Reference Levels for Diagnostic and Interventional X-ray Exposures in Germany: Development, Handling, and Perspective

Diagnostic reference levels (DRLs) serve to optimize diagnostic and interventional X-ray applications, which account for over 95% of man-made radiation exposure in Germany. The national DRLs are regularly adjusted to reflect advances in device technology and clinical practice. The aim of this article is to present the basic concept of DRLs, their methodological development, and the resulting improvements in patient protection.The relevant regulations of the new radiation protection legislation in Germany are summarized, the development of DRLs between 2003 and 2022 is described, guidance for the practical application of DRLs and the implementation of supplementary facility-specific measures is provided, and finally an outlook on future issues is given.Since the first official announcement of DRLs in Germany, they have been reduced remarkably through continuous protocol optimization and the use of more advanced hardware and software. Over the period of review of almost 20 years, the catalog of X-ray exposures for which DRLs have been established has been expanded considerably, although some DRLs have been removed for various exposures that are no longer routinely indicated.The consistent implementation of the DRL concept has proven effective in practice and has led to a substantial reduction in patient exposure over the years. This positive development in terms of patient protection justifies the personnel effort as well as the potential need to update hardware and software. Despite the success achieved, the DRL concept requires continuous further development in the future. · Diagnostic reference levels (DRLs) are an effective tool to optimize X-ray exposures.. · In Germany, many DRLs have been more than halved in nearly 20 years.. · With good equipment and practice, DRLs can and should be considerably undercut.. · Dose management systems considerably facilitate the practical implementation of the DRL concept.. · The national DLRs should be complemented by facility-specific local DRLs.. · de las Heras Gala H, Giussani A, Schlattl H et al. Reference Levels for Diagnostic and Interventional X-ray Exposures in Germany: Development, Handling, and Perspective. Rofo 2026; DOI 10.1055/a-2790-4742.