European Diagnostic Reference Levels Research Articles

Establishment of local diagnostic reference levels for abdomen and chest radiographies in the region of Algarve, Portugal

PurposeTo assess doses variabilities in the same abdomen and chest RX exams for adults, to check the need for dose harmonization. To calculate Diagnostic Reference Levels (DRL), mandatory in the European Union, for the Algarve district in Portugal. Our results can be a valuable reference for the Portuguese official determination of DRLs, still in progress. MethodWe considered 4,936 abdomen and 41,320 chest radiographs of adults, covering 7 health centres and 35 radiographers in Algarve. Entrance skin dose (ESD) was calculated for each radiograph and the corresponding uncertainty estimated. Mean doses per centre and per technician, and their uncertainties, were calculated to access dose variabilities. DRLs, set at the 3rd quartile of the total ESD distribution, were determined for a standard patient and for intervals of body mass index (BMI) to study their correlation with patient anatomical variations. Standard quartile errors were estimated. ResultsOur results suggest significant dispersion in applied ESDs among different centres and radiographers. Estimates of DRLs also show small fluctuations across years and an important dependence on BMI intervals. For a standard patient, they are 8.7 ± 0.1 (abdomen) and 0.44 ± 0.01 (chest), while the European DRLs are, respectively, 5.1 and 0.2 (all in mGy). ConclusionsResults suggest that there is room for dose optimization and harmonization with European DRLs, urging a national dose survey and the establishment of official national DRLs. Official DRLs in intervals of BMI would be quite beneficial, to avoid unnecessary dose exposures.

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.

Diagnostic reference levels for chest computed tomography in children as a function of patient size

BackgroundRadiation exposures from computed tomography (CT) in children are inadequately studied. Diagnostic reference levels (DRLs) can help optimise radiation doses.ObjectiveTo determine local DRLs for paediatric chest CT performed mainly on modern dual-source, multi-slice CT scanners as a function of patient size.Materials and methodsFive hundred thirty-eight chest CT scans in 345 children under 15 years (y) of age (median age: 8 y, interquartile range [IQR]: 4–13 y) performed on four different CT scanners (38% on third-generation and 43% on second-generation dual-source CT) between November 2013 and December 2020 were retrospectively analysed. Examinations were grouped by water-equivalent diameter as a measure of patient size. DRLs for volume CT dose index (CTDIvol) and dose-length product (DLP) were determined for six different patient sizes and compared to national and European DRLs.ResultsThe DRLs for CTDIvol and DLP are determined for each patient size group as a function of water-equivalent diameter as follows: (I) < 13 cm (n = 22; median: age 7 months): 0.4 mGy, 7 mGy·cm; (II) 13 cm to less than 17 cm (n = 151; median: age 3 y): 1.2 mGy, 25 mGy·cm; (III) 17 cm to less than 21 cm (n = 211; median: age 8 y): 1.7 mGy, 44 mGy·cm; (IV) 21 cm to less than 25 cm (n = 97; median: age 14 y): 3.0 mGy, 88 mGy·cm; (V) 25 cm to less than 29 cm (n = 42; median: age 14 y): 4.5 mGy, 135 mGy·cm; (VI) ≥ 29 cm (n = 15; median: age 14 y): 8.0 mGy, 241 mGy·cm. Compared with corresponding age and weight groups, our size-based DRLs for DLP are 54% to 71% lower than national and 23% to 85% lower than European DRLs.ConclusionWe developed DRLs for paediatric chest CT as a function of patient size with substantially lower values than national and European DRLs. Precise knowledge of size-based DRLs may assist other institutions in further dose optimisation in children.

Comparison of Radiation Dose in CT Examinations At PIMS with European Commission Reference Doses

