Abstract
Background. The wide use of ionising radiation in medical care has resulted in the largest man-made cause of radiation exposure. In recent years, diagnostic departments in Kenya have adapted the high-speed film/screen combination without well-established quality control, objective image quality criteria, and assessment of patient dose. The safety of patients in terms of justification and the as-low-as-reasonably-achievable (ALARA) principle is inadequate without quality assurance measures.
 Aim. This study assessed the level of film rejects, device performance, image quality and patient dose in 4 representative hospitals using high-speed film/screen combination.
 Results. The X-ray equipment quality control tests performance range was 67% to 90%, and 63% of the radiographs were of good diagnostic value. The measured prevalent chest examination entrance surface dose (ESD) showed levels above the international diagnostic reference levels (DRLs), while lumbar spine and pelvis examination was the largest source of radiation exposure to patients.
 Conclusion. The optimisation of patient protection can be achieved with optimally performing X-ray equipment, the application of good radiographic technique, and continuous assessment of radiographic image quality.
Highlights
The high rate of poverty, illiteracy and disease in most developing countries results in high demands for effective healthcare
The measured prevalent chest examination entrance surface dose (ESD) showed levels above the international diagnostic reference levels (DRLs), while lumbar spine and pelvis examination was the largest source of radiation exposure to patients
According to the American College of Radiology (ACR), the use of DRLs assists imaging professionals in managing radiation exposure by exercising good practice based on current knowledge, obtainable resources, and the specific needs of patients, in a safe and cost-effective medical care environment.[3]
Summary
The high rate of poverty, illiteracy and disease in most developing countries results in high demands for effective healthcare. Imaging professionals should develop clearly defined guidelines that promote quality assurance in accordance with the latest technical knowledge of the equipment concerned. According to the American College of Radiology (ACR), the use of DRLs assists imaging professionals in managing radiation exposure by exercising good practice based on current knowledge, obtainable resources, and the specific needs of patients, in a safe and cost-effective medical care environment.[3] This system falls within the recommendations of the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR)[4] and the International Commission on Radiological Protection,[5] and as so far revealed by research conducted by the International Atomic Energy Agency.[6]. The safety of patients in terms of justification and the as-lowas-reasonably-achievable (ALARA) principle is inadequate without quality assurance measures
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