Local Diagnostic Reference Levels for Some Common Diagnostic X-Ray Examinations In Sabzevar County of Iran

Document Type : Original Paper


1 Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran

2 Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Diagnostic reference level (DRL) is a useful tool for the promotion of optimization. The national DRLs (NDRLs) are useful, brief, and robust guidelines for optimizing radiation protection in a country. The aim of this study was to extract the local DRLs (LDRLs) for some common radiologic examination in Sabzevar county.
Materials and Methods: There are eight radiology departments in Sabzevar County, Iran. The entrance skin dose (ESD) distributions were determined by use of thermoluminescence dosimeter (TLD) chips for 10 standard projections (i.e., anterioposterior [AP] abdomen, AP and posteroanterior [PA] chest, AP and lateral [LAT] lumbar spine, AP pelvis, cervical AP, cervical LAT, as well as AP and LAT skull). The third quartiles of the measured ESDs were compared with the previously published data.
Results: In the present study, the third quartile of the measured ESDs for the patients undergoing specific examination were selected as LDRLs. The calculated LDRLs for the chest PA, chest AP, lumbar spine PA, lumbar spine LAT, pelvis AP, abdomen AP, cervical AP, cervical LAT, skull PA, and skull LAT were 0.54, 0.64, 1.99, 3.83, 1.47, 2.15, 0.54, 0.78, 1.22, and 1.01 mGy, respectively.
Conclusion: Our results were compared with the DRLs reported in Iran, UK, and Japan as well as those reported by the National Radiological Protection Board (NPRB) for the UK. The ESDs obtained in this study for the chest PA, cervical AP, cervical LAT, AP and LAT skull, abdomen AP, pelvis AP, lumbar PA, and lumbar LAT examinations did not exceed the DRL values reported by NPRB. 


Main Subjects

  1. Protection ICoR. ICRP Publication 60: 1990 Recommendations of the International Commission on Radiological Protection: Elsevier Health Sciences; 1991.
  2. Shandiz MS, Toosi MB, Farsi S, Yaghobi K. Local reference dose evaluation in conventional radiography examinations in Iran. J Appl Clin Med Phys. 2014;15(2).
  3. Radiologists RCo, Board NRP. Patient Dose Reduction in Diagnostic Radiology: Report by the Royal College of Radiologists and the National Radiological Protection Board: NRPB , 1990.
  4. Bahreyni Toossi MT, Akbari F. Diagnostic reference level arising from dental panoramic radiography. Iranian Journal of Medical Physics. 2012;9(3):161-7.
  5. Thiele DL, Irvine M, Want D, Bernardo M. Diagnostic reference levels for mammography in BreastScreen Queensland. Australasian Physical & Engineering Sciences in Medicine. 2011;34(3):415-8.
  6. Hart D, Wall B. UK population dose from medical X-ray examinations. Eur J Radiol. 2004;50(3):285-91.
  7. BahreyniToossi MT, Malekzadeh M. Local Diagnostic Reference Levels for Common Pediatric X-Ray Examinations in Khorasan Razavi Province, Iran. Iranian Journal of Medical Physics. 2014;11(4):301-7.
  8. Suliman I, Mohammedzein T. Estimation of adult patient doses for common diagnostic X-ray examinations in Wad-madani, Sudan: derivation of local diagnostic reference levels. Australasian Physical & Engineering Sciences in Medicine. 2014;37(2):425-9.
  9. Toossi MTB, Malekzadeh M. Radiation dose to newborns in neonatal intensive care units. Iranian Journal of Radiology. 2012;9(3):145.
  10. Asadinezhad M, Toossi MTB. Doses to patients in some routine diagnostic X-ray examinations in Iran: proposed the first Iranian diagnostic reference levels. Radiation protection dosimetry. 2008;132(4):409-14.
  11. Toosi MTB, Asadinezhad M. Local diagnostic reference levels for some common diagnostic X-ray examinations in Tehran county of Iran. Radiation protection dosimetry. 2007.
  12. Papp J. Quality management in the imaging sciences. 4th. ed. 2011: Mosby.
  13. MT BT, H Z. Excess Cancer risk assessment from some common x-ray examinations in Sabzevar County (in Persian). Iran J Med Phys. 2011;8(3):11-9.
  14. Zarghani H, Bahreyni Toossi MT. Evaluation of Organ and Effective Doses to Patients Arising From Some Common X-Ray Examinations by PCXMC Program in Sabzevar, Iran. Iranian Journal of Medical Physics. 2016;12(4):284-91.
  15. Khoshdel-Navi D, Shabestani-Monfared A, Deevband MR, Abdi R, Nabahati M. Local-Reference Patient Dose Evaluation in Conventional Radiography Examinations in Mazandaran, Iran. Journal of biomedical physics & engineering. 2016 Jun;6(2):61.  
  16. Hall E, Brenner D. Cancer risks from diagnostic radiology. The British journal of radiology. 2014.
  17. Lindell B, Dunster HJ, Valentin J. International commission on radiological protection: history, policies, procedures. Swedish Radiation Protection Institute, SE. 1998;171:16.
  18. Medical Information Research Information Network (JRIME).2015. Diagnostic Reference Levels Based on Latest Surveys in Japan. Available from: http://www.radher.jp /JRIME/report /DRLhoukokusyoEng.pdf. 
  19. Hart D, Hillier MC. Doses to patients from radiographic and fluoroscopic X-ray imaging procedures in the UK-2005 review. Health Protection Agency, Radiation Protection Division; 2007.