EuroSafe Imaging 2019
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
H. Brat, M. Hussenot, M. Laurent, V. Leduc, J. Helal, N. Correia, J. Favre, P. Bosson, M. Eric
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
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.