Abstract
Diagnostic reference levels (DRL) are recommended exposure/dose indicator values used for optimization and to ensure patient/worker radiation safety in diagnostic and interventional procedures involving ionizing radiation. The value that fits 75% of the dose indicator value distribution for a certain number of patients is defined as the DRL for that procedure. There are different DRL indicators in radiography, diagnostic and interventional fluoroscopy, mammography and computed tomography, depending on the device technology and dose measurement method. It is recommended that the determination of DRL and the evaluation of these values for the optimization process be repeated at regular intervals and after the emergence of new imaging technologies or innovations in existing ones. The sole goal in the DRL creation and follow-up process is not to reduce the radiation dose applied to the patient. It should also be demonstrated that the diagnostic quality of the images obtained were protected as a result of the optimization is preserved. The DRL value should be determined primarily in frequently performed radiological procedures. Determining the DRL for rarely performed imaging is neither practical nor necessary. When DRL values are exceeded, they do not indicate malpractice and are not investigated individually for each patient.
Keywords: Diagnostic reference levels, radiation dosage, radiation protection, radiography, computed tomography
References
International Commission on Radiological Protection (ICRP). International recommendations for X-ray and radium protection: Stockholm 1929.Ann ICRP. 1959;OS1:62-73.
Harding K, Thomson WH. Radiological protection and safety in medicine-ICRP 73.Eur J Nucl Med.1997; 24: 1207-9.
Vañó E, Miller D, Martin C, Rehani M, Kang K, Rosenstein M, et al. ICRP Publication 135: diagnostic reference levels in medical ımaging.Ann ICRP.2017; 46: 1-144.
Akhdar HF. Assessment of entrance skin dose and effective dose of some routine x-ray examinations using calculation technique.King Saud University.2007.
Suleiman ME, Brennan PC, McEntee MF. Mean glandular dose in digital mammography: a dose calculation method comparison.J Med Imaging (Bellingham).2017; 4: 13502.
Parmaksız A, Ataç GK, Bulur E, İnal T, Aslıhan A. Average glandular doses and national diagnostic reference levels in mammography examinations in Turkey.Radiat Prot Dosimetry. ; 190: 100-7.
Weisenthal K, Karthik P, Shaw M, Sengupta D, Bhargavan-Chatfield M, Burleson J, et al. Evaluation of kidney stones with reduced-radiation dose CT: progress from 2011-2012 to 2015-2016-not there yet.Radiology.2018; 286: 581-9.
Bos D, Yu S, Luong J, Chu P, Wang Y, Einstein AJ, et al. Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry.Eur Radiol.2022; 32: 1971-82.
Järvinen H, Seuri R, Kortesniemi M, Lajunen A, Hallinen E, Savikurki-Heikkilä P, et al. Indication-based national diagnostic reference levels for paediatric CT: a new approach with proposed values.Radiat Prot Dosimetry.2015; 165: 86-90.
Brat H, Zanca F, Montandon S, Racine D, Rizk B, Meicher E, et al. Local clinical diagnostic reference levels for chest and abdomen CT examinations in adults as a function of body mass index and clinical indication: a prospective multicenter study.Eur Radiol. 2019; 29: 6794-804.
Ataç GK, Parmaksız A, İnal T, Bulur E, Bulgurlu F, Öncü T, et al. Patient doses from CT examinations in Turkey.Diagn Interv Radiol.2015; 21: 428-34.
Yurt A, Özsoykal İ, Kandemir R, Ada E. Local study of diagnostic reference levels for computed tomography examinations of adult patients in İzmir, Turkey.Radiat Prot Dosimetry. 2020; 190: 446-51.
Atlı E, Uyanık SA, Öğüşlü U, Çevik Cenkeri H, Yılmaz B, Gümüş B. Radiation doses from head, neck, chest and abdominal CT examinations: an institutional dose report.Diagn Interv Radiol.2021; 27: 147-51.
Kahraman G, Haberal KM, Ağıldere AM. Establishment of local diagnostic reference levels for computed tomography with cloud-based automated dose-tracking software in Türkiye.Diagn Interv Radiol.2024; 30: 205-11.
Filiz S, Gürel S, Gürel K. Institutional clinical indication-based typical dose values of multiphasic abdominopelvic computed tomography examinations.Diagn Interv Radiol.2024.
Kanal KM, Butler PF, Chatfield MB, Wells J, Samei E, Simanowith M, et al. U.S. Diagnostic reference levels and achievable doses for 10 pediatric CT examinations.Radiology. ; 302: 164-74.
