Radioprotection 2026, 61( 2), 121 – 125 © M. Azeddou et al., Published by EDP Sciences, 2026 https:// doi. org / 10.1051 / radiopro / 2025037
Available online at: www. radioprotection. org ARTICLE
Establishing diagnostic reference levels in interventional radiology: a Moroccan single-center study
M. Azeddou 1,*, M. Tahiri 2, M. Mkimel 2, B. Boutakioute 1 and N. C. I. Elganouni 1
1 Morpho Sciences Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Department of Radiology, Ar-Razi Hospital, Med VI University Hospital Center, Marrakech, Morocco. 2 Sciences and Engineering of Biomedicals, Biophysics and Health Laboratory, Higher Institute of Health Sciences, Hassan First
University, Settat 26000, Morocco. Received: 4 May 2025 / Accepted: 7 September 2025
Abstract – Interventional radiology( IR) is a key diagnostic tool but involves significant radiation exposure. This study intends to determine the local Diagnostic Reference Levels( DRL) for Interventional Radiology in a Moroccan university Hospital. A retrospective review of 220 procedures was performed, including Lower Limb Angiography( LLA), Cerebral Angiography( CA), Central Venous Access Device( CVAD) placement, and Pacemaker Implantation( PM). The 3rd quartile DAP values were as follows: LLA: 107.98 Gy · cm 2, CA: 232.18 Gy · cm 2, CVAD: 2.26 Gy · cm 2 and PM: 27.10 Gy · cm 2. The results of the study show that local DRLs are greater than the published DRLs, indicating that there is poor management and optimization of the radiation dose. This work forms the preliminary groundwork to determine the national benchmarks of DRLs for the studied procedures and improve the radiation protection standards in the country.
Keywords: dose reference level / interventional radiology / optimization / patient dose
1 Introduction
Interventional radiology( IR) serves as a vital tool for assessing vascular anatomy. By offering high-resolution imaging of both arteries and veins, it plays a key role in diagnosing vascular conditions such as atherosclerosis and stenosis. Moreover, IR is instrumental in facilitating therapeutic procedures like angioplasty and stent deployment.
Despite these benefits, the technique often involves extended fluoroscopy times and elevated radiation exposure, posing potential health risks to patients and medical staff. This includes skin reactions like erythema, dermal atrophy, and ulceration and long-term radiation exposure concerns increasing risk of cancer( Vañó et al., 2017; Ferrari et al., 2020).
To help prevent these risks, ALARA is the fundamental radiation protection principle that applies to medical exposure, and diagnostic reference levels( DRLs) are one of the tools used to support the optimization process in medical settings( European Commission, 1999). DRL was introduced by ICRP in 1990, and defined as“ thresholds for an investigation to optimize medical exposure during diagnostic and interventional
* Corresponding author: m. azedddou. ced @ uca. ac. m procedures”( Vañó et al., 2017). DRL for interventional procedures are expressed in terms of four dosimetric metrics following the ICRP publication 135. These quantities include Dose Area Product( DAP), Air KERMA at the reference point( Kair) and Fluoroscopy Time( FT).
Despite its known limitations, such as not accounting for backscatter radiation, DAP remain the standard metric for setting DRLs both nationally and internationally. It serves as a surrogate indicator of stochastic risks, such as cancer. In contrast,( K air) may offer more accurate insights into patient radiation safety, particularly regarding deterministic risks relating to skin( Vañó et al., 2017).
There is a notable lack of specific DRLs for IR procedures. While DRLs have been established for cardiologic procedures around the world( Siiskonen et al., 2018; Guenego et al., 2019; Ou-Saada et al., 2020; Ihn et al., 2021). In Morocco, there is still a lack of official bodies and policies overseeing national DRLs. Ou-Saada et al.( 2020) proposed local DRLs for cardiology-related interventions, their study did not specifically address DRLs for other IR procedures( Ou-Saada et al., 2020). This gap is particularly concerning as the increasing use of these procedures could lead to higher radiation doses. Therefore, this study aims to establish local DRLs for the
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