Diagnostic Reference Levels Values Research Articles

An audit of patient radiation doses during interventional cardiology procedures in Uttarakhand, India, and establishment of local diagnostic reference levels.

The objective of this study was to investigate patient radiation doses by a dose audit of three common interventional cardiology (IC) procedures: coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and CA-PTCA procedures performed in IC centres in the Uttarakhand state of India, for the establishment of local diagnostic reference levels (DRLs) and the estimation of average effective dose (Eav) for these procedures. For each procedure, the values of kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of cine images were recorded from 1233 CA, 458 PTCA and 736 CA-PTCA procedures performed over a 12-month period at 13 IC centres of the state. From the recorded dose data, 0.6%, 1.53% and 7.9% patients were identified to have exceeded the PKA trigger level of 500 Gy cm2 for possible skin injury for CA, PTCA and CA-PTCA procedures, respectively. The 3rd quartile of the distribution of the recorded PKA values for each type of procedure was calculated to estimate local DRL values. The estimated values of DRLs and Eav were 37, 153 and 224 Gy cm2, and 6.72, 23.97 and 34.79 mSv for CA, PTCA and CA-PTCA procedures, respectively. For about 77% of the surveyed centres, the recorded patient doses were in agreement with the international standards. The local DRLs proposed in this study may be used to achieve patient dose optimization during IC procedures and the obtained patient dose data may also be archived into national dose database for the establishment of national DRLs.

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

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.

Diagnostic Reference Levels of Radiographic and CT Examinations in Jordan: A Systematic Review.

A comprehensive search was performed to examine the literature on diagnostic reference levels (DRL) for computed tomography (CT) and radiography examinations that are performed routinely in Jordan. EBSCO, Scopus, and Web of Science were used for the search. The acronym "DRL" and the additional phrase "dose reference levels" were used to search for articles in literature. Seven papers that reported DRL values for radiography and CT scans in Jordan were identified. One study reported DRLs for conventional radiography, two studies reported CT DRLs in pediatrics, and the remaining four studies provided DRL values for adult CT scans. The most popular techniques for determining the DRLs were the entrance surface dose, volume CT dose index (CTDIvol), and dose-length product (DLP) values. Variations in Jordanian DRL values were noted across both modalities. Lower radiation doses and less variation in DRL values may be achieved by educating and training radiographers to better understand dose reduction strategies. To limit dose variance and enable dosage comparison, CT DRLs must be standardized in accordance with the guidelines of the International Commission on Radiological Protection (ICRP).

Glandular doses and diagnostic reference levels (DRLs) for Saudi breast cancer screening programme (2012-2021).

The aim of this study was to report the diagnostic reference levels (DRLs) corresponding to different compressed breast thickness (CBT) ranges. To achieve this, mammographic examinations with 187,788 exposures were analysed. The mean average glandular (AGD) dose was calculated per view, examination, and center. Moreover, the DRL values corresponding to different CBT ranges were reported. The result of the mean AGD per view was found to be 1.36 mGy for craniocaudal (CC) and 1.54 mGy for Mediolateral oblique (MLO), while the mean AGD per examination for all women was 1.45 mGy. The DRL values corresponding to CBTs between 20 to 79 mm ranges were below 2 mGy. These results were from a population of mean age = 49 ± 8 years and mean CBT = 58 ± 8 mm, and was imaged with mean exposures of 29 ± 1 kVp and 74 ± 31 mAs, and a mean compression force of 135±37 N. In conclusion, good mammography practice has been shown, as DRL values are within the limits suggested by the international organizations.

