Increased patient protection in X-ray applications – BfS reduces dose limits for medical professionals

X-ray images, computed tomography (CT) and minimally-invasive interventions performed under X-ray control are always associated with a radiation exposure to the patient. X-ray applications are subject to certain diagnostic reference values in order to keep this radiation exposure as low as possible. The Federal Office for Radiation Protection (BfS) has now reduced these reference values – by 20 percent on average, in some cases even by 50 percent.

"Reducing the reference values is essential for the benefit of the patients – however, further efforts are still required", says BfS president Wolfram König. "Radiation exposure can be reduced even further without reducing the quality of the data by applying improved technology. The potential for reducing the radiation exposure that is created by new device development must be exploited more fully."

Guide to limit the radiation exposure to patients

Diagnostic reference values are used as a guide to limit the radiation exposure to patients. Medical professionals are required to keep the radiation exposure below these values when they use X-ray applications:

• Diagnostic reference values are supposed to help recognize situations where a lower radiation dose could be used to examine or treat the patient.
• The concept of diagnostic reference values also aims at motivating medical professionals to constantly optimise radiation applications and thus reduce the radiation exposure to patients.

BfS regularly updates these values in order to take account of new insights, new procedures and new technological developments.

The update now published by BfS with respect to the diagnostic reference values is in particular due to current progress in equipment technology: Technical developments in the field of medical technology have made it possible to reduce the radiation dose required for diagnostic and interventional X-ray applications by 20 percent over the past five years.

New reference values for examinations that were not taken into account before

In addition to reducing the existing reference values BfS also introduced new reference values for examinations that were not taken into account before. This includes in particular certain computed tomography examinations and interventions that are associated with a particularly high radiation exposure – such as complex minimally-invasive interventions under X-ray control on the heart (heart valve replacement), major blood vessels (e.g. aneurysms, i.e. life-threatening bulges in blood vessels) or the brain (e.g. following a stroke).

Largest contribution to man-made radiation exposure

Radiation applications used for diagnostics or interventional radiology present by far the largest contribution to man-made radiation exposure. While the average radiation dose used per examination is relatively low in Germany, compared with other European countries, Germany is one of those countries where patients undergo frequent X-ray applications (1.4 X-ray applications per person and per year on average). In particular the number of dose-intensive CT examinations on adults increased by 130 percent between 1996 and 2012. Encouragingly, dose-intensive CT examinations or even interventional radiology are only rarely performed on children.

The constant increase in the frequency of dose-intensive X-ray applications is reason enough to further follow the developments in the fields of medicine and technology and to prepare proposals as to the possibilities of further reducing the dose per examination, completely avoiding dose-intensive examinations or replacing them by alternative procedures (such as ultrasonic examinations or magnetic resonance imaging).

Please find the updated diagnostic reference values on the BfS internet pages (in German only): www.bfs.de/diagnostische-referenzwerte