Establishing national diagnostic reference levels in fluoroscopy and fluoroscopically guided interventions in Ireland and comparing these with national diagnostic reference levels in Europe and internationally

Purpose: The purpose of this work was to establish national Irish diagnostic reference levels (DRLs) for a clinically representative and comprehensive list of clinical indications, anatomical regions, and common procedures for fluoroscopy and fluoroscopically guided interventions and compare these, where possible, to other DRLs established at a national level.

Method: A list of clinical indications, anatomical regions and common procedures was established. A national database of service providers was used to identify all medical radiological facilities providing fluoroscopy and fluoroscopically guided intervention services. These facilities were issued with an online survey. National Pka DRLs were set as the 75th percentile of the distribution of median values obtained. A national median dose was also established which is the 50th percentile of the median doses provided by facilities for the same patients and conditions as the national DRL value. The broad categorisation of equipment type was also considered. Where statistically significant differences were found between different detector types, detector specific national DRLs were established (flat panel detector and image intensifier specific DRLs).

Results: National Pka DRLs were established for 52 fluoroscopy and fluoroscopically guided intervention clinical indications, anatomical regions, and procedures. In addition, equipment specific (flat panel detector and image intensifier based systems) adult DRLs were established for the EVAR and lumbar puncture under fluoroscopy procedures. Paediatric DRLs were established for two fluoroscopy and fluoroscopically guided intervention clinical indications, anatomical regions, and procedures across various weight categories. Comparisons with other nationally set DRLs and other relevant literature suggest that Irish DRLs are typically lower than those established elsewhere.

Conclusions: This work provided a unique opportunity to establish national DRLs based on census data for a wide range of clinical indications, anatomical regions, and procedures across adult and paediatric fluoroscopy and fluoroscopically guided interventions. Where comparisons with other nationally established work was possible Irish values are largely below other DRLs.