{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T15:36:22Z","timestamp":1769355382337,"version":"3.49.0"},"reference-count":25,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","clinicalradiologyonline.net","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Clinical Radiology"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.crad.2025.107052","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:26:31Z","timestamp":1755822391000},"page":"107052","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"special_numbering":"C","title":["Assessing clinical complexity in fluoroscopy-guided interventional procedures using the modified Delphi method: a pathway to define diagnostic reference levels (DRLs)"],"prefix":"10.1016","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3672-0910","authenticated-orcid":false,"given":"A.","family":"Pimenta","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3393-4653","authenticated-orcid":false,"given":"P.","family":"Lopes","sequence":"additional","affiliation":[]},{"given":"F.","family":"Cavalheiro","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8248-1578","authenticated-orcid":false,"given":"P.","family":"Sousa","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8421-2937","authenticated-orcid":false,"given":"L.","family":"Azevedo","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5007-3000","authenticated-orcid":false,"given":"I.","family":"Ramos","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8923-5820","authenticated-orcid":false,"given":"J.","family":"Santos","sequence":"additional","affiliation":[]}],"member":"78","reference":[{"key":"10.1016\/j.crad.2025.107052_bib1","series-title":"Sources, effects and risks of ionizing radiation volume I annex A: evaluation of medical exposures to ionizing radiation","year":"2022"},{"issue":"8","key":"10.1016\/j.crad.2025.107052_bib2","doi-asserted-by":"crossref","DOI":"10.1007\/s00270-017-1674-5","article-title":"Radiation-induced skin injuries to patients: what the interventional radiologist needs to know","volume":"40","author":"Jaschke","year":"2017","journal-title":"Cardiovasc Intervent Radiol"},{"key":"10.1016\/j.crad.2025.107052_bib3","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ijcard.2017.03.031","article-title":"Radiation dose among different cardiac and vascular invasive procedures: the RODEO study","volume":"240","author":"Sciahbasi","year":"2017","journal-title":"Int J Cardiol"},{"issue":"12","key":"10.1016\/j.crad.2025.107052_bib4","doi-asserted-by":"crossref","first-page":"9346","DOI":"10.1007\/s00330-021-08029-y","article-title":"Radiation dose and diagnostic reference levels for four interventional radiology procedures: results of the prospective European multicenter survey EUCLID","volume":"31","author":"Schegerer","year":"2021","journal-title":"Eur Radiol"},{"issue":"1","key":"10.1016\/j.crad.2025.107052_bib5","doi-asserted-by":"crossref","DOI":"10.1186\/s13244-020-00859-6","article-title":"Harmonisation of imaging dosimetry in clinical practice: practical approaches and guidance from the ESR EuroSafe Imaging initiative","volume":"11","author":"Vano","year":"2020","journal-title":"Insights Imaging"},{"key":"10.1016\/j.crad.2025.107052_bib6","series-title":"Publication 73: radiological protection and safety in medicine","year":"1996"},{"key":"10.1016\/j.crad.2025.107052_bib7","series-title":"Publication 117: radiological protection in fluoroscopically guided procedures performed outside the imaging department","year":"2011"},{"issue":"3","key":"10.1016\/j.crad.2025.107052_bib8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1117\/1.JMI.4.3.031214","article-title":"Patient dose monitoring and the use of diagnostic reference levels for the optimization of protection in medical imaging: current status and challenges worldwide","volume":"4","author":"J\u00e4rvinen","year":"2017","journal-title":"J Med Imaging"},{"key":"10.1016\/j.crad.2025.107052_bib9","series-title":"Publication 135: diagnostic reference levels in medical imaging","year":"2017"},{"key":"10.1016\/j.crad.2025.107052_bib10","series-title":"Publication 121: radiological protection in paediatric diagnostic and interventional radiology","year":"2013"},{"key":"10.1016\/j.crad.2025.107052_bib11","series-title":"Radiation protection no195 European study on clinical diagnostic reference levels for X-ray medical imaging","year":"2021"},{"key":"10.1016\/j.crad.2025.107052_bib12","article-title":"Radiation doses to operators performing transjugular intrahepatic portosystemic shunt using a flat-panel detector-based system and ultrasound guidance for portal vein targeting","author":"Luca","year":"2016","journal-title":"Eur Radiol"},{"key":"10.1016\/j.crad.2025.107052_bib13","doi-asserted-by":"crossref","DOI":"10.1148\/radiol.2533090354","article-title":"Reference levels for patient radiation doses in interventional radiology: proposed initial values for