{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T05:43:30Z","timestamp":1768283010246,"version":"3.49.0"},"reference-count":37,"publisher":"IOP Publishing","issue":"2","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/iopscience.iop.org\/page\/copyright"},{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/iopscience.iop.org\/info\/page\/text-and-data-mining"}],"content-domain":{"domain":["iopscience.iop.org"],"crossmark-restriction":false},"short-container-title":["J. Radiol. Prot."],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Diagnostic reference levels (DRLs) and achievable doses (ADs) provide guidance to optimise radiation doses for patients undergoing medical imaging procedures. This multi-centre study aimed to compare institutional DRLs (IDRLs) across hospitals, propose ADs and multi-centric DRLs (MCDRLs) for four common x-ray examinations in Sri Lanka, and assess the potential for dose reduction. A prospective cross-sectional study of 894 adult patients referred for abdomen anteroposterior (AP), kidney-ureter-bladder (KUB) AP, lumbar spine AP, and lumbar spine lateral (LAT) x-ray examinations was conducted. Patient demographic information (age, sex, weight, BMI) and exposure parameters (tube voltage, tube current-exposure time product) were collected. Patient dose indicators were measured in terms of kerma-area product (P<jats:sub>KA<\/jats:sub>) using a P<jats:sub>KA<\/jats:sub> meter. IDRLs, ADs, and MCDRLs were calculated following the International Commission on Radiological Protection guidelines, with ADs and MCDRLs defined as the 50th and 75th percentiles of the median P<jats:sub>KA<\/jats:sub> distributions, respectively. IDRL ranges varied considerably across hospitals: 1.42\u20132.42 Gy cm<jats:sup>2<\/jats:sup> for abdomen AP, 1.51\u20132.86 Gy cm<jats:sup>2<\/jats:sup> for KUB AP, 0.83\u20131.65 Gy cm<jats:sup>2<\/jats:sup> for lumbar spine AP, and 1.76\u20134.10 Gy cm<jats:sup>2<\/jats:sup> for lumbar spine LAT. The proposed ADs were 1.82 Gy cm<jats:sup>2<\/jats:sup> (abdomen AP), 2.03 Gy cm<jats:sup>2<\/jats:sup> (KUB AP), 1.27 Gy cm<jats:sup>2<\/jats:sup> (lumbar spine AP), and 2.21 Gy cm<jats:sup>2<\/jats:sup> (lumbar spine LAT). MCDRLs were 2.24 Gy cm<jats:sup>2<\/jats:sup> (abdomen AP), 2.40 Gy cm<jats:sup>2<\/jats:sup> (KUB AP), 1.43 Gy cm<jats:sup>2<\/jats:sup> (lumbar spine AP), and 2.38 Gy cm<jats:sup>2<\/jats:sup> (lumbar spine LAT). Substantial intra- and inter-hospital variations in P<jats:sub>KA<\/jats:sub> were observed for all four examinations. Although ADs and MCDRLs in Sri Lanka were comparable to those in the existing literature, the identified intra- and inter-hospital variations underscore the need for dose reduction without compromising diagnostic information. Hospitals with high IDRLs are recommended to review and optimise their practices. These MCDRLs serve as preliminary national DRLs, guiding dose optimisation efforts by medical professionals and policymakers.<\/jats:p>","DOI":"10.1088\/1361-6498\/ad3837","type":"journal-article","created":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T18:21:56Z","timestamp":1711563716000},"page":"021506","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Towards the establishment of national diagnostic reference levels for abdomen, KUB, and lumbar spine x-ray examinations in Sri Lanka: a multi-centric study"],"prefix":"10.1088","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3593-4068","authenticated-orcid":true,"given":"Sachith","family":"Welarathna","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8473-767X","authenticated-orcid":false,"given":"Sivakumar","family":"Velautham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0854-2077","authenticated-orcid":true,"given":"Sivananthan","family":"Sarasanandarajah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"266","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"jrpad3837bib1","article-title":"Sources, effects and risks of ionizing radiation UNSCEAR 2020\/2021 report to the general assembly, with scientific annexes. Volume I. Scientific annex A","author":"UNSCEAR","year":"2022"},{"key":"jrpad3837bib2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1093\/rpd\/ncad294","article-title":"Entrance surface air kerma to patients during digital radiographic examinations in Tanzania","volume":"200","author":"Makoba","year":"2023","journal-title":"Radiat. Prot. Dosim."},{"key":"jrpad3837bib3","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.clinimag.2020.08.006","article-title":"Lifetime attributable risk of cancer incidence and mortality in routine digital radiology procedures","volume":"67","author":"Zangeneh","year":"2020","journal-title":"Clin. Imaging"},{"key":"jrpad3837bib4","doi-asserted-by":"publisher","first-page":"941","DOI":"10.3348\/kjr.2023.0791","article-title":"The growing problem of radiologist shortage in Sri Lanka","volume":"24","author":"Karunaratne","year":"2023","journal-title":"Korean J. Radiol."