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Issahaku S, Boadu M, Inkoom S, Hasford F, Sackey TA. Establishment and utilisation of national diagnostic reference level for adult computed tomography examinations in Ghana. RADIATION PROTECTION DOSIMETRY 2024; 200:564-571. [PMID: 38453140 DOI: 10.1093/rpd/ncae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
The International Atomic Energy Agency, as part of the new regional project (RAF/9/059), recommend the establishment of diagnostic reference levels (DRLs) in Africa. In response to this recommendation, this project was designed to establish and utilise national DRLs of routine computed tomography (CT) examinations. These were done by estimating CT dose index and dose length product (DLP) from a minimum of 20 patient dose report of the most frequently used procedures using 75th percentile distribution of the median values. In all, 22 centres that formed 54% of all CT equipment in the country took part in this study. Additionally, a total of 2156 adult patients dose report were randomly selected, with a percentage distribution of 60, 12, 21 and 7% for head, chest, abdomen-pelvis and lumber spine, respectively. The established DRL for volume CT dose index were 60.0, 15.7, 20.5 and 23.8 mGy for head, chest, abdomen-pelvis and lumber spine, respectively. While the established DRL for DLP were 962.9, 1102.8, 1393.5 and 824.6 mGy-cm for head, chest, abdomen-pelvis, and lumber spine, respectively. These preliminary results were comparable with data from 16 other African countries, European Commission and the International Commission on Radiological Protection. Hence, this study would serve as a baseline for the establishment of a more generalised regional and national adult DRLs for Africa and other developing countries.
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Affiliation(s)
- Shiraz Issahaku
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Mary Boadu
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Stephen Inkoom
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Francis Hasford
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Theophilus A Sackey
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
- Korle-Bu Teaching Hospital, Department of Radiology, PMB, Accra, Ghana
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Bouchareb Y, Al-Maimani A, Al-Balushi AY, Al-Kalbani M, Al-Maskari H, Al-Dhuhli H, Al-Kindi F. Establishment of diagnostic reference levels in computed tomography in two large hospitals in Oman. RADIATION PROTECTION DOSIMETRY 2023; 199:2148-2155. [PMID: 37594414 DOI: 10.1093/rpd/ncad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Abstract
This study aimed to estimate diagnostic reference levels (DRLs) for the most frequent computed tomography (CT) imaging examinations to monitor and better control radiation doses delivered to patients. Seven CT imaging examinations: Head, Chest, Chest High Resolution (CHR), Abdomen Pelvis (AP), Chest Abdomen Pelvis (CAP), Kidneys Ureters Bladder (KUB) and Cardiac, were considered. CT dosimetric quantities and patient demographics were collected from data storage systems. Local typical values for DRLs were calculated for CTDIvol (mGy), dose length product (DLP) (mGy·cm) and effective doses (mSv) were estimated for each examination. The calculated DRLs were given as (median CTDIvol (mGy):median DLP (mGy·cm)): Head: 39:657; Chest: 13:451; CHR: 6:228; AP: 12:578; CAP: 20:807; KUB: 7:315, and Cardiac: 2:31. Estimated effective doses for Head, Chest, CHR, AP, CAP, KUB and Cardiac were 1.3, 12.7, 6.3, 12.5, 18.1, 5.8 and 0.8 mSv, respectively. The estimated DRLs will act as guidance doses to prevent systematic excess of patient doses.
