Congress:
EuroSafe Imaging 2018
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
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 recent ICRP publication 135 (P135) on “Diagnostic Reference Levels in Medical Imaging” [8] (figs.
1-2) is the result of the work of a Working Party of ICRP Committee 3,
which was created during the annual meeting held in Bethesda,
MD,
USA on 22–28 October 2011.
DRL is the ICRP term for a form of investigation level used to aid in optimisation of protection in the medical exposure of patients for diagnostic and interventional procedures.The DRL process has proven to be an effective tool that aids in optimisation of protection.
There were issues in previous ICRP guidance that have been addressed in P135.
For example,
definitions of some of the terms used,
determination of the values for DRLs,
the appropriate interval for re-evaluating and updating these values,
appropriate use of DRLs in clinical practice,
methods for practical application of the DRL process,
and application of the concept to certain newer imaging technologies [e.g.
dual-energy computed tomography (CT),
positron emission tomography-CT (PET-CT),
single photon emission CT (SPECT-CT),
cone-beam CT,
digital radiography and tomosynthesis].
There were also additional advices related to paediatric practices,
particularly due to the wide range in patient sizes and in interventional radiology,
due to the different anatomy and pathology ranges in patients treated
The target audience for the ICRP publication 135 is national,
regional,
and local authorities; professional societies; and staff responsible for the management and operation of facilities where ionising radiation is used for medical exposures.