Implementation of pediatric diagnostic reference levels in the Netherlands

Diagnostic reference levels (DRLs) have been recommended by the International Commission on Radiological Protection (ICRP) as an advisory measure to improve optimization of patient protection, by identifying high patient dose levels which might not be justified on the basis of image quality requirements. The implementation of DRLs in the Netherlands has been performed in a three phase project carried out from 2006 - 2012. In the 2012 guidelines DRLs have been defined for only 4 pediatric examinations (PiDRLs), x-thorax, x-pelvis, CT-head and micturating cystourethrogram.

Given the current lack of PiDRLs in the Netherlands, the NCS and NVKF strongly recommended to start a project to establish national DRLs for pediatric examinations using automatic data collection. In the current project Dutch hospitals will be asked to upload their dose information on pediatric diagnostic and interventional procedures to a central database. Radiography, fluoroscopy and Computed Tomography procedures will be included. Not only dedicated hospitals for pediatric medical care will be involved, but also more general academic and peripheral hospitals will be involved. The aim is to use the data from at least 8 hospitals with a total database of >1000 examinations on children. In addition, a proposal will be made for hospitals how to use the established national PiDRLs, even in cases where small numbers of children are being examined.

The first meeting of this committee was 7 November 2019.

Topics to be covered            

  • Definition of categories of patients (age, length, weight) 
  • Setup and filling of a project database for dose data
  • Analysis of the project database and comparison to the European PiDRL
  • Establishing national PiDRLs
  • Development of methods how to use the established national PiDRLs
  • Presentation of the report and communication to health care professionals

Members of this NCS subcommittee

  • Martijn Boomsma (Isala)
  • Lida Dam - Vervloet (Isala, Chair
  • Nanko de Graaf (Erasmus UMC)
  • Marcel Greuter (UMCG)
  • Laurine Keulemans (VWS)
  • Bart Mangnus (Amsterdam UMC, location AMC)
  • Carola van Pul (Maxima Medical Center)
  • Jenny Schaar (UMCG)
  • Geert Streekstra (Amsterdam UMC, location AMC, Secretary)
  • Alie Vegter (Treant Hospital)
  • Nanko de Graaf (Erasmus MC, representative NCS board)