EUCLID – European Study on Clinical Diagnostic Reference Levels for X-ray Medical Imaging

The 33-month European Commission tender project EUCLID was concluded successfully with the acceptance of the final project report in October 2020.

The project will provide up-to-date clinical DRLs for the most important, from a radiological perspective, x-ray imaging tasks in Europe. The project was led by the European Society of Radiology (ESR) and started in August 2017.

The concept of Diagnostic Reference Levels (DRLs) has been introduced to indicate unusually high or low patient radiation doses from medical imaging examinations and procedures. The establishment and use of DRLs are required in the European Council Directive 2013/59/Euratom – Basic Safety Standards (BSS).

The national DRLs should be compared with available European DRLs whenever either of the values have been established or updated. Whenever the national DRLs applied are consistently exceeded, appropriate investigations to identify the reasons, and corrective actions to improve the clinical practice, if necessary and feasible, should be undertaken without undue delay (Article 58 f, Council Directive 2013/59/Euratom BSS).

In 1999, the European Commission (EC) issued Radiation Protection 109 (RP 109) publication on Guidance on diagnostic reference levels DRLs for medical exposure. Although RP 109 highlights the importance of establishing DRLs for high-dose medical examinations, in particular computed tomography (CT) and interventional radiology, it does not provide examples of DRLs for these procedures. The importance of the need for DRLs in CT is highlighted by the fact that patient doses from CT examinations are relatively high and contribute a major part of the population dose from all diagnostic uses of radiation. Interventional procedures result in substantial patient doses due to prolonged fluoroscopy time and radiographic exposure and, therefore, DRLs are needed for these procedures.

Usually, DRLs are specified in relation to the body region without specification of the clinical indication. A few national radiation protection authorities, only, have defined a very limited number of DRLs for different clinical indications, so far. Despite a large number of studies available from European countries, there is very limited information about clinical-indication specific DRLs for x-ray medical imaging. The European Commission recognised this gap and thus approved the EUCLID project (European Study on Clinical Diagnostic Reference Levels for X-ray Medical Imaging).

EUCLID is coordinated by the European Society of Radiology (ESR)
ESR Office Am Gestade 1 | AT – 1010 Vienna
Phone: +43 (1) 533 40 64 -20
E-mail: Monika Hierath, monika [.] hierath [@] myesr [.] org

The project has received funding from the European Commission under Service Contract No° ENER/2017/NUCL/SI2.759174.