Qaelum responds promptly to German Diagnostic Reference Levels update

December 15, 2022

The Federal Office for Radiation Protection (Das Bundesamt für Strahlenschutz, BfS) has announced the publication of updated Diagnostic Reference Levels (DRLs or DRWs in German, Werte für die diagnostischen Referenzwerte)1. Diagnostic reference levels are determined based on nationwide surveys of doses reported for common exams and are used in medical imaging for procedure optimization and identification of unusual practices.

National DRLs were previously published in Germany in 2016 for computed tomography (CT), mammography, conventional radiography, and in 2018 for interventional procedures. Recommended dose metrics for monitoring included the dose length product (DLP) and CT dose index for CT, average glandular dose for mammography, and dose area product for conventional radiography and interventional procedures.

The most significant change in the new recommendations is to use scan length instead of DLP for CT exam monitoring. New exam groups have also been added to include the following:

  • AP thorax for conventional radiography (adult patients)
  • AP/PA thorax, AP/PA abdomen, and AP/PA pelvis for conventional radiography of pediatric patients weighing 32-56 kg (5-10 yo)
  • Breast tomosynthesis
  • Paranasal sinuses, FOV ≤ 25 cm², FOV > 25 cm² for dental radiography
  • Electrophysiological procedures

DRLs have largely decreased in the ranges of 0-29%, 13-44%, 11-36%, 0-25% for conventional radiography, interventional radiology, fluoroscopy, and CT examinations, respectively. Several exam types have been excluded from the publication e.g. pediatric and adult AP/LAT skull in conventional radiography, adult small intestine in fluoroscopy, and adult thorax and upper abdomen in CT.

Qaelum’s dose management system DOSE allows complete implementation of any national DRL monitoring, with the possibility to define weight and various other patient/exam parameters. New German DRLs in DOSE are updated automatically using an import functionality. The flexibility in DOSE allows users to decide whether to follow the national recommendations or monitor their own individual set of dose parameters. Users that are reluctant to replace DLP with scan length for regulatory compliance can therefore monitor both parameters, if desired. Multiple DRL versions can exist simultaneously with application date ranges indicated by the user, so that patient studies can be benchmarked against the appropriate DRL version according to study date. Exams exceeding national DRLs can be easily spotted using the traffic light system signaling protocols most eligible for optimization:


Qaelum’s support team in collaboration with Dedalus (Qaelum’s partner in Germany) began its update of German DRLs in DOSE immediately and made the new DRLs available within a week. Swiftness and ease of implementation was made possible by joint efforts of Qaelum’s development and support teams resulting in system flexibility and compliance to the German radiation protection guidelines. This is just one example of Qaelum’s dedication, care and customization that applies to all our customers around the world.



1 Bekanntmachung der Aktualisierten diagnostischen Referenzwerte für diagnostische und interventionelle röntgenuntersuchungen (2022) Bundesamt für Strahlenschutz. BfS. Available at: