The DOI matches its Crossref record; 10 of the 10 references it cites were found in a registry or an index.
How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement
Open accessAbstract
Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging ‘Clinical DRLs’ working group formed with the purpose to produce scientific and educational material on DRLs and promote the concept of local DRLs. Guidelines on how to establish and how to use local DRLs presented herein can be implemented using a multidisciplinary team approach. Local DRLs are easy to determine and implement and they reflect local equipment performance and local clinical needs. They can be updated more frequently than the national DRLs, especially if a dose management system is available. To establish local DRLs, a practical approach could be to collect a reasonable set, i.e., at least 20–30 procedures, of data for well-defined clinical indications and calculate the 3rd quartile values. The median values of the distribution can be set to define the ‘typical values’. The International Commission of Radiological Protection (ICRP) suggests setting ‘typical values’ for newer technologies that enable decreased amounts of radiation exposure for a similar level of image quality. Local DRLs should be similar or lower to the national DRLs. They could be higher only if the clinical benefits for some medical indications are fully explained and reported. Local DRLs may be used as a quality benchmark to track outliers and can be also used as alert values.
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“The ACR Dose Index Registry (DIR) aggregates data from numerous U.S. imaging sites, facilitating critical benchmarking for the creation and enhancement of DRLs.107,108”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [108]
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Cites
ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging
Vañó, E., Miller, D. L., Martin, C. J., Rehani, M. M., Kang, K., Rosenstein, M., Ortiz-López, P., Mattsson, S., Padovani, R., & Rogers, A. (2017) · Annals of the ICRP · doi:10.1177/0146645317717209 · Cited by 1,043
CT Radiation Dose Management: A Comprehensive Optimization Process for Improving Patient Safety
Parakh, A., Kortesniemi, M., & Schindera, S. T. (2016) · Radiology · doi:10.1148/radiol.2016151173 · Cited by 73
Loose, R., Vano, E., Mildenberger, P., Tsapaki, V., Caramella, D., Sjöberg, J., Paulo, G., Torresin, A., Schindera, S. T., Frija, G. G., et al. (2020) · European Radiology · doi:10.1007/s00330-020-07290-x · Cited by 52
Self-citationBrat, H. G., Zanca, F., Montandon, S., et al. (2019) · European Radiology · doi:10.1007/s00330-019-06257-x · Cited by 48
Self-citationUbeda, C., Miranda, P. J., & Vano, E. (2015) · Medical Physics · doi:10.1118/1.4905116 · Cited by 47
Self-citationThe growing potential of diagnostic reference levels as a dynamic tool for dose optimization
Damilakis, J. E., & Vassileva, J. (2021) · Physica Medica · doi:10.1016/j.ejmp.2021.03.018 · Cited by 26
Self-citationPapanastasiou, E., Protopsaltis, A., Finitsis, S. N., et al. (2021) · Physica Medica · doi:10.1016/j.ejmp.2021.07.029 · Cited by 23
Local diagnostic reference levels for paediatric non-cardiac interventional radiology procedures
Morcillo, A. B., Alejo, L., Huerga, C., et al. (2020) · Physica Medica · doi:10.1016/j.ejmp.2020.03.001 · Cited by 14
Benmessaoud, M., Housni, A., Elmabrouki, M., et al. (2021) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncab095 · Cited by 12
Kropelnicki, A., Eaton, R., Adamczyk, A., et al. (2020) · British Journal of Radiology · doi:10.1259/bjr.20190878 · Cited by 8
Research works printed but not linked: 1
- Official Journal of the European Union (2014) European Council Directive 2013/59/Euratom on basic safety standards for protection against the dangers arising from exposure to ionising radiation and repealing directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43 Euratom and 2003/122/Euratom. OJ of the EU. L13;57:1–73 Available from https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2014:013:0001:0073:EN:PDF. Accessed August 2022
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Sorted by citations
O’Hora, L., Neville, N., Tuffy, J., Craig, A., O’Brien, K., Sugrue, K., McGarry, M., Duggan, B., & Egan, S. (2023) · European Radiology · doi:10.1007/s00330-023-09992-4 · Cited by 8
Oglat, A., Shdaifat, S., Sayah, M., Abukonna, A., & Khogali, W. (2026) · Drug, Healthcare and Patient Safety · doi:10.2147/dhps.s595721
Metadata
- Authors
- Damilakis, J., Frija, G., Brkljacic, B., Vano, E., Loose, R., Paulo, G., Brat, H., Tsapaki, V., & the European Society of Radiology
- Affiliations
- University of Crete (GR)
- Université Paris Cité (FR)
- Universidad Complutense de Madrid (ES)
- Nuremberg Hospital (DE)
- Universidade Politécnica de Coimbra (PT)
- Hôpital de Sion (CH)
- European Society of Radiology (AT)
- Corresponding author
- Damilakis, John
- Venue
- Insights into Imaging
- Published
- 2023-02-06
- Volume
- 14
- Issue
- 1
- Pages
- 27-27
- ISSN
- 1869-4101 (ISSN-L)
- PMC
- PMC9902573
- OpenAlex
- W4319311958
- Cited by
- 76
- References
- 10
- Citations by year
- 2026: 23 · 2025: 26 · 2024: 18 · 2023: 9
- FWCI
- 12.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Insights into Imaging (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Physical Sciences › Physics and Astronomy › Radiation › Advanced Radiotherapy Techniques
- Keywords
- diagnostic reference levels, local diagnostic reference levels, patient radiation protection, dose management, typical values, median values, dose management system, quality benchmarking, outlier detection, ICRP recommendations
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- Damilakis, J., Frija, G., Brkljacic, B., Vano, E., Loose, R., Paulo, G., Brat, H., Tsapaki, V., & the European Society of Radiology. (2023). How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement. Insights into Imaging. https://doi.org/10.1186/s13244-023-01369-x
