Diagnostic reference levels and the role of medical physics experts

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Diagnostic reference levels are not the suggested or ideal dose for a particular procedure or an absolute upper limit for dose. Rather, they represent the dose level at which an investigation of the appropriateness of the dose should be initiated¹. And it is the responsibility of the medical physics expert to help ensure they are applied appropriately.

¹ (imagewisely.org)

Diagnostic reference levels

The Council Directive defines diagnostic reference levels as follows:

The Council directive defines diagnostic reference levels as follows:

Radiation dose levels in medical radio-diagnostic or interventional radiology practices, or, in the case of radio-pharmaceuticals, levels of activity, for typical examinations for groups of standard-sized patients or standard phantoms for broadly defined types of equipment; for procedures using medical radiological equipment, where practicable, specific diagnostic reference levels are put in place.

The Council directive defines diagnostic reference levels as follows:

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There are three levels of justification - general, specific/generic, and individual.

The Council directive defines diagnostic reference levels as follows:

The general justification is the acceptance of the application of radiation in medicine as doing more good than harm.

The specific/generic justification links certain applications to certain objectives (certain symptoms justify specific protocols).

The individual or chosen examination should “fit” the unique needs of the patient.

The use of reference levels is a form of optimization. It is not recommended to use dose constraints or dose limits in regards to medical treatment. The use of radiation must fit a specific patient need. However, when looking at groups of comparable patients and comparable procedures, it is possible to establish a diagnostic reference level (DRL). This DRL is a boundary which you should not exceed under standard circumstances. So, it is not a legal limit, but it helps you assess your protocols for comparability with other institutions. Appropriate review should be undertaken whenever DRLs are consistently exceeded and corrective action taken without undue delay.

The Directive says that Member States must ensure the establishment, regular review, and use of diagnostic reference levels for radiodiagnostic examinations, and where appropriate, for interventional radiology procedures. It goes on to say, that depending on the medical radiological practice, it is the medical physics expert who:

Takes responsibility for dosimetry, including physical measurements for evaluation of the dose delivered to the patient and other individuals subject to medical exposure.
Gives advice on medical radiological equipment.
Contributes (in particular) to the optimization of the radiation protection of patients and other individuals subject to medical exposure, including the application and use of diagnostic reference levels.

Voluntary exposure

For voluntary exposure due to biomedical research, not only should the DRL’s be in place, but specific dose constraints need to be established and upheld (if there is no direct medical benefit). Also for carers and comforters, dose constraints need to be in place, where appropriate.

Medical physics expert

The Council Directive defines medical physics expert as follows:

The Council directive defines diagnostic reference levels as follows:

An individual or, if provided for in national legislation, a group of individuals, having the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to medical exposure, whose competence in this respect is recognized by the competent authority.

The Council directive defines diagnostic reference levels as follows:

In the new directive, the role of the medical physics expert has been specified more clearly and their involvement in medical procedures has been described more extensively. The medical physics expert is expected to act or give specialist advice, as appropriate, on matters relating to radiation physics for implementing the requirements for medical exposure (Chapter VIII) including those for equipment, optimization, responsibilities, training and special protection during pregnancy.

The medical physics expert takes responsibility for dosimetry, including physical measurements for evaluation of the dose delivered to the patient and other individuals subject to medical exposure, give advice on medical radiological equipment, and contribute in particular to the following (article 83):

Optimization of the radiation protection of patients and other individuals subject to medical exposure, including the application and use of diagnostic reference levels medical exposure, including the application and use of diagnostic reference levels
The definition and performance of quality assurance of the medical radiological equipment
Acceptance testing of medical radiological equipment
The preparation of technical specifications for medical radiological equipment and installation design
The surveillance of the medical radiological installations
The analysis of events involving, or potentially involving, accidental or unintended medical exposures
The selection of equipment required to perform radiation protection measurements
The training of practitioners and other staff in relevant aspects of radiation protection

There might be some overlap between the tasks of the medical physics expert and the radiation protection expert for specific institutions. In the Directive, it is therefore specifically mentioned that where appropriate, the medical physics expert shall liaise with the radiation protection expert. However, the medical physics expert and the radiation protection expert may be one in the same person in some institutions.

The medical physics expert must be involved with all others entitled to carry out practical aspects of medical radiological procedure optimization – the referrer, the practitioner (i.e. radiologist), radiation protection expert, and any individual(s) entitled to act in this respect in a recognized field of specialization – the level of involvement being commensurate with the radiological risk posed by the practice.

Resources

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Diagnostic reference levels and the role of medical physics experts

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Diagnostic reference levels

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There are three levels of justification - general, specific/generic, and individual.

Medical physics expert

An individual or, if provided for in national legislation, a group of individuals, having the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to medical exposure, whose competence in this respect is recognized by the competent authority.

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