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SC 4-3: Diagnostic Reference Levels in Medical Imaging: Recommendations for Application in the United States  

Committee members

Diagnostic Reference Levels (DRLs) are similar to investigational levels and provide guidance for radiologists regarding the appropriateness of patient radiation doses for specific x-ray projections and imaging procedures. NCRP Scientific Committee 4-3 is preparing a definitive report on this subject, and held its initial meetings on March 23-24 and October 27-28, 2009.

Some of the U.S. Food and Drug Administration’s Nationwide Evaluation of X-Ray Trends (NEXT) CT data was not finalized at that time but was submitted in a summary form. Additional data will be put into the draft report before it is submitted to the Council for comments.

It was decided that chiropractors will be added to the report. The DRL for them will be the same as for other practitioners for the abdomen and lumbar spine.

The concept of “achievable dose” will be included in the report. The diagnostic reference level is usually set at the 75th to 80th percentile of national surveys. This is a relatively high dose based on a state-of-the-practice survey. When the 75th percentile is used then 75 % of all facilities are using doses lower than this. Although this might be considered the first step in the optimization process, it does not encourage 75 % of the facilities to optimize their radiation doses and image quality. “Achievable dose” is recommended by the ICRP as a way to further encourage optimization and is typically set at the 50th percentile or less. The Health Protection Agency of the United Kingdom has been promoting this concept since the late 1990s. The achievable dose is set at a reasonable level that a state-of-the-art facility will be able to attain without significant effort and expense.

The Committee held a teleconference on May 21, 2010 and a meeting at NCRP on June 4, 2010. Most of the text is presently in draft form. A WebEx teleconference was scheduled for the week of July 26, 2010. The final text was submitted to the NCRP Staff Consultant for editing by July 30, 2010 for submission to NCRP by August 15th.

On September 9, 2010 the draft report was distributed for PAC review with a deadline for comments of October 7, 2010.

On February 14, 2011 the draft report was circulated for Council review with a deadline of March 14, 2011. The draft has been undergoing revisions with email discussions between the Committee members and the NCRP Staff Consultant.

The draft report is being revised following Council review.

The membership of SC 4-3 is:

J.A. Brink, Chairman
J.M. Boone
K.A. Feinstein
J.M. Michalski
R. Pizzutielo
D.C. Spelic
S.C. White
J. Yee
J.T. Bushberg, Consultant
J. Duncan, Consultant
D. Yoo, Consultant
J.E. Gray, NCRP Staff Consultant

 

Meetings:

March 23-24, 2009  >
October 27-28, 2009 >

 

SC 4-4 Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant >

 

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