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Affiliation(s)
- Yassine Bouchareb
- Sultan Qaboos University, College of Medicine & Health Sciences, Muscat, Oman
| | - Amal Al-Maimani
- Sultan Qaboos University Hospital, Radiology and Molecular Imaging, Muscat, Oman
| | | | | | | | - Humoud Al-Dhuhli
- Sultan Qaboos University Hospital, Radiology and Molecular Imaging, Muscat, Oman
| | - Faiza Al-Kindi
- Radiology Department, Royal Hospital, PO. Box 1331, Muscat, Oman
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Arlany L, Toh HG, Nazir B, Ng JJ, Tay YH, Tay YS, Poon CJX, Lee LN, Fum WKS, Lee EYT, Mariah SI, Fortier MV, Tham WP, Chew LL, Chong KHE, Chong LR. Establishment of CT diagnostic reference levels (DRLs) for a Singapore healthcare cluster. Radiography (Lond) 2023; 29:184-189. [PMID: 36469993 DOI: 10.1016/j.radi.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION The use of computed tomography (CT) in healthcare institutions has increased rapidly in recent years. The Singapore Health Services (SingHealth) cluster of healthcare institutions has taken the first step in establishing a local cluster-wide CT Diagnostic Reference Levels (DRL) in Singapore. CT dose data from each institution were collected through two primary dosimetry metrics: volume CT dose index (CTDIvol measured in mGy) and dose-length product (DLP measured in mGy.cm). METHODS Data from 19 CT scanners in seven institutions under one of Singapore healthcare cluster were retrospectively collected and analysed. The five common adult CT examinations analysed were CT Brain (non-contrast enhanced), CT Chest (IV contrast enhanced), CT Kidney-Ureter-Bladder (CT KUB, non-contrast enhanced), CT Pulmonary Angiogram (CT PA, IV contrast enhanced) and CT Abdomen-Pelvis (CT AP, IV contrast enhanced, single phase). Median CTDIvol and DLP values for the five CT examinations from each institution were derived, with the cluster DRLs determined as the 75th percentile of the distribution of the institution median dose values. RESULTS A total of 2413 dose data points were collected over a six-month period from June to November 2020. The cluster CT DRLs for the five CT examinations were determined to be 47 mGy and 820 mGy.cm for CT Brain, 5.4 mGy and 225 mGy.cm for CT Chest, 6.7 mGy and 248 mGy.cm for CT PA, 4.6 mGy and 190 mGy.cm for CT KUB and 6.9 mGy and 349 mGy.cm for CT AP. CONCLUSION The establishment of the cluster CT DRLs provided individual institutions with a better understanding if their CT doses are unusually high or low, while emphasising that these DRLs are not meant as hard dose limits or constraints to follow strictly.
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Affiliation(s)
- L Arlany
- Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886.
| | - H G Toh
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - B Nazir
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610
| | - J J Ng
- Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886
| | - Y H Tay
- Kandang Kerbau Hospital, 100 Bukit Timah Road, Singapore 229899
| | - Y S Tay
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - C J X Poon
- Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - L N Lee
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - W K S Fum
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - E Y T Lee
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609
| | - S I Mariah
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433
| | - M V Fortier
- Kandang Kerbau Hospital, 100 Bukit Timah Road, Singapore 229899
| | - W P Tham
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - L L Chew
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610
| | - K H E Chong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609
| | - L R Chong
- Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Uushona V, Boadu M, Nyabanda R, Diagne M, Inkoom S, Issahaku S, Hasford F, Haiduwa P, Koteng A, Omondi B, Diop AY, Gilley DB. ESTABLISHMENT OF REGIONAL DIAGNOSTIC REFERENCE LEVELS IN ADULT COMPUTED TOMOGRAPHY FOR FOUR AFRICAN COUNTRIES: A PRELIMINARY SURVEY. RADIATION PROTECTION DOSIMETRY 2022; 198:414-422. [PMID: 35596952 DOI: 10.1093/rpd/ncac074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/09/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
This preliminary study aims towards the establishment of regional diagnostic reference levels (DRLs) for routine adult computed tomography (CT) examinations. The study was performed on 54 CT facilities from four African countries (Ghana, Kenya, Namibia and Senegal) and the results compared with international DRLs. Data were collected from facilities using a structured questionnaire provided by the International Atomic Energy Agency. Dose descriptors (volume computed tomography dose index [CTDIvol] and dose length product [DLP]) evaluations were performed on CT head and body phantoms for head, chest and abdomen CT examination protocols using standard methods. The estimated dose indices were compared with console-displayed dose values. Experienced radiologists accepted the diagnostic image quality of the images as per departmental imaging requirements. Median CTDIvol and DLP data from each facility were compiled to estimate the typical dose in each country. National DRLs were established based on the 75th percentile of median values, whereas the regional DRLs were based on the median of the national DRLs. Comparison of measured CTDIvol with console values of all facilities in all four countries was within 20% as recommended. The established CTDIvol DRLs for head CT, chest CT and abdomen CT were 60.9 mGy, 15.2 mGy and 15.7 mGy, respectively. Similarly, that of DLP, DRLs were 1259 mGy.cm, 544 mGy.cm and 737 mGy.cm, respectively for head CT, chest CT and abdomen CT. The established DRLs from this study were comparable to DRLs from other countries with some variations. This study would serve as baseline for establishment of a more generalized regional adult CT DRLs for Africa.
