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09:05 CET
EU 3 - Clinical diagnostic reference levels for x-ray medical imaging
EuroSafe Imaging
Friday, March 2, 14:00 - 15:30
Room: M 1
Moderators: J. Damilakis (Iraklion/GR), G. Frija (Paris/FR)

A-500
14:00
Chairpersons' introduction and update on the project on clinical DRLs for x-ray medical imaging (part 1)
J. Damilakis; Iraklion/GR
Learning Objectives

1. To understand the general concept of diagnostic reference levels (DRLs), in particular clinical DRLs and the project on clinical DRLs for x-ray medical imaging.
2. To learn about the current status of DRLs in paediatric imaging.
3. To become familiar with the concept of local DRLs.

Abstract

Different image quality is needed for different clinical indications of the same anatomical area. Kidney stone evaluation, for instance, can be performed using lower radiation doses than those used in evaluation of appendicitis because detection of high-contrast structures is affected less by high image noise than low contrast structures. Clinical indications dictate the main parameters that affect patient dose from CT such as scanning length, collimation and number of phases. The EC launched the ‘European study on clinical diagnostic reference levels for X-ray medical imaging’ (EUCLID) project to provide up-to-date clinical DRLs. The main objectives of the project are to; (a) conduct a European survey to collect data needed for the establishment of DRLs for the most important, from the radiation protection perspective, X-ray imaging tasks in Europe; and (b) specify up-to-date DRLs for these clinical tasks. This introductory presentation will provide a brief update on EUCLID project.

A-501
14:02
Chairpersons' introduction and update on the project on clinical DRLs for x-ray medical imaging (part 2)
G. Frija; Paris/FR
Learning Objectives

1. To understand the general concept of diagnostic reference levels (DRLs), in particular clinical DRLs and the project on clinical DRLs for x-ray medical imaging.
2. To learn about the current status of DRLs in paediatric imaging.
3. To become familiar with the concept of local DRLs.

A-502
14:05
The concept of diagnostic reference levels (DRLs)
E. Vaño; Madrid/ES
Learning Objectives

1. To understand the concept of DRLs in general.
2. To learn about the International Commission on Radiological Protection's (ICRP) work and perspective.

Abstract

Diagnostic reference Levels (DRLs) were introduced by the International Commission on Radiological Protection (ICRP) as a tool to help optimise medical imaging in diagnostic and interventional procedures. ICRP has published a new set of recommendations on DRLs (ICRP Publication 135; 2017). Several issues have been updated: definitions of the terms used in previous guidance, determination of the DRLs values (including multimodality procedures), the appropriate interval for re-evaluating these values, appropriate use of DRLs in clinical practice and application of the DRL concept to newer imaging technologies. Weight bands are recommended for establishing paediatric DRLs. Concerning medical imaging tasks, the DRL values should be tied to defined clinical and technical requirements. The assessment of clinical image quality or the proper diagnostic information when multiple images are used should be performed as part of the optimisation process. ICRP has also included recommendations on establishing regional (for several countries) DRL values that can be based on either a representative sample of health facilities or on national DRL values. Regional DRL values may provide guidance on how to optimise the protection of neighbouring countries with no DRL surveys of their own. When relatively few national DRL values exist for the countries within a region, regional DRL values may be derived through a consensus of the region’s competent authorities. ICRP suggested that the problem to combine large and small countries could be dealt with by weighting national DRL values according to the population of each participating country.

A-503
14:20
The concept of clinical diagnostic reference levels (DRLs)
G. Frija; Paris/FR
Learning Objectives

1. To become familiar with the concept of clinical DRLs.
2. To learn about the EUCLID project.
3. To learn about practical implications and advantages of clinical DRLs.

Abstract

Diagnostic reference levels (DRLs) are an important tool for optimisation. They are usually established for specific anatomical locations, although some countries established also DRLs based on clinical indications. This talk will highlight the advantages of this latter approach, and will briefly introduce the EUCLID project (European Study on Clinical DRLs), a European Commission tender project aimed at establishing DRLs on clinical indications.

