Analysis of radiation exposure data from common radiological procedures in Dutch hospitals.

INTRODUCTION: In the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice. METHODS: A national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey. RESULTS: For six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure. CONCLUSION: The results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg. IMPLICATIONS FOR PRACTICE: The current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.

Digital imaging and radiographic practise in diagnostic radiography: An overview of current knowledge and practice in Europe.

INTRODUCTION: Recent research has identified the issue of 'dose creep' in diagnostic radiography and claims it is due to the introduction of CR and DR technology. More recently radiographers have reported that they do not regularly manipulate exposure factors for different sized patients and rely on pre-set exposures. The aim of the study was to identify any variation in knowledge and radiographic practice across Europe when imaging the chest, abdomen and pelvis using digital imaging. METHODS: A random selection of 50% of educational institutes (n = 17) which were affiliated members of the European Federation of Radiographer Societies (EFRS) were contacted via their contact details supplied on the EFRS website. Each of these institutes identified appropriate radiographic staff in their clinical network to complete an online survey via SurveyMonkey. Data was collected on exposures used for 3 common x-ray examinations using CR/DR, range of equipment in use, staff educational training and awareness of DRL. Descriptive statistics were performed with the aid of Excel and SPSS version 21. RESULTS: A response rate of 70% was achieved from the affiliated educational members of EFRS and a rate of 55% from the individual hospitals in 12 countries across Europe. Variation was identified in practice when imaging the chest, abdomen and pelvis using both CR and DR digital systems. There is wide variation in radiographer training/education across countries. CONCLUSION: There is a need for standardisation of education and training including protocols and exposure parameters to ensure that there is continued adherence to the ALARA principle.

Compliance to Diagnostic Reference Levels for radiation exposure in common radiological procedures in Dutch hospitals: A nation-wide survey carried out by medical imaging students.

INTRODUCTION: In the Netherlands, hospitals have difficulty in implementing the formal procedure of comparing radiation dose values to Diagnostic Reference Levels (DRLs). METHODS: To support the hospitals, train radiography students, and carry out a nationwide dose survey, diagnostic radiography students performed 125 DRL comparisons for nine different procedures in 29 radiology departments. Students were instructed at three Dutch Universities of Applied Sciences with a radiography programme and supervised by medical physicists from the participating hospitals. RESULTS: After a pilot study in the western part of the country in eight hospitals, this study was enlarged to involve 21 hospitals from all over the Netherlands. The 86 obtained dose comparisons fall below the DRLs in 97% of all cases. This very high compliance may have been enhanced by the voluntary participation of hospitals that are confident about their performance. CONCLUSION: The results indicate that the current DRLs that were not based on a national survey, may need to be updated, sometimes to half their current value. For chest and pelvis examinations the DRLs could be lowered from 12 and 300 µGy·m2 to the 75-percentile values found in this study of 5,9 and 188 µGy·m2, respectively.