Systematic Review of Diagnostic Reference Levels (DRLs) associated with the use of fluoroscopy in thoracoabdominal endovascular procedures.
DOI:
https://doi.org/10.83356/2026.rr.n19.29Keywords:
DRL, ICRP 135, Fluoroscopy, Aortic Pathology, Endovascular Procedures, Systematic ReviewAbstract
The use of fluoroscopy is common in the endovascular management of thoracoabdominal aortic aneurysms. The establishment of Diagnostic Reference Levels (DRLs) is essential for dose optimisation and is based on indicators such as PKA (kerma–area product) and Ka,r (air kerma at the patient entrance reference point). Despite european/national requirements, implementation remains challenging, and Portugal has not yet defined national DRLs for these procedures. Objective: To identify DRLs for thoracoabdominal endovascular procedures in the literature, according to procedure type and equipment used. This systematic review followed PRISMA methodology and was registered in PROSPERO. It included articles published between 2015 and 2025 with defined DRLs for endovascular procedures, reporting Ka,r and PKA data in accordance with ICRP 135. Studies involving paediatric populations, lacking equipment specification, or with methodological limitations were excluded. The search was conducted across scientific databases and grey literature, and screening was performed using the Rayyan platform. Risk of bias was assessed using the Joanna Briggs Institute checklist. Of 81 articles identified, 14 studies were included after being considered at low risk of bias. Of these, 6 defined typical values, 3 local DRLs, and 5 national DRLs; 79% were conducted in Europe. The review identified variability in DRLs, influenced by anatomical, technical, and clinical factors. Technical optimisation reduced radiation exposure without compromising image quality. The absence of regional DRLs and lack of standardisation highlight the need for more consistent methods.
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