A-504
14:30
An update on current European diagnostic reference levels (DRLs) in adult imaging
J. Damilakis; Iraklion/GR
Learning Objectives

1. To learn about methodological requirements for establishing DRLs.
2. To learn about the current status of DRLs in adult imaging in Europe and beyond.
3. To understand why clinical DRLs are needed in adult imaging.

Abstract

Τhe clinical indication is the main determinant of patient radiation dose. Therefore, DRLs should be specified for a given clinical indication. The ‘European study on clinical diagnostic reference levels for X-ray medical imaging’ (EUCLID) project aims to specify up-to-date DRLs for the most important, from the radiation protection perspective, X-ray imaging tasks in Europe. A comprehensive review has been carried out to identify the status of existing clinical DRLs for CT, interventional radiology and radiography in Europe and beyond by analysing recent studies, standards and publications. Information about existing clinical DRLs has also been collected from national competent authorities and other organisations involved in the project. A few national radiation protection authorities, only, have defined a limited number of DRLs for different clinical indications, so far. Although a large number of studies on doses from X-ray imaging are available, there is very limited information about clinical-indication specific DRLs.

A-505
14:45
An update on current paediatric diagnostic reference levels (DRLs)
C. Granata; Genoa/IT
Learning Objectives

1. To become familiar with paediatric DRLs.
2. To learn about the European Guidelines on DRLs for Paediatric Imaging (PiDRL).
3. To learn about recent work undertaken by the ESR to establish paediatric DRLs.

Abstract

Particular attention should be paid to using diagnostic reference levels (DRLs) in paediatric radiology, as children are at higher risk compared to adults of being affected by the detrimental effects of radiations in some organs and body areas. However, only a few European countries have established paediatric DRLs, mostly for a limited set of examinations. The existing DRLs are often derived from old European Commission (EC) recommendations or from surveys conducted in other countries with inconsistent methodology and rarely updated. Furthermore, DRLs are still largely based on age and not on size, which can be very different among children of the same age. Recently, an EC project on new European guidelines for DRLs in paediatric Imaging (PiDRL) was assigned to a consortium directed by ESR with the involvement of ESPR, EFRS, EFOMP, and STUK. This project resulted in a series of recommendations concerning the appropriate methods to establish new paediatric DRLs. These recommendations define what is intended for local, national, and European paediatric DRLs, the set of examinations for which paediatric DRLs should be established, patient subdivision into groups, dosimetric parameters to be considered, and instructions on how to make good use of paediatric DRLs.

A-506
15:00
The concept of local diagnostic reference levels (DRLs)
N. Saltybaeva; Zurich/CH
Learning Objectives

1. To become familiar with the concept of local diagnostic reference levels (LDRLs).
2. To understand the key factors affecting LDRLs.
3. To learn how the LDRLs can be established and used for dose optimisation; what action should be taken if LDRLs are exceeded.

Abstract

Diagnostic reference levels (DRLs) are an important dose optimization tool endorsed by many professional and regulatory organizations. National DRLs (NDRLs) are commonly set by the local health authority at the third quartile values (75%) of the dose distribution determined for representative examinations conducted across different healthcare facilities. Besides NDRLs, local DRLs (LDRLs) can be also established for a single center or group of healthcare facilities and used as a baseline for quality control and dose optimization. The invited speaker will give an overview of how LDRL should be defined; which dose tracking tools can be used for this purpose and how the DRLs can be adjusted to the specific needs of the individual healthcare facility.

15:15
Panel discussion (part 1)
J. Damilakis; Iraklion/GR
15:18
Panel discussion (part 2)
G. Frija; Paris/FR
15:21
Panel discussion (part 3)
E. Vaño; Madrid/ES
15:24
Panel discussion (part 4)
J. N. Vassileva; Sofia/BG
15:27
Panel discussion (part 5)
M. del Rosario Perez; Geneva/CH
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