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Variabilities in X-ray diagnostic reference levels

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Abstract

Objectives

To estimate the variability of X-ray diagnostic reference levels (DRLs) depending on the number of X-ray devices and data per device.

Methods

Dose-area products (DAP) were collected by the national nuclear control agency from the 590 devices installed in 345 medical centers in the country. From 2015 to 2017, the number of chest (postero-anterior (PA) view alone, and both postero-anterior and lateral views (PA/LAT)), abdomen, pelvis, and lumbar spine examinations collected in these centers ranged from 23,000 to 77,000. The impact of the number of devices and DAP data per device on DRLs’ variabilities (95th confidence intervals divided by medians) is estimated using a bootstrapping method as a function of the number of devices and DAP per device.

Results

The DRLs’ variabilities ranged from 30 to 200% depending on the number of devices and DAP data per device but stabilized at 30% when the number of devices was higher than 200 for chest PA and abdomen examinations, 300 for lumbar spine and pelvis examinations, and 400 for chest PA/LAT examinations, regardless of the number of DAP data per device. Extrapolations of our results suggest that thousands of devices are necessary to reduce DRLs’ variabilities to 10%.

Conclusion

DAP-related DRL variabilities are high but only moderately influenced by the number of DAP data per device and of devices provided this number is higher than 200 to 400 devices according to the type of examination. Harmonization of methods of data collection between the authorities of the EU states should be recommended.

Key Points

• DAP-related DRLs are not fixed values but ranges of values with at least 30% variability.

• DAP-related DRLs strongly depend on the number of devices included when lower than 100.

• If the number of devices included exceeds 200 to 400, the DRLs’ variabilities do not depend on the number of DAP per device and should not exceed 30%.

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Abbreviations

CT:

Computed tomography

DAP:

Dose-area product

DLP:

Dose-length product

DRL:

Diagnostic reference level

EU:

European Union

P75:

75th percentiles

PA/LAT:

Postero-anterior and lateral views

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Federal Agency for Nuclear Control (FANC), Rue Ravenstein 36, 1000, Brussels, Belgium

    Thibault Vanaudenhove

  2. Department of Chest Medicine, Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium

    Alain Van Muylem

  3. Department of Radiology, Clinique des Grangettes, 7 Chemin des Grangettes, 1224, Chêne-Bougeries, Switzerland

    Nigel Howarth

  4. Department of Radiology, Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium

    Pierre Alain Gevenois

  5. Department of Radiology, Epicura, Clinique Louis Caty, 136 Rue Louis Caty, 7331, Baudour, Belgium

    Denis Tack

Authors
  1. Thibault Vanaudenhove
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  2. Alain Van Muylem
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  3. Nigel Howarth
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  4. Pierre Alain Gevenois
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  5. Denis Tack
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Corresponding author

Correspondence to Denis Tack.

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Guarantor

The scientific guarantor of this publication is Denis Tack.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study since, according to EU legislation (i.e., the Regulation (EU) 2016/679 regarding the protection of data of individuals), a purely observational study with complete anonymization of the data at the source, which removes any possibility of identifying the individual patients, is not subject to ethical review. See “The European parliament and the council of the European Union (2016) Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC. OJ L 119, 4.5.2016, p. 1–88. Available via https://op.europa.eu/en/publication-detail/-/publication/3e485e15-11bd-11e6-ba9a-01aa75ed71a1/ Accessed 24 Oct 2019.”

Ethical approval

Institutional Review Board approval was not required because see above.

Methodology

• Retrospective

• Observational

• Multicenter study

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Vanaudenhove, T., Van Muylem, A., Howarth, N. et al. Variabilities in X-ray diagnostic reference levels. Eur Radiol 30, 4641–4647 (2020). https://doi.org/10.1007/s00330-020-06819-4

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  • DOI: https://doi.org/10.1007/s00330-020-06819-4

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