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International survey on diagnostic reference levels based on clinical indications in plain radiography.

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Title: International survey on diagnostic reference levels based on clinical indications in plain radiography.
Authors: Schegerer, Alexander A.1,2 (AUTHOR), Stamm, Georg3 (AUTHOR) Georg.stamm@med.uni-goettingen.de, Aberle, Christoph4 (AUTHOR), Ammon, Josefin5 (AUTHOR), Bazrafshan, Babak6 (AUTHOR), Borowski, Markus7 (AUTHOR), Eßeling, Rainer8 (AUTHOR), Madsack, Bärbel9 (AUTHOR), Menz, Roman4 (AUTHOR), Müller, Constance8 (AUTHOR), Oberhofer, Nadia10 (AUTHOR), Renger, Bernhard11 (AUTHOR), Singer, Julian2 (AUTHOR), Verius, Michael12 (AUTHOR), Walz, Michael9 (AUTHOR), Jungnickel, Kerstin13 (AUTHOR)
Source: European Radiology. Jun2025, Vol. 35 Issue 6, p3336-3346. 11p.
Subjects: Radiography, Radiation doses, Standardization, Radiation dosimetry, Clinical indications, Radiation protection
Geographic Terms: Europe, Austria, Germany, Switzerland
Abstract: Purpose: To collect and analyze radiation dose-related data as part of international cooperation; to define diagnostic reference levels (DRL) for 24 X-ray projections in plain radiography (DX) considering anatomical region, clinical task, and procedural technique; and to harmonize the exposure practice across country borders. Methods: A multicenter study was performed in Austria, Germany, Italy, and Switzerland in 2022–23 to provide dose-related data. Healthcare facilities were asked to provide processed data from their dose management systems. A 5%-level was used for assessing the statistical significance of dose differences between various groups. Results: Dose-related data from 85 radiographic systems in academic and non-academic, public, and private healthcare facilities were analyzed. Dose-related parameters differed significantly for many projections with different clinical tasks and techniques. Dose-related data of the procedures varied by a maximum factor of 16 for the same system, and median dose values also differed between hospitals by a maximum factor of 31. A fifth of the surveyed systems exhibit doses above more than half of the new DRLs defined in this study. Apart from the three reference procedures, no significant dose differences were observed between X-ray systems of different ages, from different manufacturers, or from different countries. Conclusions: This is the first survey in which exposure practices were investigated in institutions in different central European countries by establishing clinical DRLs for radiography. The observed dose variations could be explained by different reasons, such as non-optimized dose protocols. The new DRLs help to harmonize the exposure practice across country borders. Key Points: QuestionWhat is the exposure practice for plain radiography procedures for which no clinical diagnostic reference levels (DRLs) have been defined? Are there differences between countries? FindingsThe dose for the same clinical task and technique can vary considerably among institutions but, on average, do not significantly differ between neighboring countries in Europe. Clinical relevanceIn this international multicenter study, clinical DRLs were defined for 24 plain radiography projections to promote the optimization of the exposure practice, to reduce dose variations among institutions even across national borders, and to strengthen international cooperation among users. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: International survey on diagnostic reference levels based on clinical indications in plain radiography.
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Jun2025, Vol. 35 Issue 6, p3336-3346. 11p.
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– Name: Abstract
  Label: Abstract
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  Data: Purpose: To collect and analyze radiation dose-related data as part of international cooperation; to define diagnostic reference levels (DRL) for 24 X-ray projections in plain radiography (DX) considering anatomical region, clinical task, and procedural technique; and to harmonize the exposure practice across country borders. Methods: A multicenter study was performed in Austria, Germany, Italy, and Switzerland in 2022–23 to provide dose-related data. Healthcare facilities were asked to provide processed data from their dose management systems. A 5%-level was used for assessing the statistical significance of dose differences between various groups. Results: Dose-related data from 85 radiographic systems in academic and non-academic, public, and private healthcare facilities were analyzed. Dose-related parameters differed significantly for many projections with different clinical tasks and techniques. Dose-related data of the procedures varied by a maximum factor of 16 for the same system, and median dose values also differed between hospitals by a maximum factor of 31. A fifth of the surveyed systems exhibit doses above more than half of the new DRLs defined in this study. Apart from the three reference procedures, no significant dose differences were observed between X-ray systems of different ages, from different manufacturers, or from different countries. Conclusions: This is the first survey in which exposure practices were investigated in institutions in different central European countries by establishing clinical DRLs for radiography. The observed dose variations could be explained by different reasons, such as non-optimized dose protocols. The new DRLs help to harmonize the exposure practice across country borders. Key Points: QuestionWhat is the exposure practice for plain radiography procedures for which no clinical diagnostic reference levels (DRLs) have been defined? Are there differences between countries? FindingsThe dose for the same clinical task and technique can vary considerably among institutions but, on average, do not significantly differ between neighboring countries in Europe. Clinical relevanceIn this international multicenter study, clinical DRLs were defined for 24 plain radiography projections to promote the optimization of the exposure practice, to reduce dose variations among institutions even across national borders, and to strengthen international cooperation among users. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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