The growing potential of diagnostic reference levels as a dynamic tool for dose optimization.

Published on Mar 20, 2021in Physica Medica2.485
· DOI :10.1016/J.EJMP.2021.03.018
John Damilakis44
Estimated H-index: 44
(UoC: University of Crete),
Jenia Vassileva15
Estimated H-index: 15
(IAEA: International Atomic Energy Agency)
Abstract Diagnostic Reference Levels (DRLs) is an important tool that can improve radiation safety in medical imaging. However, there are certain aspects that need improvement and several obstacles that should be overcome before DRLs are fully implemented in practice. It is the authors belief that DRLs should be a dynamic tool that follows the development of clinical practice and technology advances. The establishment of adult and paediatric DRLs based on clinical indications should be considered as a priority. A common methodology and terminology is needed to allow for their clinical use. Dose monitoring systems can improve and accelerate the establishment, update and use of DRLs. However, certain steps need to be taken for proper collection. organization and analysis of big data. Availability of clinically qualified medical physicists in medical imaging departments, awareness on the importance of dose optimization and proper cooperation of relevant stakeholders are important prerequisites for the successful establishment and use of DRLs.
#1Virginia TsapakiH-Index: 21
#2John Damilakis (UoC: University of Crete)H-Index: 44
Last. Guy Frija (Paris V: Paris Descartes University)H-Index: 31
view all 7 authors...
The objective of this study was to investigate the feasibility of defining diagnostic reference levels (DRLs) on a European basis for specific clinical indications (CIs), within the context of the European Clinical DRLs (EUCLID) European Commission project. A prospective, multicenter, industry-independent European study was performed to provide data on 10 CIs (stroke, chronic sinusitis, cervical spine trauma, pulmonary embolism, coronary calcium scoring, coronary angiography, lung cancer, hepato...
4 CitationsSource
Radiation dose in computed tomography (CT) has become a hot topic due to an upward trend in the number of CT procedures worldwide and the relatively high doses associated with these procedures. The main aim of this review article is to provide an overview of the most frequently used metrics for CT radiation dose characterization, discuss their strengths and limitations, and present patient dose assessment methods. Computed tomography dosimetry is still based on a CT dose index (CTDI) measured us...
2 CitationsSource
#1Dea Dundara Debeljuh (University of Rijeka)H-Index: 2
#2Slaven Jurković (University of Rijeka)H-Index: 7
Last. Jenia Vassileva (IAEA: International Atomic Energy Agency)H-Index: 15
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Abstract Purpose In order to introduce the concept of diagnostic reference levels (DRLs) in the national nuclear medicine practice a survey was proposed and completed through all nuclear medicine departments in Croatia. An additional aim was to increase the awareness of importance and full implementation of a comprehensive quality program that includes devices used in the nuclear medicine chain. Methods Data were collected for more than 30 nuclear medicine single photon emission procedures. Nati...
1 CitationsSource
#6Werner JaschkeH-Index: 62
#7Guy Frija (Paris V: Paris Descartes University)H-Index: 31
In August 2017, the European Commission awarded the “European Study on Clinical Diagnostic Reference levels for X-ray Medical Imaging” project to the European Society of Radiology, to provide up-to-date Diagnostic Reference Levels based on clinical indications. The aim of this work was to conduct an extensive literature review by analysing the most recent studies published and the data provided by the National Competent Authorities, to understand the current situation regarding Diagnostic Refere...
8 CitationsSource
#1Francesca De MonteH-Index: 3
#2Biagio Castaldi (UNIPD: University of Padua)H-Index: 13
Last. A. RoggioH-Index: 7
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PURPOSE To define weight-stratified Diagnostic Reference Levels (DRL) typical values for pediatric interventional cardiology (IC) procedures adopting standardized methodologies proposed by ICRP135 and RP185. METHODS Procedures performed at the pediatric catheterization room of the University-Hospital of Padua were analysed. Patients were stratified into body weight (BW) classes and DRL quantities were analysed for the most performed procedures. Typical values are defined as median PKA and Ka,r. ...
2 CitationsSource
OBJECTIVES: To establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive. METHODS: Seventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic a...
4 CitationsSource
#2L. AlejoH-Index: 5
Last. Eduardo Guibelalde (Complutense University of Madrid)H-Index: 14
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Abstract Purpose To establish local diagnostic reference levels (DRLs) for non-cardiac interventional procedures in paediatrics. Methods The type of procedure, the patient’s weight and age and dose-related data from 279 interventions was recorded in a database completed by interventional radiologists, radiographers and technicians of the Medical Physics department. These procedures were classified into 14 categories and 6 weight ranges. Local DRLs were proposed for those ranges in which a sample...
4 CitationsSource
#1Mohamad Fawzi Awad (AUB: American University of Beirut)H-Index: 1
#2Lina Karout (AUB: American University of Beirut)H-Index: 2
Last. Charbel Saade (AUB: American University of Beirut)H-Index: 10
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Head and body computed tomography (CT) is a routinely employed diagnostic tool for the detection and diagnosis of disease processes. With the chief focus of radiation dose reduction and improvements in CT scanners, radiation dose exposure still remains an ever-increasing concern. However, scanning protocol optimization relative to body weight and scanner manufacturer still lags behind Diagnostic Reference Levels (DRL) that are set on an international scale. The aim of this systematic review is t...
1 CitationsSource
#1Roberto M. Sánchez (Hospital Clínico San Carlos)H-Index: 15
#2Eliseo Vano (Complutense University of Madrid)H-Index: 58
Last. Bonifacio TobarraH-Index: 1
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Abstract The aim of this study is to propose national diagnostic reference levels (DRL) for updating in the field of interventional cardiology and to include technical details to help plan optimization. Medical physics experts and interventional cardiologists from 14 hospitals provided patient dose indicators from coronary angiography and percutaneous coronary interventions. Information about X-ray system dose settings and image quality was also provided. The dose values from 30,024 procedures a...
5 CitationsSource
#1P. Roch (Institut de radioprotection et de sûreté nucléaire)H-Index: 6
#2David Celier (Institut de radioprotection et de sûreté nucléaire)H-Index: 4
Last. Madan M. Rehani (Harvard University)H-Index: 32
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Objectives To analyze 11-year data of France for temporal trends in dose indices and dose optimization and draw lessons for those who are willing to work on creation and update of diagnostic reference levels (DRLs).
11 CitationsSource
Cited By1
#1Lama Hadid-Beurrier (University of Paris)H-Index: 2
#2Djamel Dabli (University of Montpellier)H-Index: 2
Last. Julien Le Roy (University of Montpellier)H-Index: 5
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PURPOSE To establish diagnostic reference levels (DRLs) and achievable levels (ALs) for the most common fluoroscopically guided interventions (FGIs) performed in operating rooms using mobile C-arm equipment. METHODS A national survey was performed in 57 centers in France. Anonymous data from 6817 patients undergoing FGIs were prospectively collected over a period of 7 months. DRLs (third quartile of the distribution) and ALs (median of the distribution) were determined for each type of intervent...