Evaluasi Nilai Diagnostic Reference Level (DRL) pada pemeriksaan CT Scan Thorax Kontras klinis tumor paru di RS X Jakarta

A contrast thorax CT scan is a CT scan procedure in the chest area (thorax) that uses a contrast agent to improve visualization of organs and structures in the chest. Lung tumors are the growth of abnormal lumps in lung tissue which can be benign or malignant. Awareness of the potential and increasing radiation dose in all CT scan examinations encourages radiographers to want and be able to minimize radiation exposure as the main goal in radiological examinations and also strive for radiation protection during examinations. CT scan radiation dose accounts for 70% of the total dose received from medical imaging. High or low doses of radiation received can increase the risk of cancer. The large dose of radiation received by a patient during a CT scan, therefore regulations are needed that will guarantee monitoring of the radiation dose received by the patient to ensure that the dose received is commensurate with medical purposes. The radiation dose to the patient needs to be optimized by applying the Diagnostic Reference Level (DRL) to optimize medical exposure protection for the patient. Dosage evaluation in clinical contrast chest CT scan examinations for lung tumors and the application of DRL in these examinations have never been carried out at RS X Jakarta. Objective: This study aims to determine the DRL value in clinical contrast thorax CT scan examination of lung tumors at RS CTDIvol and DLP values from clinical contrast Thorax CT Scan examination of lung tumors. The DRL value is calculated at Quartile 3 (75 percentile) using the descriptive frequency test and Wilcoxon test in the SPSS application, then compared with the latest IDRL value. Results: Quartile 3 value (75 percentile) from CTDIvol and DLP CT scan chest contrast clinical lung tumors, namely The CTDIvol value was 12.55 mGy and the DLP was 439 mGy.cm. Conclusion: The DRL value in the clinical contrast thorax CT scan for lung tumors at Hospital X Jakarta. is still below the recommended standard, which shows that the radiation output dose in this examination practice is within normal limits and is classified as safe.

National survey to update the diagnostic reference levels in interventional radiology procedures in Italy: working methodology.

Interventional Radiology (IR) deals with the diagnosis and treatment of various diseases through medically guided imaging. It provides unquestionable benefits to patients, but requires, in many cases, the use of high doses of ionizing radiation with a high impact on radiation risks to patients and to overall dose to the population. The International Commission on Radiological Protection introduced Diagnostic reference levels (DRLs) as an effective tool to facilitate dose verification and optimize protection for patients undergoing radiological procedures. In addition, EURATOM Council Directive 2013/59 and its Italian transposition (Legislative Decree 101/2020) have reiterated that DRLs must be established for many common radiological diagnostic procedures to compare the radiation dose delivered for the same diagnostic examination. Within this framework, Istituto Superiore di Sanità-Italian National Institute of Health (ISS)-, in collaboration with relevant Italian Scientific Societies, has provided documents on DRLs in radiological practices such as diagnostic and IR and diagnostic nuclear medicine. These reference documents enable National Hospitals to comply national regulation. The implementation of DRLs in IR is a difficult task because of the wide distribution of doses to patients even within the same procedure. Some studies have revealed that the amount of radiation in IR procedures is influenced more by the complexity of the procedure than by the weight of the patient, so complexity should be included in the definition of DRLs. For this reason, ISS promoted a survey among a sample of Italian Centers update national DRL in IR procedures with related complexity factors than can be useful for other radiological centers and to standardize the DRLs values. In the present paper the procedural methodology developed by ISS and used for the survey will be illustrated.

Diagnostic reference levels in spinal CT: Jordanian assessments and global benchmarks.

To reduce radiation dose and subsequent risks, several legislative documents in different countries describe the need for Diagnostic Reference Levels (DRLs). Spinal radiography is a common and high-dose examination. Therefore, the aim of this work was to establish the DRL for Computed Tomography (CT) examinations of the spine in healthcare institutions across Jordan. Data was retrieved from the picture archiving and communications system (PACS), which included the CT Dose Index (CTDI(vol)) and Dose Length Product (DLP). The median radiation dose values of the dosimetric indices were calculated for each site. DRL values were defined as the 75th percentile distribution of the median CTDI(vol) and DLP values. Data was collected from 659 CT examinations (316 cervical spine and 343 lumbar-sacral spine). Of the participants, 68% were males, and the patients' mean weight was 69.7 kg (minimum = 60; maximum = 80, SD = 8.9). The 75th percentile for the DLP of cervical and LS-spine CT scans in Jordan were 565.2 and 967.7 mGy.cm, respectively. This research demonstrates a wide range of variability in CTDI(vol) and DLP values for spinal CT examinations; these variations were associated with the acquisition protocol and highlight the need to optimize radiation dose in spinal CT examinations.

