The Establishment of Institutional Diagnostic Reference Levels (DRLs) in the Cipto Mangunkusumo Hospital

T. Amalia, B. Zulkarnaien, C. Anam, K. Nurcahyo, H. Tussyadiah, D. E. Pradana

Abstract


Institutional diagnostic reference levels are used for quality assurance in radiology departments. The purpose of this study was to establish an institutional diagnostic reference level (DRL) and to provide a practical tool in diagnostic radiology and nuclear medicine. For each type of procedure/examination, it needs at least 20 patients. The patients with regular size (average body size is 65 ± 10 kg for adult patients and 15±15 kg for pediatric patients) were enrolled in this project. The 75 percentile values of doses were used as institutional DRLs.  For nuclear medicine, the administered activities was based on the dose of activity to produce a good image. The DRL values were obtained for general radiography, nuclear medicine, mammography, CT examination, and interventional radiography. The DRL's result was compared to national DRL (NDRL) and values in other countries. The DRL values for general radiography in this study are higher compared to NDRL and Japanese study. The administered activities (MBq) for nuclear medicine in this study are higher compared to European Commission but lower when compared to a Japanese study. The DRL values for mammography in this study are higher compared to ARPANSA; however, they are lower than NDRL and UK studies. The DRL values for CT examination in this study are higher compared to Netherland, Canadian, and USA studies but lower than NDRL. The DRL values in interventional radiography (IR) in this study are lower compared to the IAEA study. This finding indicates that it is still necessary to optimize procedures in the future. The established institutional DRL values can be used as a tool for optimization.


Keywords


Diagnostic reference levels; Diagnostic radiology; Optimization; Patient safety

Full Text:

PDF

References


ICRP, The 2007 Recommendations of the International Commission on Radiological Protection, ICRP Publication 103, Ann. ICRP 37 (2-4) (2007).

ICRP, Assessing Dose of the Representative Person for the Purpose of Radiation Protection of the Public and the Optimisation of Radiological Protection: Broadening the Process, ICRP Publication 101, Ann. ICRP 36(3) (2006).

ICRP, Radiological protection in medicine, ICRP Publication 105, Ann. ICRP 37(6) (2007).

Anonymous, Medical Radiation Exposure of the European Population Part 1/2, in: Radiation Protection N° 180, European Commission, Luxembourg (2014) 1.

C. J. Martin, Radiat. Prot. Dosim. 169 (2016) 211.

ICRP, Diagnostic Reference Levels in Medical Imaging, ICRP Publication 135, Ann. ICRP 46(1) (2017).

C. Ghetti, O. Ortenzia, F. Palleri et al., Radiat. Prot. Dosim. 175 (2017) 38.

J. Boos, C. Thomas, E. Appel et al., J. Radiol. Prot. 38 (2018) 536.

Anonymous, Diagnostic Reference Levels in Thirty-six European Countries Part 2/2, in: Radiation Protection N° 180, European Commission, Luxembourg (2014) 1.

C. J. Martin, J. L. Heron, C. Borrás et al., J. Radiol. Prot. 33 (2013) 711.

C. Anam, T. Fujibuchi, F. Haryanto et al., J. Radiol. Prot. 39 (2019) 112.

IAEA, Dosimetry in Diagnostic Radiology: An International Code of Practice, in: Technical Reports Series No. 457, International Atomic Energy Agency, Vienna (2007) 105.

J. Vassileva and M. Rehani, Am. J. Roentgenol. 204 (2015) W1.

IAEA, Radiation Protection and Safety in Medical Uses of Ionizing Radiation, in: IAEA Safety Standards for protecting people and the environment, Specific Safety Guide No. SSG-46, International Atomic Energy Agency, Vienna (2018) 1.

Anonymous, Joint Commission International Accreditation Standards for Hospitals. 7th ed., Joint Commission International, United States (2020) 1.

C. S. Mayo, J. M. Moran, W. Bosch et al., Int. J. Radiat. Oncol. Biol. Phys. 100 (2018) 1057.

Anonymous, Adult Routine Head CT Protocols Version 2.0, American Association of Physicists in Medicine (AAPM), Virginia (2016) 1.

Anonymous, Pedoman Teknis Penyusunan Tingkat Panduan Diagnostik atau Diagnostic Reference Level (Drl) Nasional, in: Seri Rekaman Dokumen Unit Kerja TA. 2016 REV. 02/2019, Pusat Pengkajian Sistem dan Teknologi Pengawasan Fasilitas Radiasi dan Zat Radioaktif - Badan Pengawas Tenaga Nuklir, Jakarta (2019) 1.

Anonymous, Diagnostic Reference Levels Based on Latest Surveys in Japan, in: Japan DRLs 2015, (2015) 1.

ARPANSA, Radiation Protection in the Medical Applications of Ionizing Radiation, in: Radiation Protection Series Publication No. 14, Australian Radiation Protection and Nuclear Safety Agency, Yallambie (2008).

D. R. Dance, K. C. Young and R. E. V. Engen, Phys. Med. Biol. 54 (2009) 4361.

A. J. V. D. Molen, A. Schilham, P. Stoop et al., Insights into Imaging 4 (2013) 383.

G. M. Wardlaw and N. Martel, Med. Phys. 43 (2016) 4932.

P. F. Butler and K. M. Kanal, J. Am. Coll. Radiol. 15 (2018) 932.

K. E. Kocher, W. J. Meurer, R. Fazel et. al., Ann. Emergency Med. 58 (2011) 452.

IAEA, Establishing Guidance Levels in X Ray Guided Medical Interventional Procedures: A Pilot Study, in: Safety Reports Series No. 59, International Atomic Energy Agency, Vienna (2009) 1.

IAEA, Diagnostic reference levels (DRLs) in medical imaging, https://www.iaea.org/resources/rpop/health-professionals/nuclear-medicine/diagnostic-nuclear-medicine/diagnostic-reference-levels-in-medical-imaging. Retrived in September (2020).



DOI -


https://doi.org/10.17146/aij.2022.1131



Copyright (c) 2022 Atom Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.