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Diagnostic reference levels in interventional radiology: a systematic review.

Iana Quintanilha de Borba1, Rochelle Lykawka2, Nayron Medeiros Soares2,3

  • 1Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.

Radiologia Brasileira
|November 3, 2025
PubMed
Summary

This systematic review analyzed evidence for diagnostic reference levels (DRLs) in interventional radiology. Findings show DRLs are often local, with limited international standardization and a need for broader global efforts.

Keywords:
Diagnostic reference levelsFluoroscopyRadiation protectionRadiology, interventional

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Area of Science:

  • Radiology
  • Medical Physics

Background:

  • Diagnostic reference levels (DRLs) are crucial for optimizing radiation dose in medical imaging.
  • Establishing DRLs in interventional radiology (IR) presents unique challenges due to procedural variability.

Purpose of the Study:

  • To systematically review and analyze existing scientific evidence for establishing DRLs in interventional radiology.
  • To identify current practices, challenges, and influencing factors in DRL determination for IR procedures.

Main Methods:

  • Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
  • Searched PubMed/Medline and Embase for studies on IR and DRLs, excluding CT-guided procedures and systematic reviews.
  • Two independent reviewers assessed 30 eligible articles from an initial 475, extracting data on procedures, DRL values, and equipment.

Main Results:

  • 30 articles yielded 113 procedures, with endovascular aneurysm repair and nephrostomy most frequent.
  • Most DRL values (73%) were reported at the local level; national/regional DRLs were predominantly European.
  • Influencing factors included technology, operator experience, and protocols; a lack of longitudinal studies was noted.

Conclusions:

  • Standardized procedural terminology is needed for accurate DRL comparisons.
  • A predominance of European studies highlights the need for wider international collaboration in DRL implementation for IR.