Frequency and collective dose of medical procedures in Kenya

Radiation exposure by medical X-ray applications

Background: Radioactive material and ionising radiation play a central role in medical diagnostics and therapy. The benefit of ionising radiation is opposed by the risk of