OBJECTIVE - The purpose of this study was to assess the radiation dose levels from common computed tomography (CT) examinations performed in Radiology Department of Pakistan Institute of Medical Sciences (PIMS), and evaluate these according to diagnostic reference levels (DRLs) proposed by European Commission (EC) guidelines, and thus contributing towards the establishment of local and national DRLs. To the best of our knowledge, this is the first study of its kind to explore radiation doses from CT examinations in Pakistan.&#x0D; STUDY DESIGN - This was a quantitative study conducted at PIMS, Islamabad, spanning a duration of eight weeks. Scan parameters and dose profile data of 1506 adults undergoing examinations of head, neck, chest and abdomen-pelvis regions, comprising of single- and multi-phase, contrast-enhanced and unenhanced studies. Dose indicators utilized by EC guidelines for DRLs include volume CT dose index (CTDIvol) and Dose Length Product (DLP) for single slice and complete examination radiation doses, respectively.&#x0D; METHOD - Values of CTDIvol, DLP and scan lengths were extracted from the CT operators console. Other control variables included gender, contrast enhancement and phasicity of study. IBM SPSS package was used to obtain descriptive statistics such as mean and quartiles.&#x0D; RESULTS - DRLs calculated as 75th percentile of CTDIvol, DLP for various anatomical regions are by and far comparable to European DRLs.&#x0D; CONCLUSION – This study describes institutional diagnostic reference levels for common CT exams in Islamabad and provides benchmark values for future reference. Our DRL values are mostly comparable to European and international DRLs. Similar, albeit large scale, surveys are recommended for establishment of local and national DRLs, eventually contributing towards development of regional DRLs.&#x0D; KEYWORDS: CTDIvol, DLP, Diagnostic Reference Levels, Computed Tomography, Radiation Monitoring, Scan length

Diagnostic reference levels in paediatric fluoroscopy: how does a secondary referral centre compare with 2018 European guidelines?

To compare diagnostic reference levels (DRLs) in paediatric fluoroscopy at a secondary referral centre with 2018 European guidelines. Secondly, to compare secondary referral centre DRLs for paediatric fluoroscopy examinations not included in European guidelines with 2010 national UK DRLs. Paediatric fluoroscopy studies were grouped by age (groups: 0, 1, 5, 10, 15 years) for examination type and analysed retrospectively, over a period of 14 years. DRLs were compared with European DRLs (micturating cystourethrograms (MCUs)) and 2010 UK national DRLs (contrast swallows and meals). 1,586 studies were performed (49% MCUs; 31% meals; 9% swallows). For all age groups, DRLs for MCUs were lower than European DRLs by up to a factor 58 x (1 year age group: secondary referral centre DRL 12 mGycm2 vs European DRL 700 mGycm2). For contrast swallows and meals, 75th percentile doses were lower than 2010 UK national 25th percentile doses in all age groups. Maintaining low doses of ionising radiation is particularly important in paediatrics, and our study has found that it is possible to achieve low paediatric fluoroscopy doses in a secondary referral centre setting. Our data may prove useful to other centres and could contribute towards future European DRLs.

Local Diagnostic Reference Levels for Paediatric Head CT Procedures.

Background.Patients, especially children, are exposed to substantially high doses of ionising radiation during computed tomography (CT) procedures. Children are several times more susceptible to ionising radiation than adults. Diagnostic reference levels (DRLs) are an important tool for monitoring and optimising patient radiation exposure from radiological procedures. The aim of this study is to estimate the ionising radiation exposure doses and set local DRLs for head CT examinations according to age and to compare local DRLs with national and European DRLs and with literature data in other countries.Materials and methods.Scan parameters of single-phase head CT examinations were collected. Patients were grouped by age in the following intervals: <1, 1−5, 5−10, 10−15 and 15−18 years. Local age-based DRLs set as the 3rd quartile of the median dose-length product (DLP) were calculated. Literature analysis was performed on PubMed search engine on inclusion criteria: publication date 2015–2020, used keywords paediatric computed tomography, paediatric CT, diagnostic reference levels (DRLs). The 23 articles discussing paediatric DRLs were further analysed.Results.Data was collected from 194 paediatric head CT examinations performed in 2019. The median DLP values for head CT were 144.3, 233.7, 246.4, 288.9, 315.5 for <1, 1−5, 5−10, 10−15 and 15−18 years old groups. Estimated local DRLs for head CT examinations are 170, 300, 310, 320, 360 mGy*cm for <1, 1−5, 5−10, 10−15 and 15−18 years age groups respectively and 130, 210, 275, 320 mGy*cm for 0−3 months, 3 months−1 year, 1−6 years and ≥ 6 years age groups respectively. Conclusions.Results of this study showed that settled new local DRLs of head CT examinations were 2–4 times lower than national DRLs and about 2 times lower than European DRLs. Moreover, the study indicated that paediatric head CT doses are significantly lower in comparison with those indicated in the majority of published data from other hospitals over the last 6 years. Patient dose assessment and local DRLs establishment plays important role in future exposure optimisation.

