Patrice Roch1, David Célier2, Cécile Dessaud3, Cécile Etard2. 1. Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la division Leclerc, 92260 Fontenay-aux-Roses, France. Electronic address: rochpr@gmail.com. 2. Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la division Leclerc, 92260 Fontenay-aux-Roses, France. 3. CERAP, 4 rue René Razel, Domaine Technologique de Saclay, 91400 Saclay, France.
Abstract
OBJECTIVES: Twelve years since the implementation of Diagnostic Reference Levels (DRL) process in France, the Nuclear Safety and Radiation Protection French Institute (IRSN) presents its latest analyses performed on the most recent national data. METHODS: Statutorily, each year, medical imaging departments must perform patient exposure evaluation from their clinical practice for at least 2 types of radiographic and computed tomography (CT) examinations freely chosen in the regulatory list. The samples of dosimetric data used for the evaluations must be sent to IRSN for national assessment using a dedicated and secured web portal. The analyses of collected data for radiography and CT allow IRSN to estimate the representativeness of current DRLs in terms of target practices and examinations, dosimetric quantities and numerical values. Technical data are transmitted, such as detector type in radiography or commissioning date of CT, and are included in some complementary analyses in order to evaluate their influence on patient exposure. RESULTS: Since 2004 the involvement of professionals in the DRL process has highly increased in CT (about 80% in 2015) but remains quite weak in radiography (almost 30%). Analyses show some discordance between regulation references and clinical practice leading to clinical doses data which are 40% lower than DRLs in 2015. As a consequence, the list of examinations types and some numerical values should be updated in the regulation. Focused analyses show a significant patient exposure reduction when digital radiography is used and when CT equipment is under five years old. CONCLUSIONS: Based on these findings, IRSN recommends to update DRL regulation with current and relevant examination lists, dosimetric quantities and numerical values. In addition, this study shows that technology and generation of equipment, such as detector type in radiography or image reconstruction algorithm in CT, take an important place in the dose optimisation process, enabling significant patient exposure reduction when it is associated with protocols optimisation.
OBJECTIVES: Twelve years since the implementation of Diagnostic Reference Levels (DRL) process in France, the Nuclear Safety and Radiation Protection French Institute (IRSN) presents its latest analyses performed on the most recent national data. METHODS: Statutorily, each year, medical imaging departments must perform patient exposure evaluation from their clinical practice for at least 2 types of radiographic and computed tomography (CT) examinations freely chosen in the regulatory list. The samples of dosimetric data used for the evaluations must be sent to IRSN for national assessment using a dedicated and secured web portal. The analyses of collected data for radiography and CT allow IRSN to estimate the representativeness of current DRLs in terms of target practices and examinations, dosimetric quantities and numerical values. Technical data are transmitted, such as detector type in radiography or commissioning date of CT, and are included in some complementary analyses in order to evaluate their influence on patient exposure. RESULTS: Since 2004 the involvement of professionals in the DRL process has highly increased in CT (about 80% in 2015) but remains quite weak in radiography (almost 30%). Analyses show some discordance between regulation references and clinical practice leading to clinical doses data which are 40% lower than DRLs in 2015. As a consequence, the list of examinations types and some numerical values should be updated in the regulation. Focused analyses show a significant patient exposure reduction when digital radiography is used and when CT equipment is under five years old. CONCLUSIONS: Based on these findings, IRSN recommends to update DRL regulation with current and relevant examination lists, dosimetric quantities and numerical values. In addition, this study shows that technology and generation of equipment, such as detector type in radiography or image reconstruction algorithm in CT, take an important place in the dose optimisation process, enabling significant patient exposure reduction when it is associated with protocols optimisation.
Authors: Axel Meineke; Christian Rubbert; Lino M Sawicki; Christoph Thomas; Yan Klosterkemper; Elisabeth Appel; Julian Caspers; Oliver T Bethge; Patric Kröpil; Gerald Antoch; Johannes Boos Journal: Eur Radiol Date: 2019-02-19 Impact factor: 5.315
Authors: Khalid M Alshamrani; Abdulkader A Alkenawi; Bushra N Alghamdi; Rawan H Honain; Haneen A Alshehri; Marwah O Alshatiri; Noor Mail; Ahmed Subahi; Shaza S Alsharif; Abdulaziz A Qurashi; Shrooq Aldahery; Reham Kaifi Journal: Cureus Date: 2021-05-13