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Establishing national diagnostic reference levels in radiography, mammography, and dual-energy x-ray absorptiometry services in Ireland and comparing these with European diagnostic reference levels

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Abstract

Objectives

The aim of this work was to establish national diagnostic reference levels (DRLs) in Ireland and compare these to existing European DRLs where available. This work surveyed all radiological facilities providing radiography, mammography, and dual-energy x-ray absorptiometry (DXA) services in Ireland.

Methods

A list of common procedures and clinical tasks was established. A national database of service providers was used to identify the appropriate medical radiological facilities providing these services. These facilities were issued with an online survey. National DRLs were set as the 75th percentile of the distribution of median values obtained. A national median dose was also established. The broad categorisation of equipment type was also considered. Where differences between DRLs established using different detector types were deemed statistically significant, equipment-specific national DRLs were established.

Results

National DRLs were established for 12 adult radiography projections. Equipment-specific (computed radiography and digital radiography) adult DRLs were established for four radiography projections. Paediatric DRLs were established for 11 radiography projections, including two based on clinical indications, for a range of paediatric weight categories. National DRLs were established for unilateral two-view mammography and breast tomosynthesis as well as for four DXA clinical indications and projections. All but one Irish DRL figure was found to be below or equal to European data.

Conclusions

This work provided a unique opportunity to establish national DRLs based on census data for a range of procedures and clinical tasks across radiography, mammography and DXA and compare these with European levels.

Clinical relevance statement

This work established national diagnostic reference levels (DRLs) based on census data for a range of procedures and clinical tasks across radiography, mammography and dual-energy x-ray absorptiometry. The establishment of national DRLs is an essential component in the optimisation of patient radiation dose.

Key Points

• Diagnostic reference levels are easily measured quantities intended for use as an aid to optimise patient dose and to identify when levels of patient dose are unusually high.

• Data from all medical radiological facilities in Ireland was obtained to establish national diagnostic reference level (DRL) values and national median dose values in radiography, x-ray breast imaging and dual-energy x-ray absorptiometry (DXA) scanning and these were compared to existing European DRLs where available.

• National DRL values were established for the first time in breast tomosynthesis, DXA scanning, and paediatric radiography.

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Abbreviations

AP:

Anteroposterior

BDA:

Bone density analysis

CR:

Computed radiography

CC:

Craniocaudal

DRLs:

Diagnostic Reference Levels

DR:

Digital radiography

DXA:

Dual-energy X-ray absorptiometry

EAG:

Expert Advisory Group

HIQA:

Health Information and Quality Authority

ICRP:

International Commission on Radiological Protection

Lat:

Lateral

MLO:

Mediolateral oblique

PA:

Posteroanterior

VFA:

Vertebral fracture analysis

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. The Health Information and Quality Authority (HIQA), Dublin, Ireland

    Lee O’Hora, Noelle Neville, John Tuffy, Agnella Craig, Kirsten O’Brien, Kay Sugrue, Maeve McGarry, Brendan Duggan & Sean Egan

Authors
  1. Lee O’Hora
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  2. Noelle Neville
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  3. John Tuffy
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  4. Agnella Craig
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Corresponding author

Correspondence to Lee O’Hora.

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Guarantor

The scientific guarantor of this publication is John Tuffy.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because National DRLs were established using irrevocably anonymised data sets established as part of national competent authority functions.

Ethical approval

Institutional Review Board approval was not required because National DRLs were established using irrevocably anonymised data sets established as part of national competent authority functions.

Study subjects or cohorts overlap

The data collected as part of this study was used to establish DRLs which were subsequently published on the organisation website as part of our competent authority function; however, this was not a scientific publication or peer-reviewed.

Methodology

• Retrospective

• Observational

• Multicentre study

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O’Hora, L., Neville, N., Tuffy, J. et al. Establishing national diagnostic reference levels in radiography, mammography, and dual-energy x-ray absorptiometry services in Ireland and comparing these with European diagnostic reference levels. Eur Radiol 33, 9469–9478 (2023). https://doi.org/10.1007/s00330-023-09992-4

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