U.S. Practice","volume":"253","author":"Miller","year":"2009","journal-title":"Radiology"},{"issue":"2","key":"10.1016\/j.crad.2025.107052_bib14","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1007\/s00270-015-1164-6","article-title":"Radiation exposure in transjugular intrahepatic portosystemic shunt creation","volume":"39","author":"Miraglia","year":"2016","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"1","key":"10.1016\/j.crad.2025.107052_bib15","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-016-0165-8","article-title":"Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology","volume":"16","author":"Eubank","year":"2016","journal-title":"BMC Med Res Methodol"},{"issue":"6","key":"10.1016\/j.crad.2025.107052_bib16","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1007\/s11606-020-06514-6","article-title":"Online modified-delphi: a potential method for continuous patient engagement across stages of clinical practice guideline development","volume":"36","author":"Grant","year":"2021","journal-title":"J Gen Intern Med"},{"issue":"2","key":"10.1016\/j.crad.2025.107052_bib17","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/his.14650","article-title":"Developing consensus in Histopathology: the role of the Delphi method","volume":"81","author":"Taze","year":"2022","journal-title":"Histopathology"},{"issue":"2","key":"10.1016\/j.crad.2025.107052_bib18","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.enfi.2020.09.001","article-title":"Essential elements to elaborate a study with the (e)Delphi method","volume":"32","author":"Romero-Collado","year":"2021","journal-title":"Enferm Intensiva"},{"issue":"12","key":"10.1016\/j.crad.2025.107052_bib19","doi-asserted-by":"crossref","first-page":"4268","DOI":"10.1007\/s00330-016-4334-2","article-title":"Diagnostic reference levels and complexity indices in interventional radiology: a national programme","volume":"26","author":"Ruiz-Cruces","year":"2016","journal-title":"Eur Radiol"},{"key":"10.1016\/j.crad.2025.107052_bib20","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejmp.2021.07.029","article-title":"Institutional diagnostic reference levels and peak skin doses in selected diagnostic and therapeutic interventional radiology procedures","author":"Papanastasiou","year":"2021","journal-title":"Phys Med"},{"issue":"7","key":"10.1016\/j.crad.2025.107052_bib21","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.1007\/s00330-019-06208-6","article-title":"Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study","volume":"29","author":"Schmitz","year":"2019","journal-title":"Eur Radiol"},{"issue":"3","key":"10.1016\/j.crad.2025.107052_bib22","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1093\/rpd\/ncac267","article-title":"Diagnostic reference levels and complexity indices in interventional radiology","volume":"199","author":"Vossou","year":"2023","journal-title":"Radiat Prot Dosim"},{"issue":"3","key":"10.1016\/j.crad.2025.107052_bib23","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.jvir.2016.10.006","article-title":"Establishing local diagnostic reference levels in IR procedures with dose management software","volume":"28","author":"Heilmaier","year":"2016","journal-title":"J Vasc Interv Radiol"},{"issue":"4","key":"10.1016\/j.crad.2025.107052_bib24","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.jvir.2015.11.033","article-title":"Combined use of a patient dose monitoring system and a real-time occupational dose monitoring system for fluoroscopically guided interventions","volume":"27","author":"Heilmaier","year":"2016","journal-title":"J Vasc Interv Radiol"},{"issue":"11","key":"10.1016\/j.crad.2025.107052_bib25","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1016\/j.jvir.2015.08.001","article-title":"Improving patient safety: implementing dose monitoring software in fluoroscopically guided interventions","volume":"26","author":"Heilmaier","year":"2015","journal-title":"J Vasc Interv Radiol"}],"container-title":["Clinical Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0009926025002570?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0009926025002570?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T21:07:26Z","timestamp":1767820046000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0009926025002570"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":25,"alternative-id":["S0009926025002570"],"URL":"https:\/\/doi.org\/10.1016\/j.crad.2025.107052","relation":{},"ISSN":["0009-9260"],"issn-type":[{"value":"0009-9260","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Assessing clinical complexity in fluoroscopy-guided interventional procedures using the modified Delphi method: a pathway to define diagnostic reference levels (DRLs)","name":"articletitle","label":"Article Title"},{"value":"Clinical Radiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.crad.2025.107052","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Royal College of Radiologists. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"107052"}}