Estimation of entrance surface air kerma due to diagnostic X-ray examinations of adult patients in Uttarakhand, India and establishment of local diagnostic reference levels

Abstract This study aimed to calculate patient radiation doses for adults during the seven most commonly performed conventional X-ray procedures, and to propose national diagnostic reference levels (DRLs). A representative sample of patients from 29 hospitals was included. The entrance surface air kerma (ESAK) was calculated by measuring X-ray tube output and the corresponding technical and exposure factors for each patient. Third-quartile values of the mean ESAK distributions were proposed as DRL values. The DRLs in mGy were as follows: 0.6 for chest postero–anterior (PA), 3.5 for skull AP, 1.7 for skull lateral (LAT), 2.7 for abdominal, 2.6 for pelvic AP, 3.7 for lumbar spine AP and 8 for lumbar spine LAT. Compared with literature, the maximum percentages increase were in chest PA (329%) and skull AP (187%). Since the suggested DRL for chest PA was higher than literature values, dose optimization and a review of its value is recommended.

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Establishment of local diagnostic reference levels for typical radiography examinations in the west region of Croatia

Nuclear Technology and Radiation Protection ◽

10.2298/ntrp180831015s ◽

2019 ◽

Vol 34 (1) ◽

pp. 102-106 ◽

Cited By ~ 2

Author(s):

Doris Segota ◽

Ana Diklic ◽

Slaven Jurkovic

Keyword(s):

Public Health ◽

University Hospital ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

X Ray ◽

West Region ◽

Public Health Institutions ◽

Patient Doses ◽

Health Institutions ◽

Entrance Surface Air Kerma

Majority of health institutions in Croatia do not have medical physicists in diagnostic radiology. Regarding this, in the west region of Croatia collaboration between public health institution and University Hospital Rijeka was initiated in 2015. Quality Assurance program was implemented in these public health institutions during 2015 and 2016 and the next step was to assess patient doses for the most frequent X-ray examinations. This included five public health institutions: 1 university hospital, 1 general hospital, 1 special hospital, 2 public health institutions with 13 facilities. The aim of this study was to carry out assessment of patient doses and to establish local diagnostic reference levels of entrance surface air kerma for every institution for six most frequent X-ray examinations. Also, local diagnostic reference levels for the whole west region of Croatia were established and compared with the national diagnostic reference levels and latest published data. Median entrance surface air kerma values for thorax PA, thorax LAT, cervical spine AP, thoracic spine AP, lumbar spine AP, pelvis AP and sinuses are 0.14 mGy, 0.50 mGy, 0.52 mGy, 1.50 mGy, 2.52 mGy, 2.03 mGy, and 1.03 mGy, respectively. Diagnostic reference levels proposed for our region were comparable with other studies.

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PROPOSAL FOR LOCAL DIAGNOSTIC REFERENCE LEVELS IN GENERAL RADIOGRAPHY IN JAPAN

Radiation Protection Dosimetry ◽

10.1093/rpd/ncz172 ◽

2019 ◽

Author(s):

Yasuki Asada ◽

Koji Ono ◽

Yuya Kondo ◽

Kazuma Sugita ◽

Takuma Ichikawa ◽

...

Keyword(s):

Radiation Dose ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Distributions ◽

X Ray ◽

Non Invasive ◽

Air Kerma ◽

Aichi Prefecture

Abstract The present study aimed to propose local diagnostic reference levels (DRLs) formulated by calculating entrance surface doses for general radiography at 20 facilities of Aichi prefecture in Japan, by comparing these values with DRLs established in Japan in 2015 (DRLs 2015) and assessing radiation dose differences among facilities. X-ray outputs (half-value layer and air kerma) of each facility were measured with a non-invasive type of detector. The results were employed to formulate local DRLs based on the 75th percentiles of dose distributions. These local DRLs were lower than the DRLs 2015 for all examinations. If proposed local DRLs from other 46 prefectures can be collected, this paper can be used to benefit the next effort to draft better DRL for Japan.

