Damilakis John, Brkljacic Boris, Frija Guy, De Bondt Timo, Paulo Graciano, Tsapaki Virginia, Vano Eliseo
School of Medicine, University of Crete, Iraklion, Crete, Greece.
School of Medicine, University of Zagreb, Šalata 3, 10000, Zagreb, Croatia.
Insights Imaging. 2025 Jul 18;16(1):156. doi: 10.1186/s13244-025-02028-z.
Despite progress in implementing diagnostic reference levels (DRLs) across Europe, clinical practices remain variable. This prompts the EuroSafe Imaging campaign to conduct a survey assessing current practices, perceptions, and challenges related to DRLs. A total of 146 responses were collected from radiology departments in 38 countries, predominantly in the EU/EEA region. While 52.4% reported established local DRLs, significant gaps were identified, with 34.5% lacking local DRLs and 13.1% unaware of their existence. DRLs were primarily established for computed tomography (CT) (88.7%) and conventional radiography (77.5%), with lower implementation in interventional radiology (36.6%). Key challenges included time constraints, data collection difficulties, and limited standardization across institutions. Education gaps were notable, with less than half of the respondents reporting DRL-related training for radiology residents. Respondents emphasized the need for dose management systems, personalized DRLs based on clinical indications, and enhanced education and policy support. Addressing barriers through targeted training, policy enhancements, and technological innovations can improve DRL implementation. Future efforts should focus on promoting standardized clinical protocols, increasing awareness, and fostering European and international collaboration to ensure the consistent use and optimization of DRLs in clinical practice. CRITICAL RELEVANCE STATEMENT: The article critically examines the variability and challenges in implementing diagnostic reference levels (DRLs) across European radiology departments, providing actionable recommendations on policy, education, and technological advancements to optimize radiation protection and improve clinical radiology practices. Diagnostic reference levels (DRLs) help healthcare providers ensure that radiation doses from medical imaging, like CT scans and X-rays, are not higher than necessary. This study looked at how DRLs are used across Europe. It found that while many hospitals have established and follow DRLs, others do not, which may affect patient safety. Challenges like time constraints and lack of training prevent better use of DRLs. Improving education for medical staff and updating protocols can help protect patients by reducing unnecessary radiation exposure while still ensuring accurate diagnoses. KEY POINTS: Variability persists in diagnostic reference level (DRL) practices across Europe. Over half of radiology departments have established local DRLs. Less than half of radiology residents receive structured DRL training. Improved DRL adoption can optimize radiation protection and patient safety. Collaboration, training, and standardized protocols are essential for better DRL practices.
尽管欧洲在实施诊断参考水平（DRLs）方面取得了进展，但临床实践仍然存在差异。这促使欧洲安全影像运动开展一项调查，评估与DRLs相关的当前实践、认知和挑战。共收集了来自38个国家放射科的146份回复，主要来自欧盟/欧洲经济区地区。虽然52.4%的回复称已制定当地的DRLs，但仍发现存在显著差距，34.5%的机构缺乏当地的DRLs，13.1%的机构不知道其存在。DRLs主要针对计算机断层扫描（CT）（88.7%）和传统放射摄影（77.5%）制定，在介入放射学中的实施率较低（36.6%）。主要挑战包括时间限制、数据收集困难以及各机构之间标准化程度有限。教育差距显著，不到一半的受访者表示为放射科住院医师提供了与DRLs相关的培训。受访者强调需要剂量管理系统、基于临床指征的个性化DRLs，以及加强教育和政策支持。通过有针对性的培训、政策改进和技术创新来消除障碍，可以改善DRLs的实施。未来的努力应集中在推广标准化临床方案、提高认识以及促进欧洲和国际合作，以确保在临床实践中一致使用和优化DRLs。关键相关性声明：本文批判性地审视了欧洲放射科在实施诊断参考水平（DRLs）方面的差异和挑战，就政策、教育和技术进步提供了可操作的建议，以优化辐射防护并改善临床放射学实践。诊断参考水平（DRLs）有助于医疗保健提供者确保来自医学影像（如CT扫描和X光）的辐射剂量不高于必要水平。本研究考察了DRLs在欧洲的使用情况。研究发现，虽然许多医院已经制定并遵循DRLs，但其他医院则没有，这可能会影响患者安全。时间限制和缺乏培训等挑战阻碍了DRLs的更好使用。改善医务人员的教育并更新方案有助于通过减少不必要的辐射暴露同时仍确保准确诊断来保护患者。关键点：欧洲各地诊断参考水平（DRL）实践中仍存在差异。超过一半的放射科已制定当地的DRLs。不到一半的放射科住院医师接受结构化的DRL培训。更好地采用DRLs可以优化辐射防护和患者安全。合作、培训和标准化方案对于更好地实施DRLs至关重要。
