Clinical Scorecard: Global Assessment of Diagnostic Reference Levels According to Clinical Indications in Conventional Radiography

At a Glance

Key Highlights

• Clinical responsibility mandates limiting radiation to medically justified procedures and optimizing dose according to ALARA principles.
• Diagnostic Reference Levels (DRLs) are defined as the 3rd quartile of median dose values and serve as investigation levels to trigger dose optimization.
• Clinical DRLs incorporate clinical task, anatomical location, and procedural technique for more precise dose optimization compared to anatomical DRLs alone.

Guideline-Based Recommendations

Diagnosis

• Select imaging procedures based on clinical indication and guidelines to ensure medical justification.
• Use clinical DRLs to define dose expectations for specific clinical tasks and procedural techniques.

Management

• Implement dose optimization by adapting radiation exposure to clinical task, procedure complexity, anatomical location, and patient size.
• Collaborate with radiation protection specialists (e.g., medical physicists) for protocol design and dose management.
• Regularly review and update DRLs to harmonize exposure practices across institutions and countries.

Monitoring & Follow-up

• Use dose management systems (DMS) to collect and analyze dose-related data (e.g., kerma-area product, PKA).
• Investigate any continuous exceedance of DRLs and implement corrective measures.
• Ensure periodic quality assurance of X-ray systems with dose measurement deviations less than 30%.

Risks

• Exceeding DRLs may indicate unnecessary radiation exposure requiring investigation and optimization.
• Inadequate dose optimization can lead to increased patient radiation risk without clinical benefit.

Patient & Prescribing Data

Adult patients (>16 years) undergoing conventional radiography procedures

Dose data collected from multiple institutions with experienced personnel showed consistent equipment and protocols, enabling definition of common clinical DRLs.

Clinical Best Practices

• Define DRLs based on combined clinical task, anatomical location, and procedural technique (CAP approach) rather than anatomical location alone.
• Use retrospective dose data from multiple institutions to establish harmonized clinical DRLs.
• Engage experienced radiology staff and radiation protection specialists in dose optimization efforts.
• Ensure dose data quality through validated dose management systems and adherence to international standards.

References

• European Basic Safety Standards Directive
• International Commission on Radiological Protection (ICRP) Publication on Diagnostic Reference Levels
• Roentgen Society’s Working Group of Physics and Technology Survey