title: Diagnostic reference levels and complexity indices in interventional radiology: a national programme.
abstract: OBJECTIVE
  To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses.
  
  
  METHODS
  Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values.
  
  
  RESULTS
  The KAP (3rd quartile) in Gy cm2for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4.
  
  
  CONCLUSIONS
  The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology.
  
  
  CONCLUSIONS
  • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made.
authors.affiliation: School of Medicine, University of Malaga, Malaga, Spain. rrcmf@uma.es.
authors.forename: R
authors.initials: R
authors.lastname: Ruiz-Cruces
authors.affiliation: San Carlos Hospital, Medical School, Complutense University, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Vano
authors.affiliation: Juan Ramon Jimenez University Hospital, Huelva, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Carrera-Magariño
authors.affiliation: Juan Ramon Jimenez University Hospital, Huelva, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Moreno-Rodriguez
authors.affiliation: Reina Sofia University Hospital, Cordoba, Spain.
authors.forename: M M
authors.initials: MM
authors.lastname: Soler-Cantos
authors.affiliation: Reina Sofia University Hospital, Cordoba, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Canis-Lopez
authors.affiliation: University Hospital of Canary Islands, Tenerife, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Hernández-Armas
authors.affiliation: University Hospital of Canary Islands, Tenerife, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Diaz-Romero
authors.affiliation: Basurto Hospital, Bilbao, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Rosales-Espizua
authors.affiliation: San Carlos Hospital, Medical School, Complutense University, Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Fernandez-Soto
authors.affiliation: San Carlos Hospital, Medical School, Complutense University, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Sanchez-Casanueva
authors.affiliation: Virgen de la Victoria University Hospital, Malaga, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Martin-Palanca
authors.affiliation: School of Medicine, University of Malaga, Malaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Perez-Martinez
authors.affiliation: General University Hospital, Ciudad Real, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Gil-Agudo
authors.affiliation: General University Hospital, Ciudad Real, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Zarca-Diaz
authors.affiliation: Carlos Haya University Hospital, Malaga, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Parra-Osorio
authors.affiliation: Carlos Haya University Hospital, Malaga, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Muñoz Ruiz-Canela
authors.affiliation: Juan Ramon Jimenez University Hospital, Huelva, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Moreno-Sanchez
authors.affiliation: Basurto Hospital, Bilbao, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Lopez-Medina
authors.affiliation: Carlos Haya University Hospital, Malaga, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Moreno-Saiz
authors.affiliation: Carlos Haya University Hospital, Malaga, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Galan-Montenegro
authors.affiliation: San Carlos Hospital, Medical School, Complutense University, Madrid, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Gallego-Beuter
authors.affiliation: Basurto Hospital, Bilbao, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Gonzalez-de-Garay
authors.affiliation: General University Hospital, Ciudad Real, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Zapata-Jimenez
authors.affiliation: School of Medicine, University of Malaga, Malaga, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Pastor-Vega
authors.affiliation: School of Medicine, University of Malaga, Malaga, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Cañete
mesh_terms: D000792:Angiography / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D011786:Quality Control; D011829:Radiation Dosage; D015642:Radiology, Interventional / Q000379:methods* / Q000592:standards*; D012016:Reference Values; D013030:Spain; D011795:Surveys and Questionnaires
keywords: Clinical audit; Diagnostic reference levels; Interventional radiology; Optimization; Patient doses