Studi Awal Evaluasi Optimisasi Paparan Medik pada CT Scan dan Radiografi Umum Berdasarkan Tingkat Panduan Diagnostik

Optimization of medical exposure seeks to keep the dose given to the patient as low as possible. In diagnostic and interventional radiology activities, optimization focuses on low doses and ensures sufficient image quality for diagnostic purposes. Implementation of medical exposure optimization can be evaluated by applying the Diagnostic Reference Level (DRL). Indonesia set DRL values for CT Scan and General Radiography in 2021. This study monitored efforts to optimize medical exposure nationally by comparing the annual dose profile with the Indonesian DRL (I-DRL) and I-DRL against the regional DRL, divided into five regions. The study was conducted from January to December 2022 using patient dose data at the Patient Dose Data Information System (Si-INTAN). The data was then analyzed to obtain a national dose profile through Quartile 3 analysis (Q3) and regional DRL values through median analysis (Q2). The analysis results show several CT Scan examinations, which are still higher than the National DRL. In addition, there are high doses for several types of examinations in the Bali and Nusa Tenggara Region for CT Scan and General Radiography. In the Kalimantan Region, there are types of CT Scan examinations that are still higher than the National DRL. Based on these results, BAPETEN needs to increase efforts to foster and encourage implementation, optimizing medical exposure nationally. Efforts that can be made include issuing optimization technical guidelines for each X-ray equipment, socialization and assistance on recording and reporting patient dose data, evaluating typical dose values, evaluating medical exposure optimization, and supervising the implementation of optimizing medical exposure through inspections. BAPETEN should collaborate with stakeholders so that the programmed efforts can be carried out effectively. Keywords: Optimization, Medical Exposure, Diagnostic Reference Level, CT Scan, General Radiography

Survei Penentuan Tingkat Panduan Diagnostik pada CT Scan Kepala dan Abdomen Non-Kontras di Rumah Sakit

Diagnostic reference level (DRL) is still low for monitoring patient doses on hospital CT Scan. The need for radiation monitoring of CT Scan patients is related to radiation protection. CT Scan have a large dose, and as CT Scan develop, it is necessary to monitor the dose of CT Scan, especially those related to DRL. The importance of DRL is related to efforts to optimize radiation protection, which must be monitored regularly so that patients receive the lowest possible dose with optimal image quality. Determination of the local DRL value from quartile 2 (Q2) and national DRL with Quartile 3 (Q3) from the average CTDI vol and total DLP recordings of non-contrast CT Scan of the head and abdomen. From the survey results, local DRL calculations and national DRL contribution or I-DRL are as follows: CT scan of the head based on Q2 and Q3 obtained CTDIvol of 63.45 mGy. Meanwhile, based on Q2, it is 913,68 mGy.cm; in Q3, the DLP is 1096,42 mGy.cm; this value is below the national standard. The CT Scan Abdomen CTDIvol examination based on Q2 obtained 8.08 mGy. and based on Q3 of 10.18 mGy. Both are below the national average of 17 mGy. DLP results based on Q2 got a result of 321.99 mGy.cm, and based on Q3 obtained a result of 419,82 mGy.cm; both values are below the standard. National standards are based on the Head of BAPETEN Decree 1211/K/V/2021. DRL that exceeds the national standard for head CT Scan requires a protocol review to obtain the lowest possible dose, but the image quality remains optimal. It is an effort to optimize radiation protection. Keywords: Diagnostic Reference Level, CT Scan, Head, Abdomen, Non-Contrast

Analisa Pengukuran Entrance Surface Dose (ESD) Menggunakan Optically Stimulated Luminescence Dosimeter (OSLD) Pada Pasien Anak

