Establishing national diagnostic reference levels in radiography, mammography, and dual-energy x-ray absorptiometry services in Ireland and comparing these with European diagnostic reference levels.

OBJECTIVES: The aim of this work was to establish national diagnostic reference levels (DRLs) in Ireland and compare these to existing European DRLs where available. This work surveyed all radiological facilities providing radiography, mammography, and dual-energy x-ray absorptiometry (DXA) services in Ireland. METHODS: A list of common procedures and clinical tasks was established. A national database of service providers was used to identify the appropriate medical radiological facilities providing these services. These facilities were issued with an online survey. National DRLs were set as the 75th percentile of the distribution of median values obtained. A national median dose was also established. The broad categorisation of equipment type was also considered. Where differences between DRLs established using different detector types were deemed statistically significant, equipment-specific national DRLs were established. RESULTS: National DRLs were established for 12 adult radiography projections. Equipment-specific (computed radiography and digital radiography) adult DRLs were established for four radiography projections. Paediatric DRLs were established for 11 radiography projections, including two based on clinical indications, for a range of paediatric weight categories. National DRLs were established for unilateral two-view mammography and breast tomosynthesis as well as for four DXA clinical indications and projections. All but one Irish DRL figure was found to be below or equal to European data. CONCLUSIONS: This work provided a unique opportunity to establish national DRLs based on census data for a range of procedures and clinical tasks across radiography, mammography and DXA and compare these with European levels. CLINICAL RELEVANCE STATEMENT: This work established national diagnostic reference levels (DRLs) based on census data for a range of procedures and clinical tasks across radiography, mammography and dual-energy x-ray absorptiometry. The establishment of national DRLs is an essential component in the optimisation of patient radiation dose. KEY POINTS: • Diagnostic reference levels are easily measured quantities intended for use as an aid to optimise patient dose and to identify when levels of patient dose are unusually high. • Data from all medical radiological facilities in Ireland was obtained to establish national diagnostic reference level (DRL) values and national median dose values in radiography, x-ray breast imaging and dual-energy x-ray absorptiometry (DXA) scanning and these were compared to existing European DRLs where available. • National DRL values were established for the first time in breast tomosynthesis, DXA scanning, and paediatric radiography.

Development of an Irish national policy for the management of pregnant or potentially pregnant patients that are referred for a procedure involving the use of ionising radiation.

OBJECTIVES: The management of pregnant or potentially pregnant patients who are referred for medical imaging procedures involving ionising radiation has proven to be a challenge for healthcare providers in Ireland. This has been confirmed by a number of regulatory agencies including the Environmental Protection Agency who have reported poor compliance with legislation, inadequate documentation and sub-optimal patient care. METHODS: An expert group was established to examine the issues that were at the root of these problems and produce recommendations for improvement. The issues highlighted by the group included a lack of clarity and consensus around a number of workflow issues such as exam categorisation, criteria to reasonably rule out pregnancy, dealing with paediatric patients and a protocol to allow urgent high fetal dose examinations to proceed when pregnancy cannot be excluded. The absence of a standardised national pregnancy declaration form was also identified as a contributory factor to poor regulatory compliance. RESULTS: The group produced a pregnancy policy template that healthcare providers could adopt which clarified the issues that were identified and included a standardised adult and paediatric pregnancy declaration form. The implementation of the policy template was subsequently assessed via a survey of a number of radiology departments and a representative referrer group. CONCLUSIONS: The results of these surveys revealed a substantial uptake of the template along with overall satisfaction with the contents. They also demonstrated a reduction in the use of the clinical waiver system which had been highlighted as a cause of sub-optimal patient care. KEY POINTS: • The management of pregnant or potentially pregnant patients referred for medical imaging procedures involving ionising radiation is challenging. • A new national pregnancy policy template was developed by an expert group and has been widely adopted by healthcare institutions in Ireland.