title: Establishing Local Diagnostic Reference Levels in IR Procedures with Dose Management Software.
abstract: OBJECTIVE
  To obtain local diagnostic reference levels (DRLs) in diagnostic and therapeutic IR procedures with dose management software to improve radiation protection.
  
  
  METHODS
  Dose data of various vascular and nonvascular IR procedures performed within 18 months were collected and analyzed with dose management software. To account for different levels of complexity, procedures were subdivided into simple, standard, and difficult procedures as graded by interventional radiologists. Based on these analyses, local DRLs (given as kerma-area product [KAP]) were proposed. Comparison with dose data of others was conducted, and Spearman correlation coefficients were calculated to evaluate relationships between dose metrics.
  
  
  RESULTS
  Analysis included 1,403 IR procedures (simple/standard/difficult, n = 346/702/355). Within the same procedure, KAP tended to increase with level of complexity. Overall, very strong correlation between KAP (Gy ∙ cm2) and cumulative air kerma (KA,R; Gy) was observed, and moderate to strong correlation between KAP and time and KA,Rand time was observed. For simple procedures, strong correlation was seen between KAP and time and KA,Rand time; for standard and difficult procedures, only moderate correlation was seen. Correlation between KAP and time and KA,Rand time was strong in nonvascular procedures but only moderate in vascular procedures.
  
  
  CONCLUSIONS
  Dose management software can be used to derive local DRLs for various IR procedures, taking into consideration different levels of complexity. Proposed local DRLs can contribute to obtaining detailed national DRLs as part of efforts to improve patients' radiation protection further.
authors.affiliation: Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland. Electronic address: christina.heilmaier@triemli.zurich.ch.
authors.forename: Christina
authors.initials: C
authors.lastname: Heilmaier
authors.affiliation: Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland.
authors.forename: Niklaus
authors.initials: N
authors.lastname: Zuber
authors.affiliation: Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Berthold
authors.affiliation: Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland.
authors.forename: Levent
authors.initials: L
authors.lastname: Kara
authors.affiliation: Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Weishaupt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control* / Q000592:standards*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011834:Radiation Monitoring / Q000379:methods / Q000592:standards*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000592:standards*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012984:Software / Q000592:standards*; D055815:Young Adult