AN INTERVENTIONAL CARDIOLOGY INVESTIGATION: PATIENT EXPOSURE TO RADIATION AND INTER-OPERATOR VARIABILITY IN AN IRISH SETTING.

To evaluate patient radiation exposure for Diagnostic Coronary Angiography (DCA) and Percutaneous Cardiac Intervention (PCI) performed by different operators. Retrospective (n=160) and prospective (n=62) data for DCA (n=179) and PCI (n=43) examinations performed by interventional cardiologists (n=3) using the same imaging equipment were reviewed. The operator with consistently low diagnostic reference levels (DRLs) was interviewed for their personal perceptions upon operator training. Retrospective Median [IQR] DAP was 18.8 [11.8-31.6] and 50.7 [35.3-85.6] Gy.cm2 for DCA and PCI, respectively. Prospective Median [IQR] DAP for DCA and PCI was 7.9 [5.2-10.6] and 15.9 [10.0-17.7] Gy.cm2, respectively. DRLs were within Irish and European DRLs; however, significant inter-operator variability (p<.001) was identified. Radiation exposure in Interventional cardiology is highly operator dependent; further research is warranted in standardization of operator training with evolving technologies.

The 2020 national diagnostic reference levels for nuclear medicine in Japan

The diagnostic reference levels (DRLs) are one of several effective tools for optimizing nuclear medicine examinations and reducing patient exposure. With the advances in imaging technology and alterations of examination protocols, the DRLs must be reviewed periodically. The first DRLs in Japan were established in 2015, and since 5 years have passed, it is time to review and revise the DRLs. We conducted a survey to investigate the administered activities of radiopharmaceuticals and the radiation doses of computed tomography (CT) in hybrid CT accompanied by single photon emission computed tomography (SPECT)/CT and positron emission tomography (PET)/CT. We distributed a Web-based survey to 915 nuclear medicine facilities throughout Japan and survey responses were provided by 256 nuclear medicine facilities (response rate 28%). We asked for the facility's median actual administered activity and median radiation dose of hybrid CT when SPECT/CT or PET/CT was performed for patients with standard habitus in the standard protocol of the facility for each nuclear medicine examination. We determined the new DRLs based on the 75th percentile referring to the 2015 DRLs, drug package inserts, and updated guidelines. The 2020 DRLs are almost the same as the 2015 DRLs, but for the relatively long-lived radionuclides, the DRLs are set low due to the changes in the Japanese delivery system. There are no items set higher than the previous values. Although the DRLs determined this time are roughly equivalent to the DRLs used in the US, overall they tend to be higher than the European DRLs. The DRLs of the radiation dose of CT in hybrid CT vary widely depending on each imaging site and the purpose of the examination.

European Society of Paediatric Radiology Computed Tomography and Dose Task Force: European guidelines on diagnostic reference levels for paediatric imaging.

The recent European Council Directive 2013/59/EURATOM requires the establishment of diagnostic reference levels (DRLs) to optimise radiation dose in diagnostic and interventional radiology procedures. At the time this directive was enacted, just a few European countries had already set paediatric DRLs and many of these were outdated. For this reason, the European Commission launched a project addressing European Guidelines on Diagnostic Reference Levels for Paediatric Imaging that was awarded to a consortium led by the European Society of Radiology with the collaboration of the European Society of Paediatric Radiology and other European stakeholders involved in the radiation protection of children. The main aims of this project were to establish European DRLs to be used by countries without their own national paediatric DRLs and to provide a consistent method to establish new DRLs in the future. These European guidelines have been very recently endorsed by the European Commission and published in issue N° 185 of the Radiation Protection series. The purpose of this article is to introduce these guidelines to the wide community of paediatric radiologists.