},{"key":"jrpad3837bib5","article-title":"Radiology","author":"National Hospital of Sri Lanka","year":"2023"},{"key":"jrpad3837bib6","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s41747-019-0132-3","article-title":"Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study","volume":"4","author":"Lai","year":"2020","journal-title":"Eur. Radiol. Exp."},{"key":"jrpad3837bib7","doi-asserted-by":"publisher","DOI":"10.1016\/j.apradiso.2022.110477","article-title":"Supine and erect abdominal radiography: a comparison of radiation dose and image quality","volume":"190","author":"Alzyoud","year":"2022","journal-title":"Appl. Radiat. Isot."},{"key":"jrpad3837bib8","doi-asserted-by":"publisher","first-page":"468","DOI":"10.2478\/raon-2018-0021","article-title":"Comparison of anteroposterior and posteroanterior projection in lumbar spine radiography","volume":"52","author":"Alukic","year":"2018","journal-title":"Radiol. Oncol."},{"key":"jrpad3837bib9","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1097\/BSD.0b013e3181568656","article-title":"The radiation exposure associated with cervical and lumbar spine radiographs","volume":"21","author":"Simpson","year":"2008","journal-title":"Clin. Spine Surg."},{"key":"jrpad3837bib10","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1093\/rpd\/ncaa057","article-title":"Optimal collimation significantly improves lumbar spine radiography","volume":"189","author":"Pazanin","year":"2020","journal-title":"Radiat. Prot. Dosim."},{"key":"jrpad3837bib11","first-page":"61","article-title":"The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103","volume":"37","author":"ICRP","year":"2007","journal-title":"Ann. ICRP"},{"key":"jrpad3837bib12","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6498\/acbda7","article-title":"Effective doses and risks from medical diagnostic x-ray examinations for male and female patients from childhood to old age","volume":"43","author":"Harrison","year":"2023","journal-title":"J. Radiol. Prot."},{"key":"jrpad3837bib13","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1093\/rpd\/ncy194","article-title":"Patient dose in digital radiography utilising BMI classification","volume":"184","author":"Metaxas","year":"2019","journal-title":"Radiat. Prot. Dosim."},{"key":"jrpad3837bib14","first-page":"27","article-title":"Diagnostic reference levels in medical imaging. ICRP Publication 135","volume":"46","author":"ICRP","year":"2017","journal-title":"Ann. ICRP"},{"key":"jrpad3837bib15","doi-asserted-by":"publisher","first-page":"W1","DOI":"10.2214\/AJR.14.12794","article-title":"Diagnostic reference levels","volume":"204","author":"Vassileva","year":"2015","journal-title":"Am. J. Roentgenol."},{"key":"jrpad3837bib16","article-title":"National Diagnostic Reference Level Service in more detail","author":"Australian Radiation Protection and Nuclear Safety Agency","year":"2024"},{"key":"jrpad3837bib17","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13244-023-01369-x","article-title":"How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement","volume":"14","author":"Damilakis","year":"2023","journal-title":"Insights Imaging"},{"key":"jrpad3837bib18","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.ejrad.2017.11.002","article-title":"Using diagnostic reference levels to evaluate the improvement of patient dose optimisation and the influence of recent technologies in radiography and computed tomography","volume":"98","author":"Roch","year":"2018","journal-title":"Eur. J. Radiol."},{"key":"jrpad3837bib19","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1148\/radiol.2015150971","article-title":"U.S. national diagnostic reference levels: closing the gap","volume":"277","author":"Brink","year":"2015","journal-title":"Radiology"},{"key":"jrpad3837bib20","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1007\/s00270-021-02772-x","article-title":"How to measure\/calculate radiation dose in patients?","volume":"44","author":"Loose","year":"2021","journal-title":"Cardiovasc. Intervent. Radiol."},{"key":"jrpad3837bib21","doi-asserted-by":"publisher","first-page":"W565","DOI":"10.2214\/AJR.14.12513","article-title":"Kerma-area product in diagnostic radiology","volume":"203","author":"Huda","year":"2014","journal-title":"Am. J. Roentgenol."},{"key":"jrpad3837bib22","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s43055-023-01003-2","article-title":"Evaluation of patient radiation doses using DAP meter in diagnostic radiology procedures in Birjand, Iran Egypt","volume":"54","author":"Zarghani","year":"2023","journal-title":"J. Radiol. Nucl. Med."},{"key":"jrpad3837bib23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2023.102565","article-title":"Establishment and utilization of diagnostic reference levels in medical imaging: results from a survey and consultation under the IAEA technical cooperation programme in Europe and Central Asia","volume":"108","author":"Faj","year":"2023","journal-title":"Phys. Med."},{"key":"jrpad3837bib24","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13852","article-title":"Evaluation of patient doses for routine digital radiography procedures toward establishing an institutional diagnostic reference levels: a case study in Sri Lanka","volume":"23","author":"Welarathna","year":"2022","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"jrpad3837bib25","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6498\/acfc51","article-title":"Towards the establishment of national diagnostic reference levels for chest x-ray examinations in Sri Lanka: a multi-centric study","volume":"43","author":"Welarathna","year":"2023","journal-title":"J. Radiol. Prot."