Abstract
The main purpose of this study was to investigate patient dose in the chest (PA/AP/LAT) and skull (PA/AP/LAT) X‐ray examinations, as frequent procedures. The study was performed in eight public hospitals of Khuzestan province, Iran. Patient dosimetry was conducted on 567 standard patient X‐ray examinations (males: 61.2%, female: 38.2%). Dosimetry protocol in this study was indirect method, according to the International Atomic Energy Agency (IAEA) Technical Reports series No. 457. Patients weighing 70±10 kg were considered as standard. In the indirect dosimetry approach, exposure parameters such as kVp, mAs, focal film distance (FFD), and tube outputs recorded during data acquisition were used for calculating incident air kerma on the patient's skin, entrance surface air kerma (ESAK) that is recommended by the IAEA as the most appropriate patient dosimetry quantity in simple radiographic examinations. This survey reveals significant variations in the radiological practice. Results showed that the parameters set by radiologic technologists change in a wide range: mAs varied from 2 to 80 for skull PA, 2 to 202 for chest LAT, and FFD varied from 50 to 180 for skull LAT projection. The study showed that patient doses in three chest projections exceed the IAEA and European Commission dose reference levels (EC DRLs) — 1.0, 1.12, and 2.20 mGy for chest PA, chest AP, and chest LAT, respectively. Results also showed that mean ESAKs of patients in skull projections were generally lower than the IAEA and EC DRLs, 1.5, 1.72, and 2.25 for skull LAT, skull AP, and skull PA, respectively. This study provides evidence that dose reduction in the simple X‐ray examinations is feasible by updating clinical audits and implementation of systematic quality assurance (QA) and quality control (QC) programs. The authors recommend that DRLs obtained in this study can be used as local DRLs in Khuzestan area and dose surveys must be performed in all provinces to establish national dose reference levels (NDRLs) in Iran.PACS numbers: 87.53.Bn, 87.57.uq, 87.59.B
Highlights
375 Rasuli et al.: Dose in medical x-ray examination1,000 inhabitants.[1]
A local review should be initiated to determine appropriate protective action. This means that cooperation between national authorities and professional bodies is necessary to establish national diagnostic reference levels (NDRLs), taking into account the prevailing economic and societal circumstances, as well.[2]. Regular control and dosimetry can help the physician and physicist to ensure that the dose received by patients who undergo radiologic procedures is in accordance with the ALARA (As Low As Reasonably Achievable) principle and does not exceed the amount required to obtain favorable radiographic scan
Entrance Skin Air Kerma (ESAK) is recommended by the International Atomic Energy Agency (IAEA) as the most appropriate patient dosimetry quantity in simple radiographic examinations, primarily due to the convenience of measurement, easy comparison with other studies in different countries or DRLs, and proportionality to patient effective dose that is used to find the probability of radiation-induced complications.[3]
Summary
375 Rasuli et al.: Dose in medical x-ray examination1,000 inhabitants.[1]. Widespread fast-growing demand for X-ray examinations by physicians in the developing countries, as in Iran, and increasing the number of X-ray machines in the past 10 years have led to increase the number of X-ray examinations per unit of population. International Commission on Radiation Protection (ICRP) declared that the diagnostic reference levels (DRLs) are already being used in medical diagnosis to indicate whether the levels of patient dose from a specified imaging procedure are unusually high or low in comparison to the predefined criteria. A local review should be initiated to determine appropriate protective action This means that cooperation between national authorities and professional bodies is necessary to establish national diagnostic reference levels (NDRLs), taking into account the prevailing economic and societal circumstances, as well.[2] Regular control and dosimetry can help the physician and physicist to ensure that the dose received by patients who undergo radiologic procedures is in accordance with the ALARA (As Low As Reasonably Achievable) principle and does not exceed the amount required to obtain favorable radiographic scan. Entrance Skin Air Kerma (ESAK) is recommended by the IAEA as the most appropriate patient dosimetry quantity in simple radiographic examinations, primarily due to the convenience of measurement, easy comparison with other studies in different countries or DRLs, and proportionality to patient effective dose that is used to find the probability of radiation-induced complications.[3]
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