Establishing the European diagnostic reference levels for interventional cardiology

Interventional cardiac procedures may be associated with high patient doses and therefore require special attention to protect the patients from radiation injuries such as skin erythema, cardiovascular tissue reactions or radiation-induced cancer. In this study, patient exposure data is collected from 13 countries (37 clinics and nearly 50 interventional rooms) and for 10 different procedures. Dose data was collected from a total of 14,922 interventional cardiology procedures. Based on these data European diagnostic reference levels (DRL) for air kerma-area product are suggested for coronary angiography (CA, DRL = 35 Gy cm2), percutaneous coronary intervention (PCI, 85 Gy cm2), transcatheter aortic valve implantation (TAVI, 130 Gy cm2), electrophysiological procedures (12 Gy cm2) and pacemaker implantations. Pacemaker implantations were further divided into single-chamber (2.5 Gy cm2) and dual chamber (3.5 Gy cm2) procedures and implantations of cardiac resynchronization therapy pacemaker (18 Gy cm2). Results show that relatively new techniques such as TAVI and treatment of chronic total occlusion (CTO) often produce relatively high doses, and thus emphasises the need for use of an optimization tool such as DRL to assist in reducing patient exposure. The generic DRL presented here facilitate comparison of patient exposure in interventional cardiology.

I251] Introduction and preliminary results of the euclid european project

The concept of Diagnostic Reference Levels (DRLs) is well-established and has been widely accepted for many years. Most of existing DRLs were built for specific anatomical locations. However, some limitations of this approach were pointed out as for the same anatomical location one could have several clinical indications with consequently different protocols corresponding to different exposure levels. The EUCLID project is a European Commission (EC) tender project that will provide up-to-date DRLs for the most important, from a radiological perspective, X-ray imaging tasks in Europe. The project is led by the European Society of Radiology (ESR). A European DRL survey on Computed Tomography (CT) and Interventional Radiology (IR) procedures on adult patients is being conducted. In order to identify the clinical indications to be studied, a comprehensive literature review is undertaken and information from the European national competent authorities is collected. A questionnaire is prepared that includes hospital data as well as patient clinical and technical data on exams of standard-size (Body Mass Index 18.5–25 kg/m2 or 70 ± 15 kg if height is not available) adult patients (age > 18 y) performed during the study period, but not less than 30 patients. For each examination, the anonymized Radiation Dose Structured Report or any other DICOM report available in X-ray machine (e.g. DICOM image) is also required in order to verify data collected for the establishment of clinical DRLs. A subjective image quality evaluation (perfect, good, moderate, inadequate) was also included in the questionnaire. In fluoroscopy, additional to all the above data, procedure complexity grading related to anatomy (normal/moderately difficult/very difficult) and pathology (normal/moderately difficult/very difficult) as well as data related to the skills of the operator (trainee, operator who has performed less than 5 procedures of this kind, and experienced operator) are also collected. Preliminary results of the survey will be presented.

ESTABLISHING DIAGNOSTIC REFERENCE LEVELS FOR CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAPHY IN SAUDI ARABIA.

Cardiac computed tomography angiography (CCTA) is a commonly used diagnostic imaging tool for cardiovascular disease. Despite constant improvements to imaging technologies, the radiation dose to patients remains a concern when using this procedure. Diagnostic reference levels (DRLs) are used as a trigger to identify and alert individual facilities that are using high doses during CT. This study aims to assess patient radiation dose and establish new national DRLs (NDRL) associated with CCTA in Saudi clinical practices. A structured booklet survey was designed for recording patient and scanning protocols during CCTA procedures. The data were collected retrospectively from the participating centres. NDRLs for CCTA were defined as the 75th and 25th of volumetric CT dose index (CTDIvol) and dose length product (DLP). Specific DRLs based on two main ECG-gating modes were also proposed. Data sets related to 197 CCTAs with a mean weight of 77 kg were analysed in detail. The DRL values for CTDIvol and DLP for prospective gating mode and retrospective gating mode were 29 and 62 mGy and 393 and 1057 mGy cm, respectively. NDRLs for CCTA in Saudi Arabia are comparable or slightly lower than European DRLs due to the current use of dose-saving technology. There are major variations in patient doses during CCTA due to differences in CT scanners, scanning modes and departmental CCTA protocols.

