Comment on: Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling/Diagnostische Referenzwerte für diagnostische und interventionelle Röntgenanwendungen in Deutschland: Aktualisierung und Handhabung (Alexander Schegerer, Reinhard Loose, Lothar J. Heuser, Gunnar Brix)

We highly appreciate and support the continuing efforts to minimize radiation exposure from radiologic procedures as documented by the article of A. Schegerer et al. in “RöFo” [1]. However, we feel urged to revise some details of the scan protocol recommendations for pulmonary embolism proposed in the article and thus would like to amend the otherwise excellent article by this comment:

• References

• 1 Schegerer A, Loose R, Heuser LJ. et al. Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling. Fortschr Röntgenstr 2019; 191: 739-751
• 2 Kallen JA, Coughlin BF, O’Loughlin MT. et al. Reduced Z-axis coverage multidetector CT angiography for suspected acute pulmonary embolism could decrease dose and maintain diagnostic accuracy. Emerg Radiol 2009; 17: 31
• 3 Biederer J, Wildberger JE, Reuter M. et al. Protokollempfehlungen für die Computertomografie der Lunge Konsensus der Arbeitsgemeinschaft Thoraxdiagnostik der DRG. Fortschr Röntgenstr 2008; 180: 471-479
• 4 Litmanovich D, Boiselle PM, Bankier AA. et al. Dose reduction in computed tomographic angiography of pregnant patients with suspected acute pulmonary embolism. J Comput Assist Tomogr 2009; 33: 961-966
• 5 Woo JKH, Chiu RYW, Thakur Y. et al. Risk-Benefit Analysis of Pulmonary CT Angiography in Patients With Suspected Pulmonary Embolus. Am J Roentgenol 2012; 198: 1332-1339
• 6 Mayo J, Thakur Y. Pulmonary CT Angiography as First-Line Imaging for PE: Image Quality and Radiation Dose Considerations. Am J Roentgenol 2013; 200: 522-528
• 7 Radzina M, Biederer J. Ultrasonography of the Lung. Fortschr Röntgenstr 2019;
• 8 Tsuchiya N, van Beek EJ, Ohno Y. et al. Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging. World J Radiol 2018; 10: 52-64