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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.
The Council Directive defines diagnostic reference levels as follows:
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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:
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):
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.
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