Diagnostic Reference Levels in Medical Imaging

Draft document: Diagnostic Reference Levels in Medical Imaging
Submitted by Peter Mildenberger, MD, IHE-Europe
Commenting on behalf of the organisation

Ladies and Gentlemen,

thank you for preparing this document, and there is no doubt, that DRLs are very helpful in Radiology to improve the quality and radiation protection.
In the past, DRLs are very often based on individual surveys, or selected data collections with limited representation and also without link to patient conditions (age, weight etc.).
The international DICOM Standards Committee -in corporation with IEC and others- has developed different tools to support automatic data transfer from modalities to IT-systems. MPPS has been one of the first messages, started in the end 90ies. Today, MPPS is due to its deficits (only one-time message and no evidence object) retired by DICOM. Also, the OCR collection of data is available, but one should be aware, that these images have only a limited amount of informations (and OCR could cause errors).
Actually, DOSE Structured Reports are the new and accepted form of dose communication for several years, which is also available for nuclear medicine (Supp 159 since 2013), 2nd generation for radiotherapy (Supp 175 - 179) is in work and also "Patient Radiation Dose Reporting" (Supp 191) is in comment phase. IHE Radiology has driven the use of this documention through the introduction of the profile IHE Radiation Exposure Monitoring  (http://wiki.ihe.net/index.php/Radiation_Exposure_Monitoring) since several years (act. V 11). This concept allows easily to build local, regional or even larger registers, which would allow much better information on the number of different procedures and benchmarks. Such a solution has been introduced by American College of Radiology some years ago. This register provides indidual benchmarks to radiology departments.
On the other hand, there is a need for semantic interoperability to identify and differentiate the correct category of procedures. I would like to recommend to liase with ESR in this regard. IHE-Europe is available for any consultation and could offer support in developing concepts for coding, lexica and registers.

Respectfully submitted by

Peter Mildenberger
IHE-Europe User-Cochair
Professor for Radiology at University Medical Center Mainz, Germany