title: Diagnostic reference level: an important tool for reducing radiation doses in adult and pediatric nuclear medicine procedures in Brazil.
abstract: OBJECTIVE
  This study aimed to establish a concise method for determining a diagnostic reference level (DRL) for adult and pediatric nuclear medicine patients on the basis of diagnostic procedures and administered radioisotope as a means of controlling medical exposure.
  
  
  METHODS
  A screening was carried out in all Brazilian Nuclear Medicine Service (NMS) establishments to support this study by collecting the average activities administered during adult diagnostic procedures and the rules applied to adjust these according to the patient's age and body mass. Percentile 75 was used in all the activities administered as a means of establishing DRL for adult patients, with additional correction factors for pediatric patients. Radiation doses from nuclear medicine procedures on the basis of average administered activity were calculated for all diagnostic exams.
  
  
  CONCLUSIONS
  A total of 107 NMSs in Brazil agreed to participate in the project. From the 64 nuclear medicine procedures studied, bone, kidney, and parathyroid scans were found to be used in more than 85% of all the NMSs analyzed. There was a large disparity among the activities administered, when applying the same procedures, this reaching, in some cases, more than 20 times between the lowest and the highest. Diagnostic exams based on Ga, Tl, and I radioisotopes proved to be the major exams administering radiation doses to patients. On introducing the DRL concept into clinical routine, the minimum reduction in radiation doses received by patients was about 15%, the maximum was 95%, and the average was 50% compared with the previously reported administered activities.
  
  
  CONCLUSIONS
  Variability in the available diagnostic procedures as well as in the amount of activities administered within the same procedure was appreciable not only in Brazil, but worldwide. Global efforts are needed to establish a concise DRL that can be applied in adult and pediatric nuclear medicine procedures as the application of DRL in clinical routine has been proven to be an important tool for controlling and reducing radiation doses received by patients in medical exposure.
authors.affiliation: aCancer Institute of São Paulo State (ICESP), Clinical Hospital bNuclear Medicine Service, Department of Radiology, School of Medicine, University of São Paulo, São Paulo cNational Commission on Nuclear Energy, Rio de Janeiro, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Willegaignon
authors.forename: Luis F E F
authors.initials: LF
authors.lastname: Braga
authors.forename: Marcelo T
authors.initials: MT
authors.lastname: Sapienza
authors.forename: George B
authors.initials: GB
authors.lastname: Coura-Filho
authors.forename: Marissa A R
authors.initials: MA
authors.lastname: Cardona
authors.forename: Carlos E R
authors.initials: CE
authors.lastname: Alves
authors.forename: Ricardo F
authors.initials: RF
authors.lastname: Gutterres
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Buchpiguel
mesh_terms: D000328:Adult; D001938:Brazil; D002648:Child; D003952:Diagnostic Imaging / Q000379:methods* / Q000592:standards*; D006801:Humans; D009683:Nuclear Medicine / Q000379:methods* / Q000592:standards*; D011829:Radiation Dosage; D012015:Reference Standards