Radiation Protection No. 185 European Guidelines on Diagnostic Reference Levels for Paediatric Imaging

The establishment and use of diagnostic reference levels (DRLs) have been recommended by the International Commission on Radiological Protection (ICRP) and required in the European Council Directive 2013/59/Euratom Basic Safety Standards (BSS). DRLs are a useful tool in the quest to optimise patient doses in diagnostic radiology and interventional radiology (IR). Particular attention should be paid to establishing and using DRLs in paediatric radiology because children have a higher risk (for some organs and body areas) compared to adults from the detrimental effects of radiation. A comprehensive European and worldwide review of DRLs for paediatric examinations (Section 5 and Annex C) has indicated that only a few countries have set DRLs for paediatric examinations and there is a complete lack of national DRLs for many examinations, in particular for all paediatric interventional procedures. Furthermore, the existing DRLs are often adopted from the old European Commission (EC) recommendations or from other countries, and only a few countries have based their DRLs on their own national patient dose surveys. In many countries, the initial DRLs have never been updated. Due to the huge variation of patient sizes among the paediatric population, several age, size or weight groups are needed to establish the DRLs, and there has been little consistency in grouping of the patients. Extensive patient dose surveys are needed to establish DRLs but there has been no detailed guidance on how to carry out and report such surveys in order to ensure consistent methods and comparability of the DRLs, in particular for reliable evaluation of DRLs for use at a European level.