Diagnostic Reference Levels based on clinical indications in computed tomography: a literature review
Graciano Paulo, John Damilakis, Virginia Tsapaki, Alexander Schegerer, Jacques Repussard, Werner Jaschke, Guy Frija, European Society of Radiology, Monika Hierath, Jonathan Clark
Abstract
BACKGROUND: In August 2017, the European Commission awarded the "European Study on Clinical Diagnostic Reference levels for X-ray Medical Imaging" project to the European Society of Radiology, to provide up-to-date Diagnostic Reference Levels based on clinical indications. The aim of this work was to conduct an extensive literature review by analysing the most recent studies published and the data provided by the National Competent Authorities, to understand the current situation regarding Diagnostic Reference Levels based on clinical indications for computed tomography. RESULTS: The literature review has identified 23 papers with Diagnostic Reference Levels based on clinical indications for computed tomography from 15 countries; 12 of them from Europe. A total of 28 clinical indications for 6 anatomical areas (head, cervical spine/neck, chest, abdomen, abdomen-pelvis, chest-abdomen-pelvis) have been identified. CONCLUSIONS: In all the six anatomical areas for which Diagnostic Reference Levels based on clinical indications were found, a huge variation of computed tomography dose descriptor values was identified, providing evidence for a need to develop strategies to standardise and optimise computed tomography protocols.