# Diagnostic reference levels in interventional radiology: a systematic review

## TL;DR

This paper reviews scientific evidence for setting diagnostic reference levels in interventional radiology, highlighting the need for international collaboration and standardization.

## Contribution

The study systematically reviews evidence for DRLs in interventional radiology and identifies gaps in international standardization.

## Key findings

- Most DRL values were reported at the local level, not nationally or regionally.
- Endovascular aneurysm repair and nephrostomy were the most frequently reported procedures.
- Dose management software was found to be effective for data collection and DRL establishment.

## Abstract

To comprehensively and impartially analyze the scientific evidence available
for establishing diagnostic reference levels (DRLs) in interventional
radiology.

This was a systematic review conducted in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The
search focused on studies related to interventional radiology and DRLs in
PubMed/Medline and Embase. Studies involving computed tomography-guided
procedures, studies with incomplete data, and systematic reviews were
excluded. Two independent reviewers evaluated the studies, resolving
discrepancies with a third reviewer. Articles were tabulated with
information such as title, publication year, procedures, DRL values, and
type of equipment used.

A total of 475 articles were identified. After duplicates had been excluded
and eligibility criteria had been applied, the final sample comprised 30
articles. Most DRL values (73%) were reported at the local level, as defined
by International Commission on Radiological Protection criteria,
representing typical dose values from a sample within one or a few
institutions. A total of 113 procedures were identified, with endovascular
aneurysm repair and nephrostomy being the most frequently reported. We
identified DRLs at national and regional scales, predominantly within
Europe. Influencing factors included technology, operator experience,
specific protocols, and optimization strategies. The analysis also
identified a lack of longitudinal studies assessing changes over time. The
use of dose management software emerged as an effective tool for
facilitating data collection and DRL establishment.

The lack of standardized procedural terminology hindered direct DRL
comparisons. Our findings highlight a predominance of European studies and
emphasize the need for broader international efforts to improve DRL
implementation.