Development of an online automatic diagnostic reference levels management system for digital radiography: a pilot experience

The diagnostic reference levels (DRLs) concept is a methodology proposed by the International Commission on Radiological Protection (ICRP) for identifying any unusual high patient doses involved in radiological examinations. However, some challenges are anticipated in the DRLs concept including resource demand for running the audit cycle by individual imaging departments and availability of DRLs. The objective of this study was to develop an online automatic DRLs management system for digital radiography (DR) with the aim of addressing the challenges of the DRLs obligation. An online automatic DRLs management system for DR composed of freeware was developed. The system was tested with 75 DR images. This pilot experience shows that the system successfully addresses the challenges in the DRLs management, i.e. resource demand for running the audit cycle by individual imaging departments and availability of DRLs. It can provide at a low cost an efficient and effective solution to the implementation of regular audits of patient doses using DR in busy clinical departments. It can also contribute to the development of DRLs at local and national levels. In this way, any unacceptable radiological practice (examination used unjustified high radiation dose) can be identified.