The surface dose of radiation in conventional diagnostic radiology exams, also known as the entrance surface dose (ESD), is measured to ensure optimal radiation protection for patients. This study aimed to determine and analyze the doses received by pediatric patients who underwent a chest X-ray examination while being treated in the NICU and PICU rooms at Hermina Karawang Hospital. The research involved measuring the radiation dose in pediatric patients using the OSLD nanoDot. This susceptible device can detect low-dose X-ray radiation exposure, especially in pediatric patients. The study was conducted from September to December 2022 and included 35 patients aged 0 to 5. The results of the ESD measurements received by pediatric patients at Hermina Karawang Hospital in the 0-1 year age group were found to be in line with the DRL (Diagnostic Reference Levels) of the United Kingdom (UK) and Austria, which recommend a range of 0.05 – 0.055 mGy. The average ESD value for this age group was 0.05 mGy. Similarly, for the 1-5 year age group, an average ESD value of 0.048 mGy was obtained, below the UK and Austria DRL range of 0.05 – 0.069 mGy. These results indicate that the ESD received by pediatric patients during thoracic examination at Hermina Karawang Hospital is close to the DRL values recommended by the UK and Austria. However, it is essential to note that regardless of the dose received, it must always be justified and optimized to prevent unnecessary radiation exposure. Keywords: ESD, OSLD, unnecessary exposure, paediatric radiation protection, radiation exposure

Medical radiation exposure during gastrointestinal enteral metallic stent placement: Post hoc analysis of the REX-GI study.

Recently, the use of various endoscopic procedures performed under X-ray fluoroscopy guidance has increased. With the popularization of such procedures, diagnostic reference levels (DRLs) have been widely accepted as the global standard for various procedures with ionizing radiation. The Radiation Exposure from Gastrointestinal Fluoroscopic Procedures (REX-GI) study aimed to prospectively collect actual radiation exposure (RE) data and establish DRLs in gastrointestinal endoscopy units. In this post hoc analysis of the REX-GI study, we established DRLs for each disease site by analyzing cases of gastrointestinal enteral metallic stent placement. The REX-GI study was a multicenter, prospective observational study conducted to collect actual RE data during gastrointestinal enteral metallic stent placement. To establish DRL values for three disease sites, namely the esophagus, gastroduodenum, and colon, we examined fluoroscopy time (FT; min), number of X-ray images, air kerma at the patient entrance reference point (K a,r; mGy), and the air kerma-area product (P KA; Gy cm2) during enteral metallic stent placement. Five-hundred and twenty-three stenting procedures were performed. The DRL values of FT (min) and the number of X-ray images for the esophagus/gastroduodenum/colon were 9/16/18 min and 9/15/11 min, respectively. Furthermore, the DRL values of K a,r and P KA for each disease site were 43.3/120/124 mGy and 10.3/36.6/48.4 Gy cm2, respectively. Among the procedures, esophageal stents were significantly associated with the lowest values (P < 0.001). The characteristics of RE vary according to disease site among gastrointestinal enteral metallic stent placements. Thus, it is desirable to set DRL values based on the disease site.

Patient Dose Estimation in Computed Tomography-Guided Biopsy Procedures.

This study establishes typical Diagnostic Reference Levels (DRL) values and assesses patient doses in computed tomography (CT)-guided biopsy procedures. The Effective Dose (ED), Entrance Skin Dose (ESD), and Size-Specific Dose Estimate (SSDE) were calculated using the relevant literature-derived conversion factors. A retrospective analysis of 226 CT-guided biopsies across five categories (Iliac bone, liver, lung, mediastinum, and para-aortic lymph nodes) was conducted. Typical DRL values were computed as median distributions, following guidelines from the International Commission on Radiological Protection (ICRP) Publication 135. DRLs for helical mode CT acquisitions were set at 9.7 mGy for Iliac bone, 8.9 mGy for liver, 8.8 mGy for lung, 7.9 mGy for mediastinal mass, and 9 mGy for para-aortic lymph nodes biopsies. In contrast, DRLs for biopsy acquisitions were 7.3 mGy, 7.7 mGy, 5.6 mGy, 5.6 mGy, and 7.4 mGy, respectively. Median SSDE values varied from 7.6 mGy to 10 mGy for biopsy acquisitions and from 11.3 mGy to 12.6 mGy for helical scans. Median ED values ranged from 1.6 mSv to 5.7 mSv for biopsy scans and from 3.9 mSv to 9.3 mSv for helical scans. The study highlights the significance of using DRLs for optimizing CT-guided biopsy procedures, revealing notable variations in radiation exposure between helical scans covering entire anatomical regions and localized biopsy acquisitions.

