The 2020 national diagnostic reference levels for nuclear medicine in Japan
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SPECIAL ARTICLE
The 2020 national diagnostic reference levels for nuclear medicine in Japan Koichiro Abe1 · Makoto Hosono2 · Takayuki Igarashi3 · Takashi Iimori4 · Masanobu Ishiguro5 · Teruo Ito6 · Tomomasa Nagahata7 · Hiroyuki Tsushima8 · Hiroshi Watanabe9 Received: 5 July 2020 / Accepted: 16 August 2020 © The Author(s) 2020
Abstract The diagnostic reference levels (DRLs) are one of several effective tools for optimizing nuclear medicine examinations and reducing patient exposure. With the advances of imaging technology and alterations of examination protocols, the DRLs must be reviewed periodically. The first DRLs in Japan were established in 2015, and since 5 years have passed, it is time to review and revise the DRLs. We conducted a survey to investigate the administered activities of radiopharmaceuticals and the radiation doses of computed tomography (CT) in hybrid CT accompanied by single photon emission computed tomography (SPECT)/CT and positron emission tomography (PET)/CT. We distributed a Web-based survey to 915 nuclear medicine facilities throughout Japan and survey responses were provided by 256 nuclear medicine facilities (response rate 28%). We asked for the facility’s median actual administered activity and median radiation dose of hybrid CT when SPECT/ CT or PET/CT was performed for patients with standard habitus in the standard protocol of the facility for each nuclear medicine examination. We determined the new DRLs based on the 75th percentile referring to the 2015 DRLs, drug package inserts, and updated guidelines. The 2020 DRLs are almost the same as the 2015 DRLs, but for the relatively long-lived radionuclides, the DRLs are set low due to the changes in the Japanese delivery system. There are no items set higher than the previous values. Although the DRLs determined this time are roughly equivalent to the DRLs used in the US, overall they tend to be higher than the European DRLs. The DRLs of the radiation dose of CT in hybrid CT vary widely depending on each imaging site and the purpose of the examination. Keywords Diagnostic reference level · DRL · Nuclear medicine · Radiopharmaceutical · Hybrid CT
Background The use of radiation in the medical field continues to expand. Although patients who are exposed to radiation during their diagnoses and treatment often have the tremendous opportunity to overcome life-threatening illnesses, they are also at increased risk of radiation damage. Radiation-based diagnoses and treatment are justified only when the benefit is clearly greater than the risk associated with the radiation exposure (justification), and it is necessary to take measures Koichiro Abe, Makoto Hosono, Takayuki Igarashi, Takashi Iimori, Masanobu Ishiguro, Teruo Ito, Tomomasa Nagahata, Hiroyuki Tsushima and Hiroshi Watanabe made equal contributions to this work. * Koichiro Abe k‑abe@tokyo‑med.ac.jp Extended author information available on the last page of the article
to reduce radiation doses as much as possible during justified radiological diagnoses and treatment (optimization
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