Current practices and perceptions on diagnostic reference levels: a EuroSafe Imaging Survey Analysis

Despite progress in implementing diagnostic reference levels (DRLs) across Europe, clinical practices remain variable. This prompts the EuroSafe Imaging campaign to conduct a survey assessing current practices, perceptions, and challenges related to DRLs. A total of 146 responses were collected from radiology departments in 38 countries, predominantly in the EU/EEA region. While 52.4% reported established local DRLs, significant gaps were identified, with 34.5% lacking local DRLs and 13.1% unaware of their existence. DRLs were primarily established for computed tomography (CT) (88.7%) and conventional radiography (77.5%), with lower implementation in interventional radiology (36.6%). Key challenges included time constraints, data collection difficulties, and limited standardization across institutions. Education gaps were notable, with less than half of the respondents reporting DRL-related training for radiology residents. Respondents emphasized the need for dose management systems, personalized DRLs based on clinical indications, and enhanced education and policy support. Addressing barriers through targeted training, policy enhancements, and technological innovations can improve DRL implementation. Future efforts should focus on promoting standardized clinical protocols, increasing awareness, and fostering European and international collaboration to ensure the consistent use and optimization of DRLs in clinical practice. CRITICAL RELEVANCE STATEMENT: The article critically examines the variability and challenges in implementing diagnostic reference levels (DRLs) across European radiology departments, providing actionable recommendations on policy, education, and technological advancements to optimize radiation protection and improve clinical radiology practices. Diagnostic reference levels (DRLs) help healthcare providers ensure that radiation doses from medical imaging, like CT scans and X-rays, are not higher than necessary. This study looked at how DRLs are used across Europe. It found that while many hospitals have established and follow DRLs, others do not, which may affect patient safety. Challenges like time constraints and lack of training prevent better use of DRLs. Improving education for medical staff and updating protocols can help protect patients by reducing unnecessary radiation exposure while still ensuring accurate diagnoses. KEY POINTS: Variability persists in diagnostic reference level (DRL) practices across Europe. Over half of radiology departments have established local DRLs. Less than half of radiology residents receive structured DRL training. Improved DRL adoption can optimize radiation protection and patient safety. Collaboration, training, and standardized protocols are essential for better DRL practices.