{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:33:21Z","timestamp":1787672001440,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,11]],"date-time":"2023-03-11T00:00:00Z","timestamp":1678492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Indian Council of Medical Research","award":["ICMR 5\/13\/48\/2020\/NCD-III"],"award-info":[{"award-number":["ICMR 5\/13\/48\/2020\/NCD-III"]}]},{"name":"Indian Council of Medical Research","award":["CRD4202188381"],"award-info":[{"award-number":["CRD4202188381"]}]},{"name":"PROSPERO","award":["ICMR 5\/13\/48\/2020\/NCD-III"],"award-info":[{"award-number":["ICMR 5\/13\/48\/2020\/NCD-III"]}]},{"name":"PROSPERO","award":["CRD4202188381"],"award-info":[{"award-number":["CRD4202188381"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: In August 2017, the European Commission awarded the \u201cEuropean Study on Clinical Diagnostic Reference Levels (DRL) for X-ray Medical Imaging\u201d project to the European Society of Radiology to provide up-to-date Diagnostic Reference Levels based on clinical indications. This work aimed to conduct an extensive literature review by analyzing the most recent studies published and the data provided by the National Competent Authorities to understand the current situation regarding Diagnostic Reference Levels based on clinical indications for Radiation Therapy Computed Tomography. Objective: To review the literature on established DRLs and methodologies for establishing Diagnostic reference levels in radiation therapy planning computed tomography (RTCT). Methods: Eligibility criteria: A cohort study (observational design) reporting DRLs in adult patients undergoing computed tomography (CT) for radiation therapy for the region head and neck or pelvis were included. The comprehensive literature searches for the relevant studies published between 2000 and 2021 were performed using PubMed, Scopus, CINHAL, Web of Science, and ProQuest. Results: Three hundred fifty-six articles were identified through an extensive literature search. Sixty-eight duplicate reports were removed. The title and abstract of 288 studies were assessed and excluded if they did not meet the inclusion criteria. Sixteen of 288 articles were selected for full-text screening (studies conducted between 2000 and 2021). Five articles were included in the review after the full-text screening. Conclusions: A globally approved standard protocol that includes scanning techniques, dose measurement method, and DRL percentile needs to be established to make a valuable and accurate comparison with international DRLs.<\/jats:p>","DOI":"10.3390\/diagnostics13061072","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T02:31:55Z","timestamp":1678674715000},"page":"1072","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Systematic Review on Diagnostic Reference Levels for Computed Tomography Examinations in Radiation Therapy Planning"],"prefix":"10.3390","volume":"13","author":[{"given":"Shreekripa","family":"Rao","sequence":"first","affiliation":[{"name":"Department of Radiotherapy and Oncology, Manipal College of Health Professions, Manipal 576104, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Sharan","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Oncology, Kasturba Medical College and Hospital, Manipal 576104, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9345-9790","authenticated-orcid":false,"given":"Suresh","family":"Sukumar","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinidhi Gururajarao","family":"Chandraguthi","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Oncology, Kasturba Medical College and Hospital, Manipal 576104, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rechal","family":"Nisha Dsouza","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Oncology, Manipal College of Health Professions, Manipal 576104, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena R.","family":"David","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, Karnataka, India"},{"name":"Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4421-038X","authenticated-orcid":false,"given":"Sneha","family":"Ravichandran","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berna","family":"Uzun","sequence":"additional","affiliation":[{"name":"Department of Statistics, Carlos III Madrid University, 28903 Madrid, Spain"},{"name":"Operational Research Centre in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey"},{"name":"Department of Mathematics, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajagopal","family":"Kadavigere","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal 576104, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilber","family":"Uzun Ozsahin","sequence":"additional","affiliation":[{"name":"Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Operational Research Centre in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1007\/s00247-014-3030-0","article-title":"Diagnostic reference ranges and the American College of Radiology Dose Index Registry: The pediatric experience","volume":"44","author":"Goske","year":"2014","journal-title":"Pediatr. 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