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Radijaciono opterecenje pacijenata u konvencionalnoj dijagnostickoj radiologiji - analiza radioloske prakse u Srbiji

Acta chirurgica iugoslavica ◽

10.2298/aci0703093c ◽

2007 ◽

Vol 54 (3) ◽

pp. 93-98

Author(s):

O.F. Ciraj-Bjelac ◽

M.S. Kovacevic ◽

D.D. Kosutic ◽

S.S. Stankovic

Keyword(s):

Total Population ◽

X Rays ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

X Ray ◽

Patient Doses ◽

Area Product ◽

First Time ◽

Dose Variation ◽

Entrance Surface Air Kerma

X-rays are by far most significant contributor to total population dose from man-made sources of radiation. Diagnostic reference levels provide frameworks to reduce variability. The aim of this study is to establish, for the first time, a baseline for national diagnostic reference levels in Serbia for the most common X-ray examination types. Dose estimates are based on measurements of kerma-area product and Entrance surface air kerma for at least ten patients for each examination type, in each of 16 randomly selected hospitals in Serbia. Mean, median and third quartile values of patient doses are reported. Results have shown wide variation of mean hospital doses. Entrance surface doses were compared with previously published diagnostic reference levels. Doses for all studied examination types except chest radiography were within European DRL. The reasons for dose variation are discussed. The findings emphasize the importance of regular patient dose measurement to ensure that patient doses are kept as low as reasonable achievable.

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Analysis of Average Glandular Dose (AGD) and Associated Parameters for Conventional and Digital X-Ray Mammography

10.21203/rs.3.rs-799884/v1 ◽

2021 ◽

Author(s):

Ibrahim Idris Suliman ◽

Sawsan Mohamed ◽

Alaa Mahadi ◽

Einas Bashier ◽

A Farah ◽

...

Keyword(s):

Patient Specific ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

X Ray ◽

Air Kerma ◽

Essential Step ◽

Patient Protection ◽

Average Glandular Dose ◽

Tube Output ◽

Conversion Coefficients

Abstract In this study, we determined the average glandular dose (AGD) from the craniocaudal (CC) and mediolateral oblique (MLO) views of 496 breasts (247 women) at eight clinics in Sudan. The incident air kerma from the X-ray tube output values and typical patient-specific breast exposure factors were measured. AGD values were inferred from the measured incident air kerma and breast-specific dose conversion coefficients. The AGD per CC and MLO projection and per woman ranged from 0.34–5.3 mGy (average: 2.46), 0.29–3.39 mGy (average: 1.50), and 0.6–7.4 mGy (average: 3.95). The proposed national diagnostic reference levels (mGy) are 3.48, 2.03, and 6.44 mGy for CC, MLO, and per woman, respectively. Establishing the proposed diagnostic reference levels is an essential step in ensuring patient protection from radiation and will help promote dose optimization for X-ray mammography at the national levels and beyond. The results provide important baseline data that can be used to formulate the national diagnostic reference levels.

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Establishing local diagnostic reference levels for adult computed tomography in Morocco

Radioprotection ◽

10.1051/radiopro/2021035 ◽

2022 ◽

Author(s):

M. El Mansouri ◽

M. Talbi ◽

A. Choukri ◽

O. Nhila ◽

M. Aabid

Keyword(s):

Computed Tomography ◽

Adult Patients ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Head Ct ◽

Ct Examination ◽

Japanese Studies ◽

The Uk

In Morocco, the radiation doses received by adult patients are increasing due to the number of CT examinations performed and the larger number of computed tomography (CT) scanners installed. The aim of this study was to evaluate the radiation doses received by patients for the most common adult CT examinations in order to establish local diagnostic reference levels (DRLs). Data from 1016 adult patients were collected during 3 months from four Moroccan hospitals. Dose length product (DLP) and volumetric computed tomography dose index (CTDIvol) were evaluated by determining the 75th percentile as diagnostic reference levels for the most common examinations including head, chest and abdomen. The DRL for each examination was compared with other studies. The established DRLs in Morocco in terms of CTDIvol were 57.4, 12.3 and 10.9 for CT examinations of the head, chest, abdomen, respectively. For DLP, they were 1020, 632 and 714, respectively. These established DRLs for CTDIvol were almost similar to the UK DRLs at all examinations, higher than the Egyptian DRLs and lower than the Japanese DRLs at the head CT examination, lower than the DRLs from Egypt and Japan at the CT abdomen examination. In terms of DLP, the DRLs were higher than those of the British studies, lower than those of the Egyptian and Japanese studies at the head CT examination were higher at chest CT and lower at abdominal CT than those of all selected studies. The higher level of established DRLs in our study demonstrates the requirement of an optimization process while keeping a good image quality for a reliable diagnosis.

