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Variabilities in X-ray diagnostic reference levels.

Thibault Vanaudenhove1, Alain Van Muylem2, Nigel Howarth3

  • 1Federal Agency for Nuclear Control (FANC), Rue Ravenstein 36, 1000, Brussels, Belgium.

European Radiology
|April 10, 2020
PubMed
Summary
This summary is machine-generated.

Diagnostic reference levels (DRLs) for X-ray procedures show high variability, stabilizing around 30% when over 200-400 devices are included. More devices are needed to reduce variability further.

Keywords:
Radiation protectionRadiographySurveys and questionnaires

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Area of Science:

  • Medical Imaging Physics
  • Radiation Protection
  • Health Services Research

Background:

  • Diagnostic Reference Levels (DRLs) are crucial for optimizing radiation doses in X-ray examinations.
  • Variability in DRLs can impact patient safety and healthcare resource allocation.
  • Understanding factors influencing DRL variability is essential for effective radiation protection programs.

Purpose of the Study:

  • To quantify the variability of X-ray Diagnostic Reference Levels (DRLs).
  • To assess the influence of the number of X-ray devices and collected data per device on DRL variability.
  • To determine thresholds for device and data numbers required for stable DRL estimates.

Main Methods:

  • Utilized Dose-area product (DAP) data from 590 X-ray devices across 345 medical centers (2015-2017).
  • Employed a bootstrapping method to estimate DRL variability (95th confidence intervals divided by medians).
  • Analyzed variability as a function of the number of devices and DAP data per device for various X-ray examinations.

Main Results:

  • DRL variability ranged from 30% to 200%, stabilizing at approximately 30% with >200 devices (chest PA, abdomen) or >400 devices (chest PA/LAT, lumbar spine, pelvis).
  • DRL variability stabilized regardless of the number of DAP data per device once sufficient devices were included.
  • Thousands of devices would be required to achieve DRL variability as low as 10%.

Conclusions:

  • DAP-related DRLs exhibit significant variability, influenced by the number of devices, particularly when below 100.
  • With >200-400 devices, DRL variability stabilizes around 30% and is independent of the amount of DAP data per device.
  • Harmonizing data collection methods across EU member states is recommended for consistent DRL application.