Local Diagnostic Reference Levels for Pediatric Interventional Cardiology Procedures in Argentina.

The aim of this work was to propose a preliminary local diagnostic reference levels (DRL) for pediatric interventional cardiology (PIC) procedures in Argentina, for different ranges of age and weight. This work has been conducted in the framework of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency to ensuring that radiation exposures of pediatric patients are the minimum necessary during fluoroscopy-guided interventional procedures. The local DRL values presented in this paper by weight group and age group were 7.1 Gy·cm2 (<5 kg), 10.7 Gy·cm2 (5-15 kg), 18.0 Gy·cm2 (15-30 kg), 15.9 Gy·cm2 (30-50 kg), and 28.2 Gy·cm2 (50-80 kg) and 5.3 Gy·cm2 (<1), 11.2 Gy·cm2 (1 to 5<), 19.6 Gy·cm2 (5 to 10<), and 21.4 Gy·cm2 (10 to 16<), respectively. Our dose results are among the values found in other international studies; however, there is great potential for dose optimization.

Determination of the Diagnostic Reference Level (DRL) in Samarinda Hospitals

The diagnostic reference level (DRL) is a form of investigative level used as a tool to help optimize protection to radiation exposure for diagnostic and interventional procedures. The purpose of this study was to determine the local DRL values for the examination of the abdomen, thorax, and head at radiology installations. The modality used was 128-slice CT scan. The numbers of patients whose data were used were 200 for abdominal examinations, 160 for thoracic examinations, and 100 for head examinations. Overall, the total patient whose data was used was 460. Data processing in this study was carried out with a quantitative analysis technique, namely descriptive statistics. This analysis technique used secondary data obtained from the results of recaptures or archival books for examination of the abdomen, thorax, and head. Data processing was carried out with a measure of diversity through the calculation of the third quartile in the data distribution. It was assumed that 75 % of patients performed examinations with a common diagnosis. The results of these calculations are visualized in the form of graphs of the relationship of computed tomography dose index volume (CTDIvol) with the number of patients and a graph of the relationship of dose length product (DLP) with the number of patients. In the abdominal examination, a CTDIvol of 12 mGy and a DLP of 1545.5 mGy·cm. In the thoracic examination, a CTDIvol of 11 mGy and a DLP of 903 mGy·cm were obtained. For the head examination, a CTDIvol of 34.25mGy and a DLP of 2190.25 mGy·cm were obtained. The conclusion obtained from this study is that the DRLs are relatively low, but they still need to be optimized by medical physicists.

Diagnostic reference levels for common pediatric computed tomography studies: A retrospective study.

With the rapid increase in computed tomography (CT) examinations among pediatric patients, the concern about the effects of radiation exposure in this population has increased. Therefore, it is necessary to measure and regulate radiation exposure, which can be done using diagnostic reference levels (DRLs). This study aimed to calculate typical values for common pediatric studies at the radiology department of King Abdulaziz University Hospital Jeddah, Saudi Arabia. For a single institute, these are calculated as the median of computed tomography dose index (CTDIvol, mGy) or dose length product (DLP, mGy.cm) values. Pediatric patient data from January 2015 to December 2020 were collected, including CT examinations, dose descriptors, imaging protocols, and scanning parameters. A total of 8717 radiological studies were included in the sample. They were categorized into three age groups; more than half of the 5102 (58.5%) belonged to Group 1 (0–5 years), 1790 (20.5%) were in Group 2 (6–10 years), and 1826 (20.9%) were in Group 3 (11–15 years). Brain CT angiogram, non-enhanced brain CT, and Internal Auditory Canal (IAC) CT had the highest mean CTDI Vol and DLP, while virtual bronchoscopy contrast-enhanced chest and neck CT angiography had the lowest mean CTDI Vol. The values of DRLs in the current study were approximately lower than and comparable with those reported in other studies.

Reporting Diagnostic Reference Levels for Paediatric Patients Undergoing Brain Computed Tomography.

