Diagnostic Reference Levels (DRLs) are indicators that allow assessing the quality of equipment and procedures from the point of view of the doses delivered to patients and subsequently initiate corrective actions if necessary. The purpose of this study is to encourage health professionals to investigate patient radiation doses and to determine whether those doses comply with the principles of radiation protection in medical fields so as to improve practices by reducing patient exposure without reducing clinical effectiveness. To perform this work, we have investigated patient doses for different radiological examinations from six (6) medical centers in Dakar, including the following nine routine types: chest (PA), abdomen (AP), pelvis (AP), cervical spine (AP), lumbar spine (AP, Lat), hip (AP), thoracic spine (AP, Lat). Three types of data were collected, i.e., X-ray tube machine data, patient data and output measurements. The data were analyzed statistically and the median, minimum, maximum, and third quartile values were calculated and displayed throughout boxplots graphs for all exams and medical centers. The two sigma range (95% confidence interval) was also checked. Comparison of third quartiles of Entrance Surface Dose (ESD) and Dose Area Product (DAP) by type of examination with recommended international DRLs was performed. The third quartile of ESD for pelvis (AP) and thoracic spine (AP) was up to 16% and 38% higher, respectively than their corresponding DRLs in the European Commission Report RP 180 Part 2. For all exams, except thoracic spine (lat), the third quartiles of the dose area product were higher than the corresponding DRLs in the above report. The source of dose variability between medical centers was related to many parameters such as poor radiographic techniques, lack of modern X-ray machines and adequately documented radiation protection practices. The results show the need to develop protocols for dose measurement as well as to carry out quality assurance programs and dose optimization in Senegal.
References
[1]
Recommendations of the ICRP (1991) The System of Protection for Proposed and Continuing Practices. Annals of the ICRP, 21, 32-49.
https://doi.org/10.1016/0146-6453(91)90069-S
[2]
International Atomic Energy Agency (2018) Be Informed about the Safe Use of Ionizing Radiation in Medicine. Information to Help Health Professionals Achieve Safer Use of Radiation in Medicine for the Benefit of Patients.
https://rpop.iaea.org/RPOP/RPoP/Content/index.htm
[3]
Harding, K. and Thomson, W.H. (1997) Radiological Protection and Safety in Medicine—ICRP 73. European Journal of Nuclear Medicine, 24, 1207-1209.
[4]
Rosenstein, M. (2008) Diagnostic Reference Levels for Medical Exposure of Patients: ICRP Guidance and Related ICRU Quantities. Health Physics, 95, 528-534.
https://doi.org/10.1016/0146-6453(91)90069-S
[5]
(2014) The European Basic Safety Standards (BSS) for Protection against Ionising Radiation, Official Journal of European Union.
http://eur-lex.europa.eu/JOHtml.do?uri=OJ:L:2014:013:SOM:EN:HTML
Konate, I., Monnehan, G.A., Gogon, D.B.L.H., Dali, T.P.A., Koua, A.A. and Djagouri, K. (2019) Diagnostic Reference Level in Frontal Chest X-Ray in Western Côte d’Ivoire. World Journal of Nuclear Science and Technology, 9, Article No. 4.
[8]
Moifo, B., Tapouh, J.R.M., Guena, M.N., Ndah, T.N., Samba, R.N. and Simo, A. (2017) Diagnostic Reference Levels of Adults CT-Scan Imaging in Cameroon: A Pilot Study of Four Commonest CT-Protocols in Five Radiology Departments. Open Journal of Medical Imaging, 7, Article No. 1.
https://doi.org/10.4236/ojmi.2017.71001
[9]
Evaluation of Patient Doses from Common Radiographic Procedures in Selected Hospitals in Baguio City.
https://cdu.herdin.ph/index.php/component/herdin/?view=research&cid=40272
[10]
Le Heron, J. (1999) Guidelines on Patient Dose to Promote the Optimisation of Protection for Diagnostic Medical Exposures: Documents of the NRPB v 10(1), 1999. Radiation Protection News and Notes, No. 46, 17-18.
[11]
Petoussi-Henss, N., Zankl, M., Drexler, G., Panzer, W. and Regulla, D. (1998) Calculation of Backscatter Factors for Diagnostic Radiology Using Monte Carlo Methods. Physics in Medicine & Biology, 43, 2237-2250.
https://doi.org/10.1088/0031-9155/43/8/017
[12]
European Commission (1996) European Guidelines on Quality Criteria for Diagnostic Radiographic Images: Eur 16260 EN.