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Affiliation(s)
- Vera Uushona
- National Radiation Protection Authority of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - Mary Boadu
- Ghana Atomic Energy Commission, Accra, Ghana
| | - Rose Nyabanda
- Department of Radiology, Kenyatta National Hospital, Nairobi Kenya
| | - Magatte Diagne
- University Teaching Hospital-Senegal, Institut Curie, Hôpital Universitaire le Dantec, BP, Dakar, Senegal
| | | | | | | | - Paulus Haiduwa
- Nuclear Medicine Department, Windhoek Central Hospital, Windhoek, Namibia
| | | | - Bob Omondi
- Department of Radiology, Kenyatta National Hospital, Nairobi Kenya
| | - Adji Yaram Diop
- University Teaching Hospital-Senegal, Institut Curie, Hôpital Universitaire le Dantec, BP, Dakar, Senegal
| | - Debbie Bray Gilley
- Radiation Protection of Patients Unit, Radiation Safety and Monitoring Section, Division of Radiation, Transport and Waste Safety, Department of Nuclear Safety and Security, International Atomic Energy Agency (IAEA), Vienna International Centre, Vienna, Austria
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Kawooya MG, Kisembo HN, Remedios D, Malumba R, del Rosario Perez M, Ige T, Hasford F, Brown JK, Lette MM, Mansouri B, Salama DH, Peer F, Nyabanda R. An Africa point of view on quality and safety in imaging. Insights Imaging 2022; 13:58. [PMID: 35347470 PMCID: PMC8959275 DOI: 10.1186/s13244-022-01203-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Africa has seen an upsurge in diagnostic imaging utilization, with benefits of efficient and accurate diagnosis, but these could easily be offset by undesirable effects attributed to unjustified, unoptimized imaging and poor quality examinations. This paper aims to present Africa’s position regarding quality and safety in imaging, give reasons for the rising interest in quality and safety, define quality and safety from an African context, list drivers for quality and safety in Africa, discuss the impact of COVID-19 on quality and safety, and review Africa’s progress using the Bonn Call for Action framework while proposing a way forward for imaging quality and safety in Africa. In spite of a healthcare setting characterized by meagre financial, human and technology resources, a rapidly widening disease-burden spectrum, growing proportion of non-communicable diseases and resurgence of tropical and global infections, Africa has over the last ten years made significant strides in quality and safety for imaging. These include raising radiation-safety awareness, interest and application of evidence-based radiation safety recommendations and guidance tools, establishing facility and national diagnostic reference levels (DRLs) and strengthening end-user education and training. Major challenges are: limited human resource, low prioritization of imaging in relation to other health services, low level of integration of imaging into the entire health service delivery, insufficient awareness for radiation safety awareness, a radiation safety culture which is emerging, insufficient facilities and opportunities for education and training. Solutions to these challenges should target the entire hierarchy of health service delivery from prioritization, policy, planning, processes to procedures.
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El Mansouri M, Choukri A, Nhila O, Talbi M. Evaluation of radiation dose in lumbar spine computed tomography in a single Moroccan center. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dawd JE, Ozsahin DU, Ozsahin I. A Review of Diagnostic Reference Levels in Computed Tomography. Curr Med Imaging 2021; 18:623-632. [PMID: 34517807 DOI: 10.2174/1573405617666210913093839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022]
Abstract
Computed tomography (CT) scanning generate 3-D images of the inside structures of the body by delivering comparatively radiation dose to the patient. This requires high concern of optimization via establishing diagnostic reference level (DRL). DRL values can be estimated based on reference patient percentiles (such as 90th, 75th and 50th) dose distribution. DRL has significant uses in professional judgments by generating harmonized evidence about the radiation dose received by the patient. The primary goal of this review is to assess the practical application of DRL in CT procedures internationally. The main objective of establishing DRLs is to optimize the patient dose and without compromising the image quality in order to obtain adequate diagnostic information. That means inescapability of DRL for a country in medical diagnosis is to reduce the limitation of dose dispersion, to harmonize and expand good practice, to narrow large dispersion of doses, and to create systematic supervision for unwanted radiological doses. The review presents that international records have a wide-range of mean dose distributions due to the variation of exam protocols and technical parameters in use. Hence, this review recommends that each CT health facilities are required exercising careful dose reduction strategies by accounting adequate image quality with sufficient diagnostic information via through follow up of concerned bodies.
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Affiliation(s)
- Jemal Edris Dawd
- Radiation Research and Documentation Department, Ethiopian Radiation Protection Authority, Addis Ababa, Akaki Kality, Ethiopia.,Department of Biomedical Engineering, Near East University, Nicosia/TRNC, Mersin-10, Turkey
| | - Dilber Uzun Ozsahin
- Department of Biomedical Engineering, Near East University, Nicosia/TRNC, Mersin-10, Turkey.,DESAM Institute, Near East University, Nicosia/TRNC, Mersin-10, Turkey.,Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ilker Ozsahin
- Department of Biomedical Engineering, Near East University, Nicosia/TRNC, Mersin-10, Turkey.,DESAM Institute, Near East University, Nicosia/TRNC, Mersin-10, Turkey.,Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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