Diagnostic reference levels in nuclear medicine: a systematic review

Abdel Amide Gbadamassi; Hicham Harrass; Youssef Khoulaki; Imane Fathi; Brahim Idbelkas; Khadija Charef; Amal Guensi; Driss Benchekroun

doi:10.5455/ajdi.20260228113420

Abstract
Aim/background: Radiation protection for patients in nuclear medicine is based on the fundamental principles of justification, optimization, and dose limitation. In order to monitor and facilitate the dose optimization process, the International Commission on Radiological Protection introduced the concept of diagnostic reference levels as an obvious element of the dose optimization system. The objective of this review is to present data from the literature on diagnostic reference levels (DRLs) in nuclear medicine in order to evaluate practices and perform optimizations.

Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology was used as a guide to conduct this study. Literature searches were performed using the ScienceDirect, PubMed, Web of Science, Scopus, and Google Scholar databases with a combination of the following keywords: diagnostic reference levels, nuclear medicine, patient radiation protection, adult, positron emission tomography (PET) with computed tomography (CT) and single photon emission computed tomography (SPECT) with computed tomography (CT).

Result: The search yielded 432 articles, of which 14 were selected because they met the selection criteria. Relevant information from the selected articles was summarized and analyzed. Some differences were observed in the patient selection methodology, the activity administered, and the DRLs reporting.

Conclusion: The implementation of DRLs could contribute significantly to reducing exposure, thereby offering the public risk-controlled examinations. This study provided recommendations on the establishment of future DRLs in nuclear medicine.

Key words: Diagnostic Reference Levels, Tomography, Emission-Computed (PET) Tomography, Emission-Computed, Single-Photon (SPECT)