Practical implementation of the diagnostic reference levels concept for the common radiographic examinations
https://doi.org/10.21514/1998-426X-2017-10-1-47-55
Abstract
The modern approach to the radiation protection of the patients from medical exposure is mainly based on the principle of optimization using diagnostic reference levels. Implementation of diagnostic reference levels and optimization in Russian radiological practice is limited due to lack of methodology of data collection and patient dose assessment, investigation and management of abnormally high and low patient doses. Current study is focused on the justification of the diagnostic reference levels concept and practical aspects of establishment of diagnostic reference levels for common radiographic X-ray examinations and their use in clinical practice. It is proposed to establish diagnostic reference levels as the 75%-percentiles of X-ray unit distribution
by the patient standard doses for a given X-ray examination. Methodology for standard doses assessment is presented for different types of X-ray units. Based on the results of dose data collection in different regions of the Russian Federation in 2009–2014, the national diagnostic reference levels values are estimated in terms of effective dose for the radiographic examinations of skull, chest, cervical, thoracic and lumbar spine,
abdomen and pelvis. The methodology of the optimization process is developed for the hospital use. It includes a comparison of the patient standard doses with the national diagnostic reference levels, investigation and correction of abnormally high and low patient doses. A list of corrective measures is proposed: from additional training of the staff and manual adjustment of the parameters of examinations to the replacement of an X-ray unit. It is conferment that even a limited implementation of the optimization methodology would allow to reduce standard doses with a factor of 1,5.
by the patient standard doses for a given X-ray examination. Methodology for standard doses assessment is presented for different types of X-ray units. Based on the results of dose data collection in different regions of the Russian Federation in 2009–2014, the national diagnostic reference levels values are estimated in terms of effective dose for the radiographic examinations of skull, chest, cervical, thoracic and lumbar spine,
abdomen and pelvis. The methodology of the optimization process is developed for the hospital use. It includes a comparison of the patient standard doses with the national diagnostic reference levels, investigation and correction of abnormally high and low patient doses. A list of corrective measures is proposed: from additional training of the staff and manual adjustment of the parameters of examinations to the replacement of an X-ray unit. It is conferment that even a limited implementation of the optimization methodology would allow to reduce standard doses with a factor of 1,5.
About the Author
A. V. Vodovatov
Saint-Petersburg Research Institute of Radiation Hygiene after Professor P.V. Ramzaev, Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being
Russian Federation
Russian Federation
References
1. ICRP Publication 105. Radiation Protection in Medicine.Russian translation under M. Balonov, SPb., 2011, 66 p. (In Russian)
2. Guidance on Diagnostic Reference Levels (DRLs) for Medical Exposures. Radiation Protection 109. Directorate-General, Environment, Nuclear Safety and Civil Protection. European Commission, 1999, 30 p.
3. Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards GSR Part 3. IAEA, Vienna, 2015, 518 p. (In Russian)
4. Vishnyakova N. M., Kalnitsky S.А., Cheremisin V. М., Кamyshanskaya I.G. Methodical aspects of establishment of diagnostic reference levels for radiography for adult patients. Vestnik Rossiyskoy Voenno-meditsinskoy akademii = News of Russian Military Medical Academy, 2010, No 1 (29), pp. 96– 102. (In Russian)
5. Vishnyakova N. M. Optimization of radiation protection of the patients from medical exposure: abstract of post-doctoral thesis in Medicine. SPb., 2010, 44 p. (In Russian)
6. Vodovatov A.V., Kalnitsky S.A., Balonov M.I., Kamyshanskaya I.G. Development of diagnostic reference levels of patients X-ray exposure in diagnostic radiology. Radiatsionnaya Gygiena= Radiation Hygiene, 2013, Vol. 6, No, 3, pp. 29-36. (In Russian)
7. Golikov V.Y., Balonov M.I., Kalnitsky S.A., Bratilova A.A., Sarycheva S.S., Shatsky I.G., Vodovatov A.V. Exposure levels of patients during radiological examinations in St-Petersburg and Leningrad region. Radiatsionnaya Gygiena = Radiation Hygiene, 2011, Vol. 4, No 1, pp. 5-13. (In Russian)
8. Balonov M.I., Golikov V.J., Zvonova I.A., Kalnitsky S.A., Repin V.S., Sarycheva S.S., Chipiga L.A. Current levels of medical exposure in Russia. Radiatsionnaya Gygiena = Radiation Hygiene, 2015, Vol. 8, No 3, pp. 67-79. (In Russian)
9. Vodovatov A., Bernhardsson C. Establishing national diagnostic reference levels in the Russian Federation based on regional dose surveys. Medical Physics in the Baltic States 2015.Proceeding of the 13th International Conference on Medical Physics, 5-7 November 2015, Kaunas, Lithuania. -ISSN 1822-5721.
