Diagnostic reference levels in interventional radiology: a systematic review

To comprehensively and impartially analyze the scientific evidence available for establishing diagnostic reference levels (DRLs) in interventional radiology.

This was a systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search focused on studies related to interventional radiology and DRLs in PubMed/Medline and Embase. Studies involving computed tomography-guided procedures, studies with incomplete data, and systematic reviews were excluded. Two independent reviewers evaluated the studies, resolving discrepancies with a third reviewer. Articles were tabulated with information such as title, publication year, procedures, DRL values, and type of equipment used.

A total of 475 articles were identified. After duplicates had been excluded and eligibility criteria had been applied, the final sample comprised 30 articles. Most DRL values (73%) were reported at the local level, as defined by International Commission on Radiological Protection criteria, representing typical dose values from a sample within one or a few institutions. A total of 113 procedures were identified, with endovascular aneurysm repair and nephrostomy being the most frequently reported. We identified DRLs at national and regional scales, predominantly within Europe. Influencing factors included technology, operator experience, specific protocols, and optimization strategies. The analysis also identified a lack of longitudinal studies assessing changes over time. The use of dose management software emerged as an effective tool for facilitating data collection and DRL establishment.

The lack of standardized procedural terminology hindered direct DRL comparisons. Our findings highlight a predominance of European studies and emphasize the need for broader international efforts to improve DRL implementation.