Effective dose from pediatric CT in Iceland

It is important to know the effective dose from computed tomography (CT) examinations. The aim of this study was to evaluate the effective dose from pediatric CT examinations in Iceland. For all pediatric CT exams (children < 18 years) performed during one year (1.2.2016 till 1.2.2017), data on age, examination type and dose length product was retrospectively collected from the Landspitali University Hospital's archives, as was the total number of CT examinations. The ratio of pediatric CT exams and the frequency of examination types were calculated and, for the three most common examinations, the effective dose and mean dose length product were calculated for five age groups. The total number of pediatric CT examinations was 662, 3,6% of all the CT examinations performed. The three most common pediatric CT examinations were head (40,3%), abdomen (15,6%) and thorax (10,3%). The mean effective dose in those was, in the above order: for children < 4 months: 5,3/4,9/3,0 mSv; 4 months to < 3 years: 4,2/5,5/1,9 mSv; 3 years to < 8 years: 2,7/ 3,4/1,0 mSv; 8 years to < 15 years: 3,2/4,4/1,0 mSv and 15 years to < 18 years: 2,1/6,5/3,3 mSv. The mean dose length product was above European diagnostic reference levels in most examination types and age groups. Possibilities for lower effective doses from pediatric CT examinations should be explored. For that purpose, the use of size specific dose estimates is recommended.

Investigation of reference levels and radiation dose associated with abdominal EVAR (endovascular aneurysm repair) procedures across several European Centres.

Endovascular aneurysm repair (EVAR) is considered the treatment of choice for abdominal aortic aneurysms with suitable anatomy. In order to improve radiation safety, European Directive (2013/59) requires member states to implement diagnostic reference levels (DRLs) in radio-diagnostic and interventional procedures. This study aimed to determine local DRLs for EVAR across five European centres and identify an interim European DRL, which currently remains unestablished. Retrospective data was collected for 180 standard EVARs performed between January 2014 and July 2015 from five specialist centres in Ireland (n=2) and Italy (n=3). Data capture included: air kerma-area product (PKA), total air kerma at the reference point (Ka,r), fluoroscopic time (FT), number of acquisitions, frame rate of acquisition, type of acquisition, patient height, weight, and gender. The mean values for each site A, B, C, D, and E were: PKAs of 4343 ± 994 μGym2, 18,200 ± 2141 μGym2, 11,423 ± 1390 μGym2, 7796 ± 704 μGym2, 31,897 ± 5798 μGym2; FTs of 816 ± 92 s, 950 ± 150 s, 708 ± 70 s, 972 ± 61 s, 827 ± 118 s; and number of acquisitions of 6.72 ± 0.56, 10.38 ± 1.54, 4.74 ± 0.19, 5.64 ± 0.36, 7.28 ± 0.65, respectively. The overall pooled 75th percentile PKA was 15,849 μGym2. Local reference levels were identified. The pooled data has been used to establish an interim European DRL for EVAR procedures. • Abdominal endovascular aneurysm repair (EVAR) requires the use of ionising radiation. • EVAR is a minimally invasive procedure for the treatment of abdominal aortic aneurysms. • Diagnostic reference levels (DRLs) are used to monitor patient radiation exposure. • Radiation dose data was collected from five European centres for EVAR procedures. • Local DRLs have been determined and an interim European DRL is proposed.

Establishing and monitoring DRLS

Diagnostic Reference Levels (DRLs) have proven to be an effective tool for dose optimisation of protection in medical imaging. The ‘Euratom Basic Safety Standards’ states that ‘Member States shall ensure the establishment, regular review and use of diagnostic reference levels for radiodiagnostic examinations, having regard to the recommended European diagnostic reference levels where available, and when appropriate, for interventional radiology procedures, and the availability of guidance for this purpose’. The ‘European DRLs for Paediatric Imaging’ project (abbreviation: PiDRL) has very recently developed European Guidelines on how to establish and how to use paediatric DRLs. DRLs should be established primarily for examinations that significantly contribute to the collective effective dose of the patient population. DRLs should be based on appropriate patient dose surveys. In general, it is recommended that from each institution a representative sample of at least 10 patients per procedure type and per patient group is needed for non-complex examinations such as radiography and CT and at least 20 patients per procedure type for complex procedures such as fluoroscopy and fluoroscopically guided procedures. For all body examinations, weight should be used as a parameter for patient grouping. Patient dose data should be collected from a representative sample of various types of equipment and practices in the geographical area concerned. Dose management solutions can play a very important role in the establishment and use of DRLs.

