124 M. Azeddou et al.: Radioprotection 2026, 61( 2), 121 – 125
significant than DAP and K air, making it inadequate for radiation protection purposes( Heilmaier et al., 2017; Tristram et al., 2022).
The underlying research methodology, such as sample sizes, varies across national DRLs and single facility studies, which accounts for the discrepancies. Our study reflected a small sample size for some procedures, compared to the national DRLs studies, which may skew our findings. Nonetheless, the ICRP states that such sample sizes are enough for implementing local DRLs( Vañó et al., 2017).
In accordance with ICRP Report 137 guidelines, this singlecenter study proposes the use of the median value as a local diagnostic reference level( DRL) to support the identification of potential areas for further optimization( Vañó et al., 2017; Tristram et al., 2022). However, this fact may limit the generalizability of the results to other institutions with different equipment, protocols, or operator practices. Analysis correlating dose level with procedure complexityand operator experience was not conducted, and this should be considered in future studies.
5 Conclusion
Local Diagnostic Reference Levels( DRLs) were determined for the common four IR procedures, based on Dose Area Product( DAP), air KERMA( K air), and fluoroscopy time( FT). The resulting values surpassed those found in existing published DRL ranges, pointing to a clear need for enhanced dose optimization and refinement of clinical protocols. The findings underline the importance of completing and broadening this research to support the development of national reference levels for interventional radiology procedures in Morocco.
Funding
This research did not receive any specific funding.
Conflicts of interest
The authors declare that they have no conflict of interest.
Data availability statement
The research data associated with this article are included within the article.
Author contribution statement
Mina Azeddou, performed the research, analyzed data and wrote the paper. Maroine Tahiri, performed the research and wrote the paper. Mounir Mkimel, designed the study and writing-editing. Bader Boutakioute, designed the study and writing-editing. Najat Cherif Idrissi Elganouni, designed the study and writingediting.
Ethics approval
Institutional Review Board approval was obtained.
Informed consent
This article does not contain any studies involving human subjects.
References
Aroua A, Rickli H, Stauffer JC, Schnyder P, Trueb PR, Valley JF, Vock P, Verdun FR. 2007. How to set up and apply reference levels in fluoroscopy at a national level. Eur Radiol 17: 1621 – 1633.
Bleeser F, Hoornaert M-T., Smans K, Struelens L, Buls N, Berus D, Clerinx P, Hambach L, Malchair F, Bosmans H. 2008. Diagnostic reference levels in angiography and interventional radiology: a Belgian multi-centre study. Radiat Prot Dosim 129: 50 – 55.
Crowhurst JA, Whitby M, Savage M, Murdoch D, Robinson B, Shaw E, Gaikwad N, Saireddy R, Hay K, Walters DL. 2019. Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography. J Med Radiat Sci 66: 20 – 29. D’ Helft CJ, Brennan, Mcgee AM, Mcfadden SL, Hughes CM, Winder JR, Rainford LA; 2009. Potential Irish dose reference levels for cardiac interventional examinations. British J Radiol 82: 296 – 302.
Erskine BJ, Brady Z, Marshall EM. 2014. Local diagnostic reference levels for angiographic and fluoroscopic procedures: Australian practice. Australas Phys Eng Sci Med 37: 75 – 82.
Etard C, Bigand E, Salvat C, Vidal V, Beregi JP, Hornbeck A, Greffier J. 2017. Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France. Eur Radiol 27: 4281 – 4290.
European Commission. 1999. Radiation Protection 109: Guidance on Diagnostic Reference Levels for Medical Exposures. Nuclear Safety. Publications Office.
Ferrari P, Jovanovic Z, Bakhanova E, Becker F, Krstic D, Jansen J, Principi S, Teles P, Clairand I, Knezevic Ž. 2020. Absorbed dose in the operator’ s brain in interventional radiology practices: evaluation through KAP value conversion factors. Phys Med 76: 177 – 181.
Guenego A, Mosimann PJ, Pereira VM, Nicholson P, Zuber K, Lotterie JA, Dobrocky T, Marcellus DG, Olivot JM, Piotin M, Gralla J, Fahed R, Wintermark M, Heit JJ, Cognard C. 2019. Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients. Eur Radiol 29: 3506 – 3515.
Heilmaier C, Zuber N, Berthold C, Kara L, Weishaupt D. 2017. Establishing local diagnostic reference levels in ir procedures with dose management software. J Vasc Interv Radiol 28: 429 – 441.
Ihn Y-K., Kim B, Jeong HW, Suh SH, Won YD, Lee Y-J., Kim DJ, Jeon P, Ryu C-W., Suh S, Choi DS, Choi SS, Kim SH, Byun JS, Rho J, Song Y, Jeong WS, Hong N, Baik SH, Park JJ, Lim SM, Kim J-J., Yoon W. 2021. Monitoring radiation doses during diagnostic and therapeutic neurointerventional procedures: multicenter study for establishment of reference levels. Neurointervention 16: 240 – 251.
Ou-Saada I, Boujemaa S, Campoleoni M, Brambilla R, Bentayeb F. 2020. Local diagnostic reference levels in interventional radiology. J Med Imaging Radiat Sci 51: 307 – 311.
Rizk C, Farah J, Vanhavere F, Fares G. 2019. National diagnostic reference levels in interventional radiology suites in lebanon: a multicenter survey. Radiat Prot Dosim 187: 50 – 60.