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Submitted by Marie Claire Cantone, International Committee of AIRP, Italian Association of Radiation Protection
   Commenting on behalf of the organisation
Document Diagnostic Reference Levels in Medical Imaging
 

Comments on ‘Diagnostic Reference Levels in Medical Imaging’
by International Committee of AIRP, Italian Association of Radiation Protection


General Comments

We have received very positive comments on the document under consideration, and in particular positive  judgments  about both the objectives and the structure of document.
The draft was mentioned as ‘a great document’, already from the initial part, for the clear and exhaustive Executive Summary and for the comprehensive Introduction, presenting the bases of the document.
It has been also appreciated the nature of  guidance for the practical uses of DRL, for entering into the emerging issues faced by the practice, for including the concern of optimization of follow-up examination and for taking a great challenge to address DRL in pediatric patients.


Specific Comments


Page 19 Line 31. – Consider to change “ Values DRL quantities for individual patients …”  in “Values of DRL quantities for individual patients …”


Page 23 (19) – Consider to change “The quantity effective dose, used for other purposes in the ICRP system of radiological protection, has been suggested for use as a DRL. It is not suitable for this purpose because … “  in “ The quantity effective dose, used for other purposes in the ICRP system of radiological protection, has been suggested for use as a DRL. However, it has to be reminded that the quantity effective dose is not suitable for this purpose because … “ or similar wording


Page 27 (40)- Consider to add in the target audience for this report, together with the national, regional and local authorities and clinical community,  also educational academic community


Page 63 (155) – Consider to change “For dental units, dosimetric measurements made by medical physicist visiting the clinic provide the best options, …” in “For dental units, dosimetric measurements made by medical physicist provide the best options, …”


Page 67 Line 32. – Consider to change “Patient variability refers to variability in …” in “Variability among patients refers to variability in …”


Page 84 (217), line 25 with respect to line 22 does not add any information :  - line 22 - (SPECT) “It is similar to conventional nuclear medicine planar imaging, but uses one or more rotating gamma cameras …”  - line 25 - “SPECT is mainly carried out using conventional scintillation gamma camera, which rotate around patient.”    Better to leave only line 22.


Page 85, para.221:   It should be recalled also that, in Europe, the administered activity must take into account the data and information given in the Summary of Product Characteristics (SmPC), that are part of the Marketing Authorization for  each radiopharmaceutical.  See, for example, in Guideline on core SmPc, November 2013, European Medicines Agency (EMA), the recommended activity ranges for  technetium (99mTc) sestamibi for: -assessment of global ventricular function; -scintimammography; -localization of hyper functioning parathyroid tissue; ... http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2013/12/WC500158406.pdf


Page 87 Line 13 – Consider to include 68Ga-DOTA-NOC together with 68Ga-DOTA-TATE and  DOTA-TOC


Page 96, paragraph 256 – A suggestion could be made to complete the paragraph with a short view of the AAPM Report 220 (Use of Water Equivalent Diameter for Calculating Patient Size and Size-Specific Dose Estimates (SSDE) in CT, 2014) and also by suggesting the Report for the analysis of advantages and limitations of different methods. Moreover, if considered of interest, a recent paper on the differences in SSDE calculated on the basis of both effective diameter and water-equivalent diameter can be mentioned / cited (M.Gabusi, L.Riccardi, C.Aliberti, S.Vito, M. Paiusco, Radiation dose in chest CT: Assessment of size-specific dose estimates based on water equivalent correction. Physica Medica European Journal of Medical Physics, 2016, 32, 2, pp393-397).


Page 96, paragraph 259 – Consider to review the sentence “The patient equivalent thickness is derived from patient’s anteroposterior (AP) and lateral dimensions (effective diameter = V[APxLAT]). When both the AP and lateral dimensions of the patient …” for example, as  “The patient equivalent thickness is derived from patient’s anteroposterior (AP) and lateral dimensions (LAT) (effective diameter = square root of the product of AP and LAT). When both the AP and LAT dimensions of the patient …”


Page 104 Line 1 - Typing error: “Facilities”