An extensive list of National DRLs for Fluoroscopy and fluoroscopically guided interventions published

Date of publication:

The Health Information and Quality Authority (HIQA) has today published a report on typical radiation dose levels for fluoroscopy and fluoroscopically guided interventions (FGI). 

Fluoroscopy is a procedure that uses X-rays to produce real-time imaging of the body; FGI use this imaging method to help guide devices and equipment used for medical diagnostic or treatment purposes. Over 120,000 of these procedures are carried out every year in Ireland, with coronary angiogram being the most common procedure. FGIs, while minimally invasive and generally accepted as safer than traditional surgery, can sometimes be associated with relatively high radiation doses because of the potentially complicated nature of the procedure. 

Following a survey of facilitates, HIQA has updated national diagnostic reference levels (DRLs) for fluoroscopy and FGI, and produced an extensive list of national DRLs. DRLs represent typical radiation dose levels set for common medical imaging procedures and clinical tasks undertaken in Ireland. 

The establishment of national DRLs ensures that doses can be kept as low as reasonably achievable by providing a national standard. This allows undertakings and facilities to compare doses to national levels and identify where procedures consistently exceed these typical dose levels. When outliers are identified, the procedures must be reviewed and corrected to ensure that the dose delivered is as optimal as possible. 

HIQA found that comparisons with previous national DRL surveys was difficult due to the limited data available. This survey of 64 medical facilities, which had a 100% response rate, represents the most extensive review of fluoroscopy procedures and FGIs in Ireland to date.

John Tuffy, HIQA’s Head of Healthcare, stated: “Our work in establishing national DRLs is a key part of our aim to promote patient safety within ionising radiation. These new national DRLs give undertakings and facilities an essential tool in patient dose optimisation, especially important with fluoroscopy and FGIs, as these procedures can result in a high dose for patients.”

In Ireland, HIQA found that the majority of equipment for fluoroscopy and FGIs was less than five years old. This has positive safety implications, as this equipment is considered relatively new and is often associated with advanced technology and potential dose reducing features. 
HIQA will continue to establish and review national DRLs in other areas of imaging and treatment including nuclear medicine.
The report can be found at the link below.

Further Information:
Marty Whelan, Head of Communications & Stakeholder Engagement
085 8055202,

Notes to the Editor:

  • In 2019, new regulations were put in place to transpose into Irish law the EU Council Basic Safety Standards (BSS) Directive of 2013. Under the law, HIQA is the competent authority for patient protection in relation to medical exposure to ionising radiation in Ireland and has responsibility for establishing, reviewing and publishing DRLs. 
  • National DRL values are typical radiation dose levels set for common medical imaging procedures and clinical tasks undertaken in Ireland. These allow medical facilities to compare local facility DRLs, representative of patient dose, to a national standard and use them as a benchmark to optimise patient radiation dose.
  • A facility is a medical radiological installation where medical exposures are carried out. 
  • An undertaking is a person or body who has the legal responsibility for carrying out, or engaging others to carry out, a medical radiological practice, or the practical aspects of a medical radiological procedure, as defined by the regulations.
  • A coronary angiogram is a procedure where fluoroscopy is used to look at the blood vessels of the heart.