Suggested Local Diagnostic Reference Levels for Possible Pediatric X-Ray Optimization in Addis Ababa, Ethiopia

BACKGROUND: Early childhood radiation exposure carries an enhanced radiation risk of about two to three times as high as in adults. The objective of this study was to determine local diagnostic reference levels for the most frequent pediatric x-ray examinations in Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted on 18 public and private hospitals/clinics in Addis Ababa. A total of 864 pediatric patients, undergoing eight types of routine x-ray examinations with 13 projections were evaluated from December 18/2017 to March 17 /2018. All pediatrics were categorized under four age groups. Anthropometric and radiographic parameters of each patient were recorded .The minimum, maximum, mean and third quartile values of entrance surface dose were analyzed using SPSS version 23. Finally, the suggested local diagnostic reference levels were compared with national and international reference dose values. RESULTS: Of the 864 pediatric patients, chest (AP/PA), lower and upper extremity (AP/PA) accounted for 501(58%), 110 (13%) and 103 (12%) respectively, accounting to 714(83%) of the total pediatric x-ray examinations. The suggested local diagnostic reference levels  of  chest X-ray (AP/PA) examinations in mGy were: (0.09,0.13,0.17,0.17) for age group (0-<1,1-<5 ,5-<10, and 10-<15), respectively. Similarly, for same  age group (0-<1,1-<5 ,5-<10, and 10-<15)  the  suggested local diagnostic reference levels  of  lower and upper extremities  in mGy were:  (0.06,0.08,0.09,0.09) and (0.04,0.05,0.05,0.06), respectively.  CONCLUSION: The suggested local diagnostic reference levels   were slightly higher than the national and international guidance levels, indicating the need for establishment of diagnostic reference levels in the country

Variation of Pediatric Doses Undergoing Digital and Computed Radiography Examination in Addis Ababa, Ethiopia

BACKGROUND: Various researchers who carried out national and international surveys have reported wide variations in patient dose arising from specific X-ray examinations. Thus, assessment of radiation dose is an essential part in the optimization process. The aim of this study was to compare the entrance surface doses delivered to pediatric patients undergoing digital and computed radiography X-ray examination.MATERIAL AND METHODS: A cross-sectional study was conducted on 389 pediatric X-ray projections less than 15 years of age on eight X-ray machines in Addis Ababa in February 2009 E.C. The tube output of the X-ray machines in air was measured using RaySafe XI dosimeters. Then, entrance surface dose was estimated for common x-ray examinations like chest, skull, extremities and pelvis using established relation between X-ray tube output and radiographic parameters. These data were analyzed statistically using computer (Excel and SPSS method).RESULT: The third quartile estimated ESDs in mGy for both computed and digital radiography examinations of chest (AP) for age (0-1 year) were 0.24 and 0.15, (1-5 year) 0.3and 0.16. For the age group (5-10 year), it was 1.97 and 0.26 and for the(10-15 year)group, 0.56 and 0.18 respectively.These values were higher than those of the United Nations Scientific Committee’s on the Effects of Atomic Radiation’s established dose reference levels(in mGy for age (0-1 year) 0.02, (1-5 year) 0.03, (5-10 year) 0.04, and (10-15 year) 0.05 respectively).CONCLUSION: The wider dose variation between computed and digital radiography shows that there is a pressing need to minimize the detriment caused by unnecessary computed radiography

Pediatric Residents’ and Medical Interns’ Awareness about Pediatric Ionizing Radiation Dose from Computed Tomography and Its Associated Risks in Tertiary Hospital in Ethiopia

BACKGROUND: The international literature on physicians’ knowledge regarding radiation dosages and risks due to computed tomography showed a widespread underestimation of diagnostic radiation doses. Hence, the objective of this work is to assess the awareness of pediatric residents and medical interns about pediatric CT dose and possible risks.METHODS: A cross-sectional study was conducted on May/2016 among year I to year III pediatric residents and 2015/2016 year medical interns attaching Pediatrics Department during the study period in Tikur Anbessa Specialized Referral and Teaching Hospital. Data was collected by distributing standardized structured questionnaires. Finally, after the data was checked for clarity and completeness, it was analyzed by using SPSS software.RESULT: While the majority (76.3%) of the residents and interns knew that children were more sensitive to radiation than adults, 93.7% did not know that there is currently no annual dose limit set for medical exposure of patients. The majority of the respondents (81.3%) know the risk of cancer from CT scan, but most (60%) of the respondents did not know that many imaging facilities still use adult doses for pediatric patients. Furthermore, 18.8% thought that magnetic resonance imaging involves ionizing radiation, and 8.9% of the physicians associated ultrasound examinations with ionizingradiation.CONCLUSION : Within resident group, since the level of clinical experience did not affect the outcome, we recommend that formal education and training on awareness of radiation with special concern on pediatric population is mandatory especially for pediatric residents and pediatricians who are major caretakers of children.KEYWORDS: Computed tomography, radiation exposure, awareness of radiation, pediatric CT dose, possible risks of radiation