Brain computed tomography (CT) is a diagnostic imaging tool routinely used to assess all paediatric neurologic disorders and other head injuries. Despite the continuous development of paediatric CT imaging, radiation exposure remains a concern. Using diagnostic reference levels (DRLs) helps to manage the radiation dose delivered to patients, allowing one to identify an unusually high dose. In this paper, we propose DRLs for paediatric brain CT examinations in Saudi clinical practices and compare the findings with those of other reported DRL studies. Data including patient and scanning protocols were collected retrospectively from three medical cities for a total of 225 paediatric patients. DRLs were derived for four different age groupings. The resulting DRL values for the dose-length product (DLP) for the age groups of newborns (0-1 year), 1-y-old (1-5 years), 5-y-old (5-10 years) and 10-y-old (10-15 years) were 404 mGy cm, 560 mGy cm, 548 mGy cm, and 742 mGy cm, respectively. The DRLs for paediatric brain CT imaging are comparable to or slightly lower than other DRLs due to the current use of dose optimisation strategies. This study emphasises the need for an international standardisation for the use of weight group categories in DRL establishment for paediatric care in order to provide a more comparable measurement of dose quantities across different hospitals globally.

Diagnostic Reference Levels in Interventional Pediatric Cardiology: Two-Year Experience in a Tertiary Referral Hospital in Latin America.

The goal of the present study was to propose the first local diagnostic reference levels (DRLs) for interventional pediatric cardiology procedures in a large hospital in Colombia. The data collection period was from April 2020 to July 2022. The local DRLs were calculated as the 3rd quartile of patient-dose distributions for the kerma-area product (Pka) values. The sample of collected clinical procedures (255) was divided into diagnostic and therapeutic procedures and grouped into five weight and five age bands. The Pka differences found between diagnostic and therapeutic procedures were statistically significant in all weight and age bands, except for the 1-5-year age group. The local DRLs for weight bands were 3.82 Gy·cm2 (<5 kg), 7.39 Gy·cm2 (5-<15 kg), 19.72 Gy·cm2 (15-<30 kg), 28.99 Gy·cm2 (30-<50 kg), and 81.71 Gy·cm2 (50-<80 kg), respectively. For age bands, the DRLs were 3.97 Gy·cm2 (<1 y), 9.94 Gy·cm2 (1-<5 y), 20.82 Gy·cm2 (5-<10 y), 58.00 Gy·cm2 (10-<16 y), and 31.56 Gy·cm2 (<16 y), respectively. In conclusion, when comparing our results with other existing DRL values, we found that they are similar to other centers and thus there is scope to continue optimizing the radiation dose values. This will contribute to establishing national DRLs for Colombia in the near future.

Establishing national diagnostic reference levels in radiography, mammography, and dual-energy x-ray absorptiometry services in Ireland and comparing these with European diagnostic reference levels.

The aim of this work was to establish national diagnostic reference levels (DRLs) in Ireland and compare these to existing European DRLs where available. This work surveyed all radiological facilities providing radiography, mammography, and dual-energy x-ray absorptiometry (DXA) services in Ireland. A list of common procedures and clinical tasks was established. A national database of service providers was used to identify the appropriate medical radiological facilities providing these services. These facilities were issued with an online survey. National DRLs were set as the 75th percentile of the distribution of median values obtained. A national median dose was also established. The broad categorisation of equipment type was also considered. Where differences between DRLs established using different detector types were deemed statistically significant, equipment-specific national DRLs were established. National DRLs were established for 12 adult radiography projections. Equipment-specific (computed radiography and digital radiography) adult DRLs were established for four radiography projections. Paediatric DRLs were established for 11 radiography projections, including two based on clinical indications, for a range of paediatric weight categories. National DRLs were established for unilateral two-view mammography and breast tomosynthesis as well as for four DXA clinical indications and projections. All but one Irish DRL figure was found to be below or equal to European data. This work provided a unique opportunity to establish national DRLs based on census data for a range of procedures and clinical tasks across radiography, mammography and DXA and compare these with European levels. This work established national diagnostic reference levels (DRLs) based on census data for a range of procedures and clinical tasks across radiography, mammography and dual-energy x-ray absorptiometry. The establishment of national DRLs is an essential component in the optimisation of patient radiation dose. • Diagnostic reference levels are easily measured quantities intended for use as an aid to optimise patient dose and to identify when levels of patient dose are unusually high. • Data from all medical radiological facilities in Ireland was obtained to establish national diagnostic reference level (DRL) values and national median dose values in radiography, x-ray breast imaging and dual-energy x-ray absorptiometry (DXA) scanning and these were compared to existing European DRLs where available. • National DRL values were established for the first time in breast tomosynthesis, DXA scanning, and paediatric radiography.