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Pediatric Diagnostic Reference Levels for Diagnostic and Therapeutic Cardiac Catheterization in Japan

10.21203/rs.3.rs-288911/v1 ◽

2021 ◽

Author(s):

Toru Ishibashi ◽

Yasutaka Takei ◽

Mamoru Kato ◽

Yukari Yamashita ◽

Atsuko Tsukamoto ◽

...

Keyword(s):

Cardiac Catheterization ◽

Pediatric Patients ◽

Age Groups ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Air Kerma ◽

Cardiac Angiography ◽

Pediatric Cardiac Catheterization ◽

One Year ◽

Area Product

Abstract To propose Japanese national DRLs for air-kerma at the reference point (Ka,r), air-kerma area product (PKA), fluoroscopy time (FT), and number of cine images (CI) for four age groups. We posted a nationwide questionnaire to 132 facilities. Questions focused on identifying the procedure, age, weight, height, Ka,r, PKA, FT, and CI during diagnostic and therapeutic pediatric cardiac catheterization. For diagnostic cardiac angiography, the 75th percentile values were as follows; Ka,r: 103, 127, 194, and 351 mGy; PKA: 7.0, 12.3, 14.3, and 47.2 Gy.cm2; FT: 36.8, 30.7, 33.4, and 35.7 min; and CI: 2018, 2313, 2408, and 2016 images for less than one year, 1–5 years, 6–10 years, and 11–15 years respectively. For therapeutic cardiac angiography, the 75th percentile values were as follows: Ka,r: 146, 209, 130, and 501 mGy; PKA: 7.54, 16.0, 8.35, and 46.0 Gy.cm2; FT: 56.5, 52.0, 49.4, and 52.0 min; and CI: 4075, 4514, 3576, and 5984 images for less than one year, 1–5 years, 6–10 years, and 11–15 years respectively. Our survey of diagnostic and therapeutic cardiac catheterization in Japanese pediatric patients showed that all age-based Japanese 75th percentiles for the Ka,r, PKA, FT, and CI were higher than in other surveys. Based on the result of our study, it is necessary to establish DRLs for pediatric cardiac catheterization examinations in Japan, in order to optimize the safety of pediatric protocols for diagnostic and therapeutic cardiac catheterization.

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NATIONAL DIAGNOSTIC REFERENCE LEVELS IN INTERVENTIONAL RADIOLOGY SUITES IN LEBANON: A MULTICENTER SURVEY

Radiation Protection Dosimetry ◽

10.1093/rpd/ncz137 ◽

2019 ◽

Vol 187 (1) ◽

pp. 50-60 ◽

Cited By ~ 2

Author(s):

C Rizk ◽

J Farah ◽

F Vanhavere ◽

G Fares

Keyword(s):

Radiation Protection ◽

Pacemaker Implantation ◽

High Dose ◽

National Council ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Air Kerma ◽

Transcatheter Aortic Valve ◽

Multicenter Survey ◽

Area Product

ABSTRACT Air kerma-area product (PKA), cumulative air kerma at patient entrance reference point, fluoroscopy time and number of images were retrospectively collected from 15 hospitals in Lebanon for 11282 fluoroscopically-guided interventional (FGI) procedures between March 2016 and November 2018. National diagnostic reference levels (NDRLs) were established based on the third quartile of the distribution of median values of exposure parameters per department for 27 types of FGI procedures. NDRLs were in line with international DRLs except for coronary angiography (CA), percutaneous coronary interventions (PCI) and transcatheter aortic valve implantation (TAVI) which require optimisation. Additionally, following the National Council on Radiation Protection and Measurements report 168, PCI, TAVI, triple chamber pacemaker implantation, endovascular aortic repair, nephrostomy, kyphoplasty and percutaneous transhepatic biliary drainage were classified as potentially high-dose procedures with >5% of the patients with PKA exceeding 300 Gycm2. The established NDRLs will promote dose optimisation and patient radiation protection.

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