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Diagnostic Reference Levels in Medical Imaging:

Diagnostic Reference Levels in Medical Imaging: Recommendations for Applications in the United States National Council on Radiation Protection and Measurement Presently in draft, under revision after review by Program Area Committee.

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Diagnostic Reference Levels in Medical Imaging:

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  1. Diagnostic Reference Levels in Medical Imaging: • Recommendations for Applications in the United States • National Council on Radiation Protection and Measurement • Presently in draft, under revision after review by Program Area Committee. • NCRP Council Review, available to public for comment ~January 2010

  2. NCRP SC 4-3 Committee Consultants

  3. What are Diagnostic Reference Levels? • DRLs are investigational levels • Based on survey data of state-of-the-practice facilities • Typically set at 75th percentile of survey data • Set at national level by imaging professionals • Updated on regular (five-year?) basis • If facility exceeds DRL, optimization is necessary

  4. What Is Optimization? • The goal of optimization— • Image quality appropriate for the medical imaging task • and • Radiation dose adequate to provide the appropriate image quality

  5. What areAchievable Doses? • DRLs impact 25% of facilities, i.e., those above the 75th percentile. • Achievable Doses are levels at which state-of-the-art facilities practice • Achievable Doses are set at the 50th percentile of the survey distributions • Rationale– if 50% of facilities can achieve these levels (or better), then all facilities should be able function at this level

  6. What are Reference Levels? • RLs are similar to DRLs • Apply to Interventional Radiology, Nuclear Medicine • Based on measured patient doses in clinical setting

  7. European Experience • HPA (formerly NRPB) started promoting DRLs and Achievable Doses in 1980s • UK has seen a 50% decrease in median doses from x-ray examinations over 20 years • DRLs required by EU for all member states • Most countries have seen decreases in patient doses as a result

  8. NCRP Data Sources • NEXT • ACR • RAD-IR Study (Miller, et al.) • SNM, NCRP 2010 Survey, 2008 Survey of Pediatric Hospitals (Treves, et al.)

  9. NEXT— Major Source of Data • Nationwide Evaluation of X-Ray Trends (NEXT) survey data (phantom data) • About 350 facilities surveyed in US • One projection per year • Funded by FDA, ACR, and others • Carried out by CRCPD with state agency participation

  10. NCRP Report on DRLs For Adult and Pediatric Projections • Radiographic and Fluoroscopic* • Computed Tomography* • Dental Radiography* • Interventional Radiology (RLs) • Nuclear Medicine (RLs) • *6 Adult, 2 Peds, 3 Adult CT, 2 Peds CT, 4 Dental

  11. NCRP Recommended DRLs and Achievable Doses (mGy) *CTDIvol

  12. Future Needs? • Database (Dose Registry) of patient doses per projection, in order to update DRLs, Achievable Doses, and RLs • Present sources scattered, different information– some phantom, some patient • Optimization requires up to date information on image quality and patient dose

  13. Summary • NCRP’s DRLs, RLs, and Achievable Doses are the key to Optimization • Optimization is the key to quality medical imaging and appropriate radiation doses

  14. Thank You!!

  15. Questions or Comments?? • Joel E. Gray, Ph.D • Phone +1 708-703-0260 • e-mail JoelGray@DIQUAD.com

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