PENERAPAN SSDE-DIAMETER EKUIVALEN AIR SEBAGAI TINGKAT PANDUAN DIAGNOSIS TYPICAL VALUE PADA PEMERIKSAAN CT SCAN ABDOMEN PEDIATRIK

Diagnostic Reference Level (DRL) is a method of optimizing patient doses in diagnostic and intervention procedures. The DRL value is obtained from the Volumetric Computed Tomography Dose Index (CTDIvol) which is obtained from a phantom with a diameter of 16 cm or 32 cm, so it is not yet possible to accurately estimate the dose for each patient, especially pediatric patients. The American Association of Physicists in Medicine (AAPM) then issued a water equivalent diameter (Dw) parameter to calibrate the CTDIvol to obtain a Size-Specific Dose Estimate (SSDE) so that it is more specific and effective. This study aims to obtain local DRL values ​​and compare local DRL values ​​in two pediatric age groups. This study used data from 25 pediatric abdominal CT scan patients aged &lt;15 years, divided into two groups, ages 0-4 years and ages 5-15 years. The results of this study showed that typical  DRLCTDIvol values ​​for ages 0-4 years and 5-15 years were 3.09 mGy and 4.39 mGy respectively, while DRLSSDE for the two age groups were 3.25 mGy and 3.54 mGy respectively. There is a difference of 5.27% and 19.36% respectively from the local DRL value based on CTDIvol and SSDE for the two age groups. It can be seen that in the 0-4 year age group, the DRLSSDE value is greater than the DRLCTDIvol, conversely in the 5-15 year age group the DRLSSDE value is lower than the DRLCTDIvol which indicates that the dimensional factor affects the dose received by the patient.

Radiation dose and factors related to exceeding the diagnostic reference level in 496 transnasal ileus tube placement procedures from the REX-GI study

We aimed to examine the factors contributing to radiation exposure exceeding the DRL of the transnasal ileus tube placement in this post hoc analysis from the cohort of the REX-GI study. Patients with transnasal ileus tubes were enrolled in the rex-gi study from may 2019 to december 2020. We investigated the endoscope insertion time (min), procedure time (min), tube insertion length (cm), fluoroscopy time (FT: min), air kerma at the patient entrance reference point (Ka.r: mGy), and air kerma-area product (PKA: Gycm2). The third quartile value of the PKA value was calculated as the diagnostic reference level (DRL) value. We explored the factors associated with radiation exposure exceeding the DRL. In the REX-GI study, 496 patients who underwent transnasal ileus tube placement were enrolled. The median age of the patients was 71 years. The median endoscopy insertion time, procedure time, and tube insertion length were 6 min, 20 min, and 170 cm, respectively. The third quartile/median FT, Ka.r, and PKA were 18/11.9 min, 99.2/54.4 mGy, and 46.9/28 Gycm2, respectively. The third quartile value of PKA (47 Gycm2) was set as the DRL value. There were differences in distribution by the hospital. Compared with procedures under the DRL, the FT (19 vs 10 min), procedure time (25 vs 18 min), and tube insertion length (185 vs 165 cm) were significantly longer for procedures above the DRL. We report the DRL for transnasal ileus tube placement in Japan. A longer procedure time and tube insertion length may be associated with DRL exceedance. Transnasal ileus tube placement under fluoroscopy guidance is a standard clinical procedure for bowel obstruction. However, the appropriate radiation dose level has not yet been established.We report the (DRL) for transnasal ileus tube placement in Japan. A longer procedure time and tube insertion length may be associated with DRL exceedance.