Assessment of Adult’s Abdominopelvic Computed Tomography Radiation Doses in Amhara Region, Ethiopia

BACKGROUND: Computed Tomography plays a priceless role for diagnostic and therapeutic purpose; however, applying an optimized Computed Tomography Technique to produce qualified image while delivering minimum radiation dose to patients is the common challenge. The main objective of this study was to establish local diagnostic reference levels for adult patients who visited abdominopelvic Computed Tomography examination. METHODS: A total of 158 patients who had taken abdominopelvic Computed Tomography examination from   three selectedAmhara region hospitals were investigated. Both prospective and retrospective techniques of data collection were used while collecting the data in the entire sample. Two GE - Optima Computed Tomography 540 (16 slices) and one Phillips – Brilliance (64slices), were employed during data collections. Data for patient demographics scan protocols, Computed Tomography dose descriptors and machine specifications were collected and analyzed by using SPSS software version 26. RESULTS: The third quartile estimated computed tomography dose index volume and dose length product, which is the local Diagnostic Reference Levels, were 12 mGy and 1904 cm.mGy respectively. The investigated local Diagnostic Reference Levels   of Computed Tomography Dose index volume (mGy) was comparable to other international Diagnostic Reference Levels. However, the third quartile value of dose length product (cm.mGy) was higher than other reported international Diagnostic Reference Levels. CONCLUSION: The values of local Diagnostic Reference Levels presented in this work can be used as a baseline upon which future dose measurements can be compared in Amhara region

Computed Tomography Radiation Exposure among Urinary Tract Stone Patients at Tikur Anbessa Specialized Hospital: A Retrospective Study

BACKGROUND: National and multinational surveys indicate large variability of Computed Tomography urinarytractStone doses. The wide use of abdominopelvic Computed Tomography in the diagnosis,  raised the issue of radiation exposure. Hence,this study was conducted to assess Computed Tomography  radiation exposure of urinary tract Stone Patients there by, to compare the results from established reference values and other published studies METHODS: A retrospective cross-sectional was done on 100 urinary tract Stone patients who have at least one computed tomography scan as part of their follow-up or for diagnosis purposes fromFebruary 1 to May 31, 2021, at  Tikur Anbesa Specialized Hospital.Data were collected using a structured questionnaire format that evaluates the number of Computed Tomography they had, scan parameters,  dose indicators, and socio-demographic characteristics. Finally, the collected data were analyzed  using statistical software SPSS version 22 RESULTS: Out of 100 patients 3.6%of our patients have radiation exposure of more than 4mSv, which is the standard for low-dose Computed Tomography. The median radiation exposure is 1.27mSv per scan. Exposure factors like tube current, tube current products, dose length product, and scan range all have similar values with an almost null interquartile range. All the scans that overpassed the low dose threshold(4mSv) were done outsideTikur Anbesa Specialized Hospital. CONCLUSION: Our study showed that Tikur Anbesa Specialized Hospital's low-dose CT protocol for patients with urinary tract Stone is well optimized as opposed to non- Tikur Anbesa Specialized Hospital

Level of Awareness of Mammography among Breast Cancer Patients Attending Follow-up at a Tertiary Hospital, Addis Ababa, Ethiopia

