Congress:
EuroSafe Imaging 2019
Keywords:
Action 2 - Clinical diagnostic reference levels (DRLs), Action 6 - Clinical audit tool for imaging, Action 3 - Image quality assessment based on clinical indications, Radioprotection / Radiation dose, Management, CT, Diagnostic procedure, Quality assurance, Dosimetric comparison
Authors:
H. Brat, M. Hussenot, M. Laurent, V. Leduc, J. Helal, N. Correia, J. Favre, P. Bosson, M. Eric
DOI:
10.26044/esi2019/ESI-0044
Background/introduction
Background
The mandatory revised European Basic Safety Standards Directive (2018) intends to protect the general population from unnecessary radiation exposure by strengthening radiation protection in Europe: http://www.eurosafeimaging.org/wp/wp-content/uploads/2015/03/European-BSS-Directive_Simeonov.pdf.
Summary of requirements in medical imaging:
- Record all CT doses
- Follow your local DRLs
- Investigate / justify dose excess
- Standardize protocols
- Optimize protocols (ALARA)
- Collaboration with Medical Physics Expert (MPE)
- Train for dose optimization
- Educate in radiation protection
- Accurate patient information
- External audits
Introduction
According to International Commission on Radiological Protection (ICRP) publication 135 (1):
- National DRLs are representative of an entire country.
- Local DRLs are representative of a few healthcare facilities in a local area.
They consider faster local optimization processes than NDRLs and remain anatomy-based.
- Clinical DRLs define more specific dose levels according to the a specific clinical indication (example: a CT of the abdomen to exclude renal calculi will require a lower patient exposition than to characterize a kidney tumor).
To comply with the revised European Basic Safety Standards Directive,
Groupe 3R Board required from an internal taskforce in 2015:
- to define and set-up a radiation dose optimization and education program at the group level,
- to implement a “dose culture” by guiding radiologists and technologists towards a change of practice,
in order to deliver “the right dose for the right diagnosis”
in other words: to setup clinical DRLs
The methodology ( Fig. 1 ) applied to determine clinical DRLs in a multicentre setting such as Groupe 3R,
currently comprising 10 imaging centres,
is presented in a reproductible pattern.