10. Vodovatov A. V., Balonov M. I., Golikov V. Yu., Shatsky I. G., Chipiga L. A., Bernhardsson C. Proposals for the establishment of national diagnostic reference levels for radiography for adult patients based on regional dose surveys in Russian Federation. Accepted for publication in Radiat. Prot. Dosim. doi: 10.1093/rpd/ncw341
11. Vodovatov A., Bernhardsson C. Estimation of patient doses from X-ray examinations in the Bryansk region hospitals. Medical Physics in the Baltic States 2013.Proceeding of the 11th International Conference on Medical Physics, 10-12 October 2013, Kaunas, Lithuania. – ISSN 1822-5721.
12. Golikov V. Yu., Barkovsky A.N., Baryshkov N.K., Vlasov A.Yu. Assessment of effective doses of patients from diagnostic X-ray examinations. Proceedings «Radiation Hygiene». SPb., 2003, pp. 75–88. (In Russian)
13. Hart D., Hilier M. C., Shrimpton P. C. Doses to Patients from Radiographic and Fluoroscopic X-ray Imaging Procedures in the UK – 2010 Review. HPA-CRCE-034., Health Protection Agency, 2012, 87 p.
14. Radiation Protection 180 pt. 2. Diagnostic Reference Levels in Thirty-six European Countries. European Commission, 2014, 73 p.
15. ICRP, 201x. Diagnostic Reference Levels in Medical Imaging. ICRP Publication 1XX Ann. ICRP 4X(X-X). Available from: http://www.icrp.org/ docs/C3 WPDRL Draft For Public Consultation(011116).pdf (Accessed: December 22, 2016)
16. Martin C. J. Effective dose: how should it be applied to medical exposures? The British Journal of Radiology, Vol. 80, pp. 639-647, 2007
17. Mattsson S. Need for individual cancer risk estimates in X-ray and nuclear medicine imaging. Radiation Protection Dosimetry, 2016, Vol. 169 (1-4), pp. 11-16.
18. Balonov M.I.,Golikov V. Yu., Kalnitsky S. A., Zvonova I. A., Chipiga L. A., Sarycheva S. S., Shatsky I. G., Vodovatov A. V. Russian practical guidance on radiological support for justification of x-ray and nuclear medicine examinations. Radiation Protection Dosimetry, 2015, Vol. 165 (1-4), pp. 39-42.
19. Vodovatov A.V., Kamyshanskaya I.G., Drozdov A.A. New approach for the determination of the standard patient to be used for optimization of the medical exposure protection. Radiatsionnaya Gygiena = Radiation Hygiene, 2014, Vol.7, No 4. Pp. 104-116. (In Russian)
20. Golikov V., Barkovsky A., Baryshkov N., Vlasov A. Assessment of radiation doses to the patients in medical X-ray diagnosis. In: Strahlenschutz fur Mensch und Gesellschaft im Europa von Morgen. Muck K., Hefner A. and Vana N. Eds. (Koln, Germany: TU Verlag), 2001.
21. Tapiovaara M., Siiskonen T. PCXMC. A Monte Carlo program for calculating patient doses in medical x-ray examinations. STUK-A231. Helsinki, Finland, 2
22. Doses to the public of Russian Federation based on the ESKID results in 2002-2015.Information bulletin. SPb., 2015, 40 p. (In Russian)
23. ICRP Publication 93. Managing Patient Dose in Digital Radiology.Vol. 34, No 1, 2004, 73 p.
24. Vodovatov A. V., Drozdov A. A., Telnova A. U., Bernhardsson C. Management of patient doses form digital X-ray chest screening examinations. Radiation Protection Dosimetry, 2016, Vol. 169 (1-4), pp. 232-239.
25. European Guidelines on Quality Criteria for Diagnostic Radiographic Images, European Commission, EUR 16260 EN. June 1996, 38 p.
26. Radiation Protection 178. Referral Guidelines for Medical Imaging. Availability and Use in the European Union. European Commission, 2014, 52 p.
Review
For citations:
Vodovatov A.V. Practical implementation of the diagnostic reference levels concept for the common radiographic examinations. Radiatsionnaya Gygiena = Radiation Hygiene. 2017;10(1):47-55. (In Russ.) https://doi.org/10.21514/1998-426X-2017-10-1-47-55
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