Radiation protection of patients in diagnostic radiology: Status of practice in five Eastern-European countries, based on IAEA project

The purpose of this work was to investigate status of imaging technology and practice in five countries in Eastern-European region and evaluate the impact of IAEA projects on radiation protection of patients. Information collected using standardized IAEA protocol included status of technology, practices and patient dose levels in interventional procedure, radiography, mammography and computed tomography (CT). In spite of increased number of digital units, single phase generators or units older than 30 year are still in use. Examples of obsolete practice such as using fluoroscopy for positioning, photofluorography, chest fluoroscopy and soft-beam technique for chest radiography are also in use. Modern multi-slice CT or digital mammography units are available; however, there is lack of adequate radiation protection and medical physics support in hospitals. Information on patient doses in interventional procedures, conventional radiography, mammography and CT was collected to have baseline data and corrective measures were proposed with appropriate follow up actions taken. (C) 2011 Elsevier Ireland Ltd. All rights reserved

Patient doses in radiographic examinations in 12 countries in Asia, Africa, and Eastern Europe: Initial results from IAEA projects

OBJECTIVE. The purpose of this study was to survey image quality and the entrance surface air kerma for patients in radiographic examinations and to perform comparisons with diagnostic reference levels. SUBJECTS and METHODS. In this multinational prospective study, image quality and patient radiation doses were surveyed in 12 countries in Africa, Asia, and Eastern Europe, covering 45 hospitals. The rate of unsatisfactory images and image quality grade were noted, and causes for poor image quality were investigated. The entrance surface doses for adult patients were determined in terms of the entrance surface air kerma on the basis of X-ray tube output measurements and X-ray exposure parameters. Comparison of dose levels with diagnostic reference levels was performed. RESULTS. The fraction of images rated as poor was as high as 53%. The image quality improved up to 16 percentage points in Africa, 13 in Asia, and 22 in Eastern Europe after implementation of a quality control ( QC) program. Patient doses varied by a factor of up to 88, although the majority of doses were below diagnostic reference levels. The mean entrance surface air kerma values in mGy were 0.33 ( chest, posteroanterior), 4.07 ( lumbar spine, anteroposterior), 8.53 ( lumbar spine, lateral), 3.64 ( abdomen, anteroposterior), 3.68 ( pelvis, anteroposterior), and 2.41 ( skull, anteroposterior). Patient doses were found to be similar to doses in developed countries and patient dose reductions ranging from 1.4% to 85% were achieved. CONCLUSION. Poor image quality constitutes a major source of unnecessary radiation to patients in developing countries. Comparison with other surveys indicates that patient dose levels in these countries are not higher than those in developed countries

Image quality and dose in mammography in 17 countries in Africa, Asia and Eastern Europe: Results from IAEA projects

Purpose: The objective is to study mammography practice from an optimisation point of view by assessing the impact of simple and immediately implementable corrective actions on image quality. Materials and methods: This prospective multinational study included 54 mammography units in 17 countries. More than 21,000 mammography images were evaluated using a three-level image quality scoring system. Following initial assessment, appropriate corrective actions were implemented and image quality was re-assessed in 24 units. Results: The fraction of images that were considered acceptable without any remark in the first phase (before the implementation of corrective actions) was 70% and 75% for cranio-caudal and medio-lateral oblique projections, respectively. The main causes for poor image quality before corrective actions were related to film processing, damaged or scratched image receptors, or film-screen combinations that are not spectrally matched, inappropriate radiographic techniques and lack of training. Average glandular dose to a standard breast was 1.5mGy (mean and range 0.59-3.2 mGy). After optimisation the frequency of poor quality images decreased, but the relative contributions of the various causes remained similar. Image quality improvements following appropriate corrective actions were up to 50 percentage points in some facilities. Conclusions: Poor image quality is a major source of unnecessary radiation dose to the breast. An increased awareness of good quality mammograms is of particular importance for countries that are moving towards introduction of population-based screening programmes. The study demonstrated how simple and low-cost measures can be a valuable tool in improving of image quality in mammography. (C) 2011 Elsevier Ireland Ltd. All rights reserved

IAEA Survey of Pediatric CT Practice in 40 Countries in Asia, Europe, Latin America, and Africa: Part 1, Frequency and Appropriateness

OBJECTIVE. The purpose of this study was to assess the frequency of pediatric CT in 40 less-resourced countries and to determine the level of appropriateness in CT use. MATERIALS AND METHODS. Data on the increase in the number of CT examinations during 2007 and 2009 and appropriate use of CT examinations were collected, using standard forms, from 146 CT facilities at 126 hospitals. RESULTS. The lowest frequency of pediatric CT examinations in 2009 was in European facilities (4.3%), and frequencies in Asia (12.2%) and Africa (7.8%) were twice as high. Head CT is the most common CT examination in children, amounting to nearly 75% of all pediatric CT examinations. Although regulations in many countries assign radiologists with the main responsibility of deciding whether a radiologic examination should be performed, in fact, radiologists alone were responsible for only 6.3% of situations. Written referral guidelines for imaging were not available in almost one half of the CT facilities. Appropriateness criteria for CT examinations in children did not always follow guidelines set by agencies, in particular, for patients with accidental head trauma, infants with congenital torticollis, children with possible ventriculoperitoneal shunt malfunction, and young children ( LT 5 years old) with acute sinusitis. In about one third of situations, nonavailability of previous images and records on previously received patient doses have the potential to lead to unnecessary examinations and radiation doses. CONCLUSION. With increasing use of CT in children and a lack of use of appropriateness criteria, there is a strong need to implement guidelines to avoid unnecessary radiation doses to children