Abstract
Purpose Recent developments in medical technology have broadened the spectrum of X-ray procedures
and changed exposure practice in X-ray facilities. For this reason, diagnostic reference
levels (DRLs) for diagnostic and interventional X-ray procedures were updated in 2016
and 2018, respectively. It is the aim of this paper to present the procedure for the
update of the DRLs and to give advice on their practical application.
Materials and Methods For the determination of DRLs, data from different independent sources that collect
dose-relevant data from different facilities in Germany were considered. Seven different
weight intervals were specified for classifying pediatric X-ray procedures. For each
X-ray procedure considered, the 25th, 50th, and 75th percentile of the respective
national distribution of the dose-relevant parameters were determined. Additionally,
effective doses that correspond to the DRLs were estimated.
Results In procedures with already existing DRLs before 2016, the values were lowered by
circa 20 % on average. Numerous DRLs were established for the first time (9 for interventional
procedures, 10 for CT examinations).
Conclusion For dose optimizations even below the new national DRLs, the BfS recommends establishing
local reference levels, using dose management software (particularly in CT and interventional
radiology), adapting dose-relevant parameters of X-ray protocols to the individual
patient size, and establishing internal radiation protection teams responsible for
optimizing X-ray procedures in clinical practice. When applying good medical practice
and using modern equipment, the median dose values of the nationwide dose distributions
can not only be easily achieved but can even be undercut.
Key Points:
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German diagnostic reference levels (DRLs) für diagnostic and interventional X-ray
procedures were updated in 2016 and 2018, respectively.
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For X-ray procedures for which DRLs existed already before the update, the updated
DLRs were lowered by circa 20 %, on average.
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For CT and interventional radiology, new DRLs were established.
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X-ray procedures have to be optimized even below the DRLs.
Citation Format
Key words
patient exposure - dose optimization and reduction - diagnostic reference levels (DRLs)
- diagnostic and interventional radiology - pediatric X-ray examinations
