EuroSafe Imaging 2020
Not applicable, Outcomes, Dosimetric comparison, Safety, Radiation safety, Nuclear medicine conventional, CT, Conventional radiography, Radioprotection / Radiation dose, Management, Action 2 - Clinical diagnostic reference levels (DRLs)
J. Damilakis, G. Frija
Conclusion and recommendations
The EU guidance on the establishment and use of DRLs requires updating as it is 20 years old. The EUCLID project has provided a framework for this. Indeed, the workshop discussion revealed that the EUCLID project’s list of clinical indications has already been adopted by some US colleagues. The EUCLID project’s list may furthermore be complemented by a list of 5 clinical indications for CBCT that has been developed in Switzerland. The experience gained during the EUCLID project revealed the importance of data cleaning and data verification in the establishment of DRLs. Additionally, the key role of ethical/professional codes (patient privacy etc) was recognised. It was suggested that the development of guidelines for this would be welcome.
During the analysis of the data collected by the EUCLID project, large variances in technique and corresponding dosimetric data became apparent between hospitals for most clinical indications. It also became clear that hospitals often also varied in the sequence in which multiphase examinations were carried out. The workshop discussed how agreement on a common use of terminology could potentially improve optimization, reduce errors, and better facilitate comparison of results.
The status of DRLs varies amongst different EU member states. Few have established DRLs for clinical indications, though the establishment of clinical DRLs, establishment of paediatric DRLs and automatic data collection are included in the plans of a number of countries.
The need for DRLs to be adjusted within/to national contexts (based on available expertise and infrastructure) was accepted in the workshop. It was also agreed that guidelines should be provided on image quality criteria based on the clinical indication.
The workshop concluded that the use of dose management systems is strongly advised in order to ease the establishment and update of local and national DRLs.
The establishment of DRLs for Interventional Radiology remains a particular challenge as patient doses depend on multiple factors, including procedural complexity. Further works is necessary to refine the quantification of complexity of fluoroscopically-guided procedures in order to better define its utility in the establishment of DRLs.
Although beyond the scope of the EUCLID project, the workshop discussion did reveal that paediatric DRLs have been established in a small number of EU member states and other states plan to establish them in the future. The need for DRLs for paediatric CT and IR procedures was outlined in the ‘European guidelines on DRLs for paediatric imaging’ (Radiation Protection No 185), so this was a welcome development.
The workshop also revealed the limited use of DRLs in nuclear medicine – in large numbers of SPECT/CT and significant numbers of PET/CT systems there are no paediatric acquisition protocols. This should urgently be addressed.