R. Padovani and A. Rogers. Thanks to K. Applegate for her useful comments.

References

1. FDA, 1984. Nationwide Evaluation of X-ray Trends (NEXT) Eight Years of Data (1974–1981). US Department of Health and Human Services, Public Health Service, Food and Drug Administration, Silver Spring, MD. 2. NRPB/RCR, 1990. Patient Dose Reduction in Diagnostic Radiology. Documents of the NRPB 1(3). HMSO, London. 3. NRPB, 1999. Guidelines on Patient Dose to Promote the Optimisation of Protection for Diagnostic Medical Exposures. Documents of the NRPB 10(1). National Radiological Protection Board, Chilton. 4. ICRP, 1996. Radiological protection and safety in medicine. ICRP Publication...