Diagnostic reference levels for medical exposure of patients: ICRP guidance and related ICRU quantities

In Publication 60 of the International Commission on Radiological Protection reference levels were described as values of measured quantities at which some specified action or decision should be taken. One particular form of reference level, the diagnostic reference level, applies specifically to medical exposure of patients. The objective of a diagnostic reference level is to help avoid radiation dose to the patient that does not contribute to the clinical purpose of a medical imaging task. This is accomplished by comparison between the numerical value of the diagnostic reference level and the mean or other appropriate value observed in practice for a suitable reference group of patients or a suitable reference phantom. A diagnostic reference level is not applied to individual patients. Diagnostic reference levels have no direct linkage to the numerical values for dose limits or dose constraints, and it is inappropriate to use them for regulatory or commercial purposes. Diagnostic reference levels should be selected by professional medical bodies (often in conjunction with health and radiation protection authorities) and their values may be specific to a country or region. A diagnostic reference level can be used: (1) to improve a regional, national or local distribution of observed results for a general medical imaging task, by reducing the frequency of unjustified high or low values; (2) to promote attainment of a narrower range of values that represent good practice for a more specific medical imaging task; or (3) to promote attainment of an optimum range of values for a specified medical imaging protocol. Authorized bodies are encouraged to set diagnostic reference levels that best meet their specific needs and that are consistent for the regional, national or local area to which they apply. Report 74 of the International Commission on Radiation Units and Measurements includes a commentary regarding quantities useful in establishing diagnostic reference levels.