An overview of ESR experience, with a focus on eurosafe imaging

The ESR launched EuroSafe Imaging, an ambitious radiation protection initiative, at ECR 2014 as a driver for improved quality and safety in medical imaging in Europe. The EuroSafe Imaging activities are led by a Steering Committee composed of stakeholder representatives, including EFOMP. The ‘EuroSafe Imaging Call for Action’ issued in September 2014 comprises 12 action items with concrete projects and specific goals to achieve EuroSafe Imaging’s objectives of promoting appropriateness in radiological imaging, maintaining radiation doses within diagnostic reference levels, using the ALARA principle and promoting the use of up-to-date equipment, empowering patients, and joining forces with various stakeholders. The ESR and EFOMP are collaborating in many activities under the umbrella of EuroSafe Imaging, including the projects “European Diagnostic Reference Levels for Paediatric Imaging” (PiDRL) and “BSS Transposition in the Medical Sector”. Other activities of EuroSafe Imaging focus on imaging referral guidelines embedded in clinical decision support (ESR iGuide), data collection (‘Is your Imaging EuroSafe?’), clinical audit, as well as appropriate image quality, clinical DRLs and a European CT repository. A network of institutions committed to best practice in radiation protection is created through the ‘EuroSafe Imaging Stars’ initiative. In addition, research in medical radiation protection is fostered. This variety of actions and the range of different stakeholders involved in EuroSafe Imaging reflect the ESR’s inclusive and holistic approach to medical radiation protection. EuroSafe Imaging serves as role model for medical radiation protection campaigns in other continents, such as Latin America Safe, Afro Safe and Canada Safe, and embraces a collaborative approach with these campaigns.

European diagnostic reference levels in paediatric imaging

European diagnostic reference levels in paediatric imaging

The ‘European Diagnostic Reference Levels For Paediatric Imaging’ Project

s / Physica Medica 30 (2014) e1ee15 e12 THE ‘EUROPEAN DIAGNOSTIC REFERENCE LEVELS FOR PAEDIATRIC IMAGING’ PROJECT John Damilakis. Professor of Medical Physics, University of Crete, Greece Despite a large number of studies available from European countries, the DRLs for paediatric patients are only available for some common radiological examinations. There is a need to consolidate what is available and to provide guidance on what actions are needed in using Diagnostic Reference Levels (DRLs) to further enhance radiation protection of children. The ‘European DRLs for Paediatric Imaging’ project is aimed to attend to this situation. The professional organisations involved include ESR as coordinator as well as EFOMP, EFRS, and ESPR, covering the key European stakeholders and professional groups with relevance to radiation protection of paediatric patients. The project is divided into 4 Work Packages (WPs); each work package covers specific tasks contributing to the common objective of enhancement of radiation protection of paediatric patients through the concept of DRLs. WP0, chaired by the coordinator of the project, is responsible for the management and general coordination of the project. WP1 is responsible for assessing and agreeing on a methodology for establishing and using DRLs for paediatric imaging, and for producing European guidelines including data provided by WP 2. WP2 is responsible for updating and extending the existing European DRLs to cover more procedures and a wider patient age/weight range. WP 3 chaired by the scientific coordinator will organize the European workshop in Lisbon, Portugal from October 15th to October 17th 2015 to discuss the findings of the studies conducted under the project and to subject the draft European Guidelines to critical review and discussion. SYNERGY BETWEEN NUCLEAR RESEARCH, INNOVATION AND EDUCATION IN EURATOM PROGRAMMES, WITH EMPHASIS ON SAFETY CULTURE Georges Van Goethem. European Commission, DG Research and Innovation, Dir Energy G.4 / Fission Energy, B-1049 Brussels, Belgium In a rapidly changing multicultural world full of political and economic uncertainties, research, innovation and education (RIE), in particular, in nuclear fission and radiation protection are faced with a number of scientific-technological and socio-political challenges. In the European Union (EU), these challenges are, for example, breakthrough technological developments of interdisciplinary type and enhanced public engagement in nuclear matters. The aim is to continuously improve applications of nuclear fission energy and ionising radiation in the medical and industrial fields for the benefit of all people. In the EU, the recent “Council Directive 2013/59/Euratom laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation” has a new Chapter IV “Requirements for Radiation Protection Education, Training and Information” requiring Member States to have systems in place for the education, training and recognition of specific experts (in particular, “Medical physics experts” Article 83). For power generation or for medical applications, experts with highly qualified nuclear and radiation safety culture competences will be needed over a long time period, in particular, to deal with radiation protection issues in modern diagnosis and treatment. Safety culture is usually defined as “an organisation’s values and behaviours modelled by its leaders and internalised by its members that serve to make nuclear safety the overriding priority.” In this context, the main stakeholders of Euratom RIE programmes have developed a common approach regarding needs, vision and implementation instruments. Focussing on knowledge creation and competence building, their common approach can be summarized as follows: 1e Analysis of needs: e.g. what kind of knowledge, skills and competences (KSC) should be taught in order to continuously improve technical, human and organisational aspects ? 2 e Convergence towards a common vision: e.g. towards a new type of governance for RIE in the EU, integrating expert, policy and public knowledge to support decision making processes 3 e Development of instruments: e.g. synergy of national and Euratom RIE programmes aiming at preparing a new generation of experts in a global economy (EU and beyond). Making lifelong learning and cross-border mobility a reality is an important objective of the Education, Youth and Culture policy of the EU (e.g. “European Credit system for Vocational Education and Training” /ECVET/). Lessons will be drawn from the preliminary application of ECVET tools and methodology, such as the description of qualifications in terms of “units of learning outcomes” related to KSC, in Euratom projects. INVOLVEMENT OF AAPM IN EUROPE Gene Lief. White Plains Hospital, Radiation/Oncology Department, New York,

