Updating national diagnostic reference levels for computed tomography in Greece: Challenges on patient protection optimisation

Abstract

The escalating use of Computed Tomography (CT) imaging necessitates establishment and periodic revision of Diagnostic Reference Levels (DRLs) to ensure patient protection optimization. This paper presents the outcomes of a national survey conducted from 2019 to 2022, focusing on revising DRLs for adult CT examinations. Dosimetric data from 127 scanners in 120 medical facilities, representing 25% of the country's CT scanners, were collected, emphasizing geographic distribution and technology representation. Τhe parameters used for DRLs were the CTDIvol and the DLP of a typical acquisition of the region of interest (scan DLP). In addition to the 7 CT examination for which the DRL values were revised, establishment of DRLs for neck, cervical spine, pelvic bones-hips, coronary artery calcium (Ca) score and cardiac computed tomography angiography (CCTA) examinations was performed.Revised DRLs exhibited a 15 % average decrease in CTDIvol and a 7 % average decrease in scan DLP from the initial DRLs. This reduction of dosimetric values is relatively low compared to other national studies. The findings revealed wide variations in dosimetric values and scan lengths among scanners, emphasizing the need for standardization and optimization. Incorporation of advanced technologies like Iterative Reconstruction (IR) showcased potential for further dose reduction, yet challenges in uniform implementation persist. The study underscores the importance of ongoing optimisation efforts, particularly in the context of increased CT utilization and evolving technology. The revised DRLs have been officially adopted in Greece, emphasizing the commitment to safe and effective CT practices.