After 5 y of collecting data on diagnostic reference levels (DRLs), the Nuclear Safety and Radiation Protection French Institute (IRSN) presents the analyses of this data. The analyses of the collected data for radiology, computed tomography (CT) and nuclear medicine allow IRSN to estimate the level of regulatory application by health professionals and the representativeness of current DRL in terms of relevant examinations, dosimetric quantities, numerical values and patient morphologies. Since 2004, the involvement of professionals has highly increased, especially in nuclear medicine, followed by CT and then by radiology. Analyses show some discordance between regulatory examinations and clinical practice. Some of the dosimetric quantities used for the DRL setting are insufficient or not relevant enough, and some numerical values should also be reviewed. On the basis of these findings, IRSN formulates recommendations to update regulatory DRL with current and relevant examination lists, dosimetric quantities and numerical values. © The Author 2012. Published by Oxford University Press.