[13]
ICRU (n.d.) ICRU Report 74, Patient Dosimetry for X Rays Used in Medical Imaging.
https://www.icru.org/report/patient-dosimetry-for-x-rays-used-in-medical-imaging-report-74
[14]
Mohammedzein, T.S. (2009) Measurements of Radiation Dose to Patients Undergoing Some Common Radiographic X-Ray Examinations in Wad Madani Hospitals. 41.
[15]
Compagnone, G., Pagan, L. and Bergamini, C. (2005) Local Diagnostic Reference Levels in Standard X-Ray Examinations. Radiation Protection Dosimetry, 113, 54-63.
https://doi.org/10.1093/rpd/nch432
[16]
Nickoloff, E.L., Lu, Z.F., Dutta, A.K. and So, J.C. (2008) Radiation Dose Descriptors: BERT, COD, DAP, and Other Strange Creatures. RadioGraphics, 28, 1439-1450.
https://doi.org/10.1148/rg.285075748
[17]
(1992) National Protocol for Patient Dose Measurement in Diagnostic Radiology, Dosimetry Working Party of the Institute of Physical Sciences in Medicine, Natioanl Rdiological Protection Board.
[18]
Hart, D., Hillier, M.C. and Wall, B.F. (2002) Doses to Patients from Medical X-Ray Examinations in the UK 2000 Review. United Kingdom, 08-595148-5-4.
[19]
Internationale Atomenergie-Organisation (2007) Dosimetry in Diagnostic Radiology: An International Code of Practice. International Atomic Energy Agency, Vienna.
[20]
Hart, D., Hillier, M.C. and Wall, B.F. (2005) Doses to Patients from Radiographic and Fluoroscopic X-Ray Imaging Procedures in the UK—Review. 95.
[21]
IRSN PRP-HOM (2020) Analyse des donnees relatives a la mise a jour des niveaux de reference diagnostiques en radiologie et en medecine nucleaire. Bilan 2016-2018. Rapport parut en 2020.
[22]
Schegerer, A.A. (2016) KVB-RQ-Radiologie-Strahlenschutz-Diagnostische Referenzwerte-20031.pdf. Federal official Journal, 22, 2010.
[23]
(2000) The Swedish Radiation Protection Institute’s Regulations on Xray Diagnostics.
[24]
European Commissi (2014) Radiation Protection No. 180.
https://ec.europa.eu/energy/sites/ener/files/documents/RP180%20part2.pdf
[25]
(n.d.) Niveaux de référence diagnostiques (NRD) en radiologie par projection.
https://www.astrm.ch/files/Dokumente/Verband/Fachstellen/Strahlenschutz/R-06-04_niveaux_de_reference_diagnostiques__NRD__en_radiologie_par_projection.pdf
[26]
Honey, I.D., Mackenzie, A. and Evans, D.S. (2005) Investigation of Optimum Energies for Chest Imaging Using Film-Screen and Computed Radiography. The British Journal of Radiology, 78, 422-427. https://doi.org/10.1259/bjr/32912696
[27]
Samei, E., Dobbins, J.T., Lo, J.Y. and Tornai, M.P. (2005) A Framework for Optimising the Radiographic Technique in Digital X-Ray Imaging. Radiation Protection Dosimetry, 114, 220-229. https://doi.org/10.1093/rpd/nch562
[28]
Kawashima, H., Ichikawa, K., Nagasou, D. and Hattori, M. (2017) X-Ray Dose Reduction Using Additional Copper Filtration for Abdominal Digital Radiography: Evaluation Using Signal Difference-to-Noise Ratio. Physica Medica, 34, 65-71.
https://doi.org/10.1016/j.ejmp.2017.01.015
[29]
Bushberg, J.T. (1998) The AAPM/RSNA Physics Tutorials for Resident. X-Ray Interactions. RadioGraphics, 18, No. 2.
https://doi.org/10.1148/radiographics.18.2.9536489
[30]
Rill, L.N., Brateman, L. and Arreola, M. (2003) Evaluating Radiographic Parameters for Mobile Chest Computed Radiography: Phantoms, Image Quality and Effective Dose. Medical Physics, 30, 2727-2735. https://doi.org/10.1118/1.1611291