Adult patient radiation doses from non-cardiac CT examinations: a review of published results.

CT is a valuable tool in diagnostic radiology but it is also associated with higher patient radiation doses compared with planar radiography. The aim of this article is to review patient dose for the most common types of CT examinations reported during the past 19 years. Reported dosimetric quantities were compared with the European diagnostic reference levels (DRLs). Effective doses were assessed with respect to the publication year and scanner technology (i.e. single-slice vs multislice). Considerable variation of reported values among studies was attributed to variations in both examination protocol and scanner design. Median weighted CT dose index (CTDI(w)) and dose length product (DLP) are below the proposed DRLs; however, for individual studies the DRLs are exceeded. Median reported effective doses for the most frequent CT examinations were: head, 1.9 mSv (0.3-8.2 mSv); chest, 7.5 mSv (0.3-26.0 mSv); abdomen, 7.9 mSv (1.4-31.2 mSv); and pelvis, 7.6 mSv (2.5-36.5 mSv). The introduction of mechanisms for dose reduction resulted in significantly lower patient effective doses for CT examinations of the head, chest and abdomen reported by studies published after 1995. Owing to the limited number of studies reporting patient doses for multislice CT examinations the statistical power to detect differences with single-slice scanners is not yet adequate.

Poster - Thur Eve - 68: Computed Tomography Patient Dose and National Diagnostic Reference Levels in Iran

Objective: To measure radiation doses from Computed Tomography(CT) in the head, chest and abdomen techniques and compare them with the international diagnostic reference levels, as part of National Research project, attempting to establish National Diagnostic Reference Levels (NDRL's). Materials and Methods: 50 CTscanners from all private and none private hospitals or clinics around the country were selected. All scanners were conventional or helical single‐slice or multi— detectors row CT systems. Five thousand patients undergoing above mentioned techniques were included. Collected data included patient height, weight, sex, and age; tube voltage and tube current—time product settings; pitch; slice thickness; number of slices. Weighted or volumetric CT dose index (CTDI); and dose‐length product (DLP) were measured using a pencil shape ionizing chamber with standard rod Plexiglas's with16, 32 cm in diameters for head and body respectively. Results: Mean volumetric CT dose index and DLP values were below the European diagnostic reference levels: 31 mGy and 1135 mGy‐ cm, respectively, at head CT; 12.8 mGy and 514 mGy‐cm, respectively, at chest CT; and 13.4 mGy and 537 mGy‐ cm, respectively, at abdominal CT. Estimated effective doses were 2.61, 8.74, and 8.06 mSv, respectively. Conclusion: NDRL's for CT is going to be established in the country and comparison of our results with EU revealed that we are in a good conditions but we have to reconsider CT techniques parameters for children.