},{"key":"jrpad3837bib26","article-title":"Dosimetry in diagnostic radiology: an international code of practice","author":"IAEA","year":"2007"},{"key":"jrpad3837bib27","author":"Ministry of Health, Nutrition and Indigenous Medicine, Sri Lanka and World Health Organization","year":"2014"},{"key":"jrpad3837bib28","doi-asserted-by":"publisher","DOI":"10.1016\/j.radphyschem.2020.108883","article-title":"Evaluation of patient radiation dose in routine radiographic examinations in Saudi Arabia","volume":"173","author":"Osman Hamid","year":"2020","journal-title":"Radiat. Phys. Chem."},{"key":"jrpad3837bib29","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1093\/rpd\/ncy169","article-title":"Patient doses in common diagnostic x-ray examinations","volume":"184","author":"Metaxas","year":"2019","journal-title":"Radiat. Prot. Dosim."},{"key":"jrpad3837bib30","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1093\/rpd\/ncaa072","article-title":"Estimates of patient doses and kerma-area product monitoring in digital radiography","volume":"190","author":"Kaushik","year":"2020","journal-title":"Radiat. Prot. Dosim."},{"key":"jrpad3837bib31","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20190386","article-title":"Lumbar spine radiographs\u2014is it time for widespread adoption of posteroanterior projection?","volume":"92","author":"Green","year":"2019","journal-title":"Br. J. Radiol."},{"key":"jrpad3837bib32","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1166\/jmihi.2014.1250","article-title":"Local diagnostic reference levels for x-ray examinations in an Australian tertiary hospital","volume":"4","author":"Ng","year":"2014","journal-title":"J. Med. Imaging Health Inform."},{"key":"jrpad3837bib33","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s10278-019-00199-y","article-title":"Estimates of patient radiation doses in digital radiography using DICOM information at a large teaching hospital in Oman","volume":"33","author":"Suliman","year":"2020","journal-title":"J. Digit. Imaging"},{"key":"jrpad3837bib34","article-title":"Doses to patients from radiographic and fluoroscopic x-ray imaging procedures in the UK-2010 review","author":"Hart"},{"key":"jrpad3837bib35","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1055\/a-0824-7603","article-title":"Diagnostic reference levels for diagnostic and interventional x-ray procedures in Germany: update and handling","volume":"191","author":"Schegerer","year":"2019","journal-title":"R\u00f6Fo"},{"key":"jrpad3837bib36","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.ejrad.2019.02.015","article-title":"Diagnostic reference levels for conventional radiography and fluoroscopy in Austria: results and updated national diagnostic reference levels derived from a nationwide survey","volume":"113","author":"Wachabauer","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"jrpad3837bib37","author":"Health Information and Quality Authority","year":"2021"}],"container-title":["Journal of Radiological Protection"],"original-title":[],"link":[{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837","content-type":"text\/html","content-version":"am","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"similarity-checking"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T10:50:06Z","timestamp":1755946206000},"score":1,"resource":{"primary":{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6498\/ad3837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,5]]},"references-count":37,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,4,5]]},"published-print":{"date-parts":[[2024,6,1]]}},"URL":"https:\/\/doi.org\/10.1088\/1361-6498\/ad3837","relation":{},"ISSN":["0952-4746","1361-6498"],"issn-type":[{"value":"0952-4746","type":"print"},{"value":"1361-6498","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,5]]},"assertion":[{"value":"Towards the establishment of national diagnostic reference levels for abdomen, KUB, and lumbar spine x-ray examinations in Sri Lanka: a multi-centric study","name":"article_title","label":"Article Title"},{"value":"Journal of Radiological Protection","name":"journal_title","label":"Journal Title"},{"value":"paper","name":"article_type","label":"Article Type"},{"value":"\u00a9 2024 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved. All rights, including for text and data mining, AI training, and similar technologies, are reserved.","name":"copyright_information","label":"Copyright Information"},{"value":"2024-01-19","name":"date_received","label":"Date Received","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2024-03-26","name":"date_accepted","label":"Date Accepted","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2024-04-05","name":"date_epub","label":"Online publication date","group":{"name":"publication_dates","label":"Publication dates"}}]}}