DRAFT REPORT FOR CONSULTATION: DO NOT REFERENCE 1 ICRP Ref 4836-8337-6684 2 2016 January 11 3 4 5 Annals of the ICRP 6 7 8 ICRP PUBLICATION 1XX 9 10 11 Diagnostic Reference Levels in Medical Imaging 12 13 14 Editor 15 C.H. CLEMENT 16 17 Associate Editor 18 N. HAMADA 19 20 21 Authors on behalf of ICRP 22 E. Vano, D.L. Miller, C. J. Martin, M.M. Rehani, K. Kang, M. Rosenstein, 23 P. Ortiz, S. Mattsson, R. Padovani, A. Rogers 24 25 26 PUBLISHED FOR 27 The International Commission on Radiological Protection 28 by 29 30 [SAGE logo] 31 32 Please cite this issue as ‘ICRP, 201x. Diagnostic Reference Levels in Medical Imaging. 33 ICRP Publication 1XX Ann. ICRP 4X(X-X)’ DRAFT REPORT FOR CONSULTATION: DO NOT REFERENCE 1 2 CONTENTS 3 4 [Guest?] Editorial ................................................................................................................. 5 5 Diagnostic reference levels in medical imaging .................................................................. 6 6 PREFACE ............................................................................................................................ 7 7 EXECUTIVE SUMMARY ................................................................................................. 9 8 1. Introduction ...................................................................................................................... 9 9 2. Diagnostic reference levels .............................................................................................. 9 10 3. DRL quantities and values ............................................................................................. 10 11 4. Local, national and regional DRLs ................................................................................ 11 12 5. Using DRLs for optimisation of protection ................................................................... 11 13 6. Considerations for paediatric examinations ................................................................... 12 14 REFERENCES ................................................................................................................... 12 15 GLOSSARY ...................................................................................................................... 13 16 1. INTRODUCTION ........................................................................................................ 19 17 1.1. Introduction .............................................................................................................. 19 18 1.2. Historical perspective on terminology ..................................................................... 20 19 1.3. History ...................................................................................................................... 20 20 1.4. Effectiveness of DRLs ............................................................................................. 21 21 1.5. Issues with the current use of DRLs ........................................................................ 22 22 1.6. Rationale for this report ........................................................................................... 25 23 1.7. Target Audience ....................................................................................................... 27 24 1.8. Summary .................................................................................................................. 27 25 1.9. References ................................................................................................................ 28 26 2. CONSIDERATIONS IN CONDUCTING SURVEYS TO ESTABLISH DRLS ....... 32 27 2.1. Introduction .............................................................................................................. 33 28 2.2. Approach to setting DRL values .............................................................................. 35 29 2.3. Survey considerations .............................................................................................. 37 30 2.4. Procedure selection .................................................................................................. 43 31 2.5. Data collection methods ........................................................................................... 44 32 2.6. Determining DRL values ......................................................................................... 45 33 2.7. Image quality ............................................................................................................ 50 34 2.8. References ................................................................................................................ 52 35 3. RADIOGRAPHY AND DIAGNOSTIC FLUOROSCOPY ........................................ 57 36 3.1. Radiography and diagnostic fluoroscopy examinations ............................................. 57 37 3.2. DRL quantities for radiography .................................................................................. 59 38 3.3. DRL quantities for fluoroscopy .................................................................................. 60 39 3.4. Use of phantoms in radiography and fluoroscopy ...................................................... 60 40 3.5. Mammography ............................................................................................................ 61 41 3.6. Dental radiography ..................................................................................................... 63 42 3.7. References ................................................................................................................... 64 43 4. INTERVENTIONAL PROCEDURES ........................................................................ 66 44 4.1. Introduction ................................................................................................................. 66 2 DRAFT REPORT FOR CONSULTATION: DO NOT REFERENCE 1 4.2. Complexity analyses ................................................................................................... 67 2 4.3. Data sets for interventional fluoroscopy procedures .................................................. 68 3 4.4. Use of multiple DRL quantities for interventional fluoroscopy ................................. 69 4 4.5. Interventional CT ........................................................................................................ 70 5 4.6. References ................................................................................................................... 71 6 5. DIGITAL RADIOGRAPHY, CT, NUCLEAR MEDICINE, AND MULTIMODALITY 7 PROCEDURES .......................................................................................................... 78 8 5.1. Digital radiography detectors ..................................................................................... 78 9 5.2. DRLs in digital radiography ....................................................................................... 79 10 5.2.1. DRL quantities .................................................................................................... 80 11 5.2.2. Procedure selection ............................................................................................. 80 12 5.3. Computed Tomography .............................................................................................. 80 13 5.3.1. DRLs in CT ........................................................................................................ 80 14 5.3.2. Considerations for DRL surveys in CT .............................................................. 81 15 5.3.3. Cone-beam CT .................................................................................................... 83 16 5.4. DRLs in planar and SPECT nuclear medicine imaging ............................................. 84 17 5.5. Considerations for DRL surveys for nuclear medicine .............................................. 85 18 5.6. Hybrid imaging (PET/CT, SPECT/CT and PET/MRI) .............................................. 86 19 5.6.1. PET ..................................................................................................................... 87 20 5.6.2. CT in PET/CT and SPECT/CT ........................................................................... 88 21 5.7. References ................................................................................................................... 88 22 6. PAEDIATRICS ............................................................................................................ 92 23 6.1. Considerations relevant to paediatric DRLs ............................................................... 93 24 6.2. Paediatric DRLs for CT .............................................................................................. 96 25 6.3. Paediatric DRLs for radiography, nuclear medicine and interventional procedures .. 97 26 6.4. References ................................................................................................................... 98 27 7. APPLICATION OF DRLS IN CLINICAL PRACTICE ........................................... 101 28 7.1. Patient audits of DRL quantities for x-ray examinations ......................................... 102 29 7.1.1. Setting up an audit programme in healthcare faciities ..................................... 104 30 7.1.2. Audits for dental radiography ........................................................................... 105 31 7.1.3. Corrective action .............................................................................................