National Diagnostic Reference Levels in General Radiography: A Scoping Review

Area of Science:

• Radiological Sciences
• Medical Physics
• Public Health

Background:

• National Diagnostic Reference Levels (NDRLs) are crucial for radiation dose optimization in general radiography.
• Understanding international trends and survey strategies for NDRLs is essential for consistent radiological practices.

Purpose of the Study:

• To conduct a scoping review of proposed and established NDRLs in general radiography.
• To analyze survey harmonization, radiological examinations, doses, and 20-year international trends in NDRLs.
• To highlight effective NDRL survey strategies for dose optimization.

Main Methods:

• A scoping review was performed following PRISMA-ScR guidelines.
• Searches included gray literature and databases (PubMed, MEDLINE, etc.) for papers from 1990 to 2024.
• 22 articles from 4932 identified studies, focusing on adult-human dosimetry surveys, were selected for review.

Main Results:

• NDRLs were less common in low- and lower-middle-income countries.
• Chest PA and lumbar spine examinations were frequently reported, with lumbar spine LAT having the highest doses and Chest PA the lowest.
• Proposed NDRLs from 2004-2013 showed higher doses than 2014-2024, aligning with established levels.

Conclusions:

• Consistent adherence to NDRL survey guidelines was observed despite variations.
• Quality control tests and image quality assessments are recommended to improve reliability and support dose optimization.
• Addressing gaps in current practices is vital for enhancing patient safety and diagnostic accuracy.