BACKGROUND: Breast cancer is the most common cancer type and the most common cancer related cause of death worldwide in women. This study was aimed to assess the awareness of mammography among breast cancer patients attending follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. METHODS: Hospital based cross sectional study was conducted from July 01 to August 30, 2017 at Tikur Anbessa Specialized Hospital. Interviewer administered questionnaire was used to obtain data from 270 breast cancer patients who came to radiology department for follow up imaging. Collected data were checked for completeness, coded and entered into Epi Info 3.1 software and exported to SPSS Version 21 for analysis. RESULTS: Two hundred and twenty four (83%) of the study participants had no awareness of mammography while 46 (17%) of them had awareness of mammography. Out of the total 270 women, only 38(14.1%) had mammography test. In multivariate logistic regression analysis; level of education was found to have significant association with awareness of mammography. Women with breast cancer who completed secondary education were 4.5 times (AOR= 4.5; 95% CI: 1.39, 14.77) more likely to have awareness of mammography compared to women with breast cancer who were illiterate. CONCLUSION: This study revealed low awareness, knowledge and practice of mammography among women with breast cancer. Knowledge of participants about risk factor for breast cancer was also low.&nbsp

Establishment of local diagnostic reference levels for common adult CT examinations: a multicenter survey in Addis Ababa

Abstract Background In medical imaging, a computed tomography (CT) scanner is a major source of ionizing radiation. All medical radiation exposures should be justified and optimized to meet the clinical diagnosis. Thus, to avoid unnecessary radiation doses for patients, diagnostic reference levels (DRLs) have been used. The DRLs are used to identify unusually high radiation doses during CT procedures, which are not appropriate for the clinical diagnosis. It has been successfully implemented in Europe, Canada, Australia, the United States, several industrialized countries, and a few underdeveloped countries. The present study aimed to establish DRLs for the head, chest, and abdominopelvic (AP) CT procedures in Addis Ababa, Ethiopia. Methods A pilot study identified the most frequent CT examinations in the city. At the time of the pilot, eighteen CT scan facilities were identified as having functioning CT scanners. Then, on nine CT facilities (50% of functional CT scanners), a prospective analysis of volume CT dose index (CTDIvol) and dose length product (DLP) was performed. We collected data for 838 adult patients’ head, chest, and AP CT examinations. SPSS version 25 was used to compute the median values of the DLP and CTDIvol dose indicators. The rounded 75th percentile of CTDIvol and DLP median values were used to define the DRLs. The results are compared to DRL data from the local, regional, and international levels. Result The proposed DRLs using CTDIvol (mGy) are 53, 13, and 16 for the head, chest, and AP examinations respectively, while the DLP (mGy.cm) for the respective examinations were 1210, 635, and 822 mGy.cm. Conclusion Baseline CT DRLs figures for the most frequently performed in Addis Ababa were provided. The discrepancies in dose between CT facilities and as well as between identical scanners suggests a large potential for dose optimization of examinations. This can be actually achieved through appropriate training of CT technologists and continuous dose audits

Use of Multiphase CT Protocols in 18 Countries: Appropriateness and Radiation Doses

Purpose: To assess the frequency, appropriateness, and radiation doses associated with multiphase computed tomography (CT) protocols for routine chest and abdomen–pelvis examinations in 18 countries. Materials and Methods: In collaboration with the International Atomic Energy Agency, multi- institutional data on clinical indications, number of scan phases, scan parameters, and radiation dose descriptors (CT dose–index volume ; dose–length product [DLP]) were collected for routine chest (n ¼ 1706 patients) and abdomen–pelvis (n ¼ 426 patients) CT from 18 institutions in Asia, Africa, and Europe. Two radiologists scored the need for each phase based on clinical indications (1 ¼ not indicated, 2 ¼ probably indicated, 3 ¼ indicated). We surveyed 11 institutions for their practice regarding single-phase and multiphase CT examinations. Data were analyzed with the Student t test. Results: Most institutions use multiphase protocols for routine chest (10/18 institutions) and routine abdomen–pelvis (10/11 institutions that supplied data for abdomen–pelvis) CT examinations. Most institutions (10/11) do not modify scan parameters between different scan phases. Respective total DLP for 1-, 2-, and 3- phase routine chest CT was 272, 518, and 820 mGy_cm, respectively. Corresponding values for 1- to 5-phase routine abdomen–pelvis CT were 400, 726, 1218, 1214, and 1458 mGy cm, respectively. For multiphase CT protocols, there were no differences in scan parameters and radiation doses between different phases for either chest or abdomen–pelvis CT (P ¼ 0.40 0.99). Multiphase CT examinations were unnecessary in 100% of routine chest CT and in 63% of routine abdomen– pelvis CT examinations. Conclusions: Multiphase scan protocols for the routine chest and abdomen– pelvis CT examinations are unnecessary, and their use increases radiation dose