Diagnostic Reference Levels Values Research Articles

Clinical diagnostic reference levels and image quality metrics for CT in oncology patients

Background: In CT, the volumetric CT dose index (CTDIvol), dose-length product (DLP) and patient’s size-specific dose estimates (SSDE) are used as diagnostic reference level (DRL) metrics.Objectives: To develop clinical local DRL values for CT chest-abdomen-pelvis (CAP) examinations using the CTDIvol, DLP and SSDE, and to determine the image quality achieved.Method: In total, 201 cancer patients were included in the study. The scanning parameters, dose metrics from the CT unit and participants’ body mass index (BMI) were documented. The local CT DRL values for CAP examinations were defined as the median and 75th percentiles of the dose distribution.Results: The local DRL values given in terms of median CTDIvol ranged between 8.4 mGy and 12.7 mGy for the different types of cancers. The median DLPs ranged from 848 to 1173.4 mGy.cm for the various cancers. Generally, the radiation dose was directly proportional to the BMI and number of scan phases. Significant differences were observed between the DRLs for the various size-related parameters, number of scan phases and BMI classifications. The image quality was clinically satisfactory.Conclusion: No baseline data for clinical DRL values were available for this medical oncology department. The achieved DRLs were similar to published size-specific DRLs. The image quality was maintained during CT imaging. Dose optimisation and image quality assessment should be implemented to ensure optimal scanning parameters for different cancers in CT CAP examinations.Contribution: The first size-specific local DRL values for CT CAP investigations carried out on oncology patients in South Africa have been established.

Paediatric computed tomography diagnostic reference levels in Africa: A systematic review.

Improvements in computed tomography (CT) technology in terms of image quality and reduction in absorbed dose have increased its applications in medical imaging. Diagnostic reference levels (DRLs) help to identify high radiation doses that are unusually delivered to patients undergoing exposure to ionising radiation. The aim of this review was to provide an overview of published studies by African researchers towards establishing paediatric CT DRLs in Africa. The search for articles was conducted using some relevant literature search engines including PubMed, Scopus, Science Direct, Google Scholar and Web of Science. Two reviewers were involved in the article selection process which involved a three-stage screening process of identifying; article titles, abstracts and full-test reading. One hundred and seventy-four articles were identified from the database, PubMed (30), Scopus (21), Google Scholar (53), Web of Science (25) and Science Direct (45). Fifty duplicated articles were excluded before screening. Twelve peer-reviewed articles were included in this study based on the inclusion criteria. DRL values in terms of computed tomography dose index volume of head for the age groupings 0-1, 1-5, 5-10 and 10-15 were 27, 36.6, 39.5 and 47.5 mGy while the dose length product values were 461.6, 664, 872 and 978 mGy.cm respectively. The DRLs were calculated as 75th percentile of the local DRLs reported by the 12 articles included in this review. This review has shown that only few of the African countries (19%) have published studies on paediatric CT DRLs. There were variations in the DRLs published by the various authors which indicate that harmonisation and standardisation of paediatric CT protocols is essential for the optimisation of paediatric doses.

Establishing Local Diagnostic Reference Levels for CT Angiography Examinations

Objective: Computed tomography angiography (CTA) examinations are performed to diagnose blood vessel anomalies. However, this examination results in a significant radiation dose being received by the patient. Local diagnostic reference levels (DRLs) are necessary for determining the extent of radiation dose during examinations. Therefore, the main objective of this study is to establish local DRL values for CTA examinations.Material and Methods: In this study, a total of 213 participants underwent CTA examination; wherein: 67 underwent computed tomography (CT) cerebral angiography (CTCA), 80 underwent CT pulmonary angiography (CTPA), 40 underwent CT lower limb angiography with aortogram (CTLLA), and 26 underwent CT upper limb angiography (CTULA). Body mass index along with the circumference of the body were calculated. A number of dose descriptors; such as computed tomography dose index volume (CTDIvol) and dose length product (DLP), were collected, and DLP was used to calculate the effective dose, using the conversion factor.Results: For the angiography phase, CTCA, CTPA, CTLLA, and CTULA had median CTDIvol values of: 31.62, 6.38, 12.16, and 10.12 mGy, respectively. Median DLP and effective dose for CTCA were: 1388.64 mGy*cm & 4.30 mSv, CTPA were 243 mGy*cm & 3.41 mSv, CTLLA were 1855.86 mGy*cm & 12.06 mSv, and CTULA were 945.98 mGy*cm & 2.93 mSv, respectively. Conclusion: The estimated local DRLs were lower than the international standard for the angiographic phase; however, the dose exceeded the international standard when the entire examination was considered. This study revealed the need for dose optimization in CTA examinations.

Screening Mammography Diagnostic Reference Level System According to Compressed Breast Thickness: Dubai Health.

Screening mammography is considered to be the most effective means for the early detection of breast cancer. However, epidemiological studies suggest that longitudinal exposure to screening mammography may raise breast cancer radiation-induced risk, which begs the need for optimization and internal auditing. The present work aims to establish a comprehensive well-structured Diagnostic Reference Level (DRL) system that can be confidently used to highlight healthcare centers in need of urgent action, as well as cases exceeding the dose notification level. Screening mammographies from a total of 2048 women who underwent screening mammography at seven different healthcare centers were collected and retrospectively analyzed. The typical DRL for each healthcare center was established and defined as per (A) bilateral image view (left craniocaudal (LCC), right craniocaudal (RCC), left mediolateral oblique (LMLO), and right mediolateral oblique (RMLO)) and (B) structured compressed breast thickness (CBT) criteria. Following this, the local DRL value was established per the bilateral image views for each CBT group. Screening mammography data from a total of 8877 images were used to build this comprehensive DRL system (LCC: 2163, RCC: 2206, LMLO: 2288, and RMLO: 2220). CBTs were classified into eight groups of <20 mm, 20-29 mm, 30-39 mm, 40-49 mm, 50-59 mm, 60-69 mm, 70-79 mm, 80-89 mm, and 90-110 mm. Using the Kruskal-Wallis test, significant dose differences were observed between all seven healthcare centers offering screening mammography. The local DRL values defined per bilateral image views for the CBT group 60-69 mm were (1.24 LCC, 1.23 RCC, 1.34 LMLO, and 1.32 RMLO) mGy. The local DRL defined per bilateral image view for a specific CBT highlighted at least one healthcare center in need of optimization. Such comprehensive DRL system is efficient, easy to use, and very clinically effective.

Establishment of Indonesian Diagnostic Reference Levels for Mammography and Dental Radiography for Use as Medical Exposure Optimization Tools

Diagnostic Reference Level (DRL) is a dose value that will be an indicator in optimizing patient radiation protection. This study aims to determine the national DRL value in Indonesia when examining patients using mammography and dental radiography. The method used in this study combines quantitative research and descriptive analysis. The patient radiation dose data used comes from the 2019 to 2024 dose survey from health facilities in Indonesia for each type of mammography and dental radiography examination. Based on data analysis, it has been proposed to be adopted as an Indonesian DRL value for dental radiography for the types of examinations Panoramic - Standard for pediatric patients and Cephalo - LAT, Panoramic - Standard, Panoramic - Front, Panoramic - Bitewing, Intraoral - Periapical Anterior, and Intraoral - Periapical molars in adult patients. The Indonesian DRL value for mammography for Cranial-Caudal and Mediolateral-Oblique examination types is also proposed. The proposed value to become Indonesia's DRL will be agreed upon and determined to be Indonesia's DRL value and will be applied for five years. After five years, a review was done to update Indonesia's DRL value. BAPETEN needs to guide the form of more intensive socialization and assistance to increase awareness and compliance in carrying out optimization through the use of DRL as well as compliance in recording and reporting patient radiation dose data to the National Patient Radiation Dose Data Information System (Si-INTAN). Keywords: Diagnostic Reference Level (DRL), optimization of radiation protection, radiation protection of patients, X-ray mammography, X-ray dental radiography

Proposing Multiregional Diagnostic Reference Levels for Common CT Angiography Examinations in Saudi Arabia.

Diagnostic reference levels (DRLs) are crucial tools for optimizing radiation exposure during different radiological examinations. This study aimed to establish preliminary DRLs for commonly performed computed tomographic angiography (CTA) examinations in Saudi Arabia. Data for three types of CTA examinations (cerebral, pulmonary, and lower-extremity) were collected from six medical cities across Saudi Arabia. Data sets related to 723 CTAs with a mean patient weight of 75 kg were analysed in detail. The DRL values were determined based on the 75th, median, and 25th CT dose index volume (CTDIvol) and dose length product (DLP) values. The established DRLs were 1221 mGy cm for cerebral CTAs, 475 mGy cm for pulmonary CTAs, and 1040 mGy cm for lower-extremity CTAs. These values were comparable to those reported in other studies. This study provides preliminary DRLs for three common CTA procedures in Saudi Arabia. The widespread implementation of a low kVp and a high level of image reconstruction (IR) presents an opportunity for further dose reduction. These findings can serve as a foundation for future nationwide DRL surveys and the optimization of CTA imaging protocols in Saudi Arabia.

Literature Review Dosis Radiasi Pada Pemeriksaan Radiografi Thorax Anak

Thorax radiology examination in children is one of the most frequently performed examinations in hospitals. However, the radiation used in this examination can potentially disrupt the growth and function of the child's imperfect organs. Therefore, patient radiation protection is very important to optimize the radiation dose received. The Nuclear Energy Regulatory Agency (BAPETEN) has set reference level values ​​in the form of IDRL (Indonesia Reference Level) for Diagnostic Radiology, including CT-Scan, Mammography and Fluorescence, as well as DRL (Diagnostic Reference Level) values ​​for children's thorax. The radiation dose received by the patient must be considered to avoid negative effects on the child's growth. This study aims to determine the measurement of radiation dose on chest radiography examinations of children. In this study, we will compare the radiation dose received by pediatric thorax patients based on the radiation dose standards set by UNSCEAR in 2000. Apart from that, we will also compare the radiation dose received by pediatric thorax patients with other studies. It is hoped that the results of this research will provide useful information and input for hospital diagnostic services in optimizing the radiation dose received by pediatric patients.

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.

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.

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.

Penentuan Nilai Diagnostic Reference Level (DRL) pada Pasien Abdomen menggunakan CT-Scan 128 di Instalasi RSUD A.W. Sjahranie Samarinda

Diagnostic Reference Level (DRL) is a form of investigative level used as a tool to help optimize protection in radiation exposure for diagnostic and interventional procedures. In simple terms, DRL is the amount of dose that is set and becomes a reference in identifying the reception of high radiation doses received by patients for certain types of examinations. DRL aims to optimize the use of radiation in medicine and help avoid overexposure to radiation. The purpose of this study was to determine the local DRL value on the examination of the abdomen at the Radiology Installation of A.W. Sjahranie Hospital Samarinda. Data processing in this study was carried out with quantitative analysis techniques, namely descriptive statistics. This analysis technique used secondary data obtained from the results of recaptures or archival books for examination of the abdomen. Data processing was carried out with a measure of diversity through the calculation of the third quartile (Q3) 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 a graph of the relationship of CTDIvol with the number of patients and a graph of the relationship of DLP with the number of patients. In the abdomen examination, a CTDIvol value of 12 mGy and a DLP value of 1545.5 mGy.cm. The conclusion obtained from this study is the DRL value at A.W. Sjahranie Hospital Samarinda is relatively low, but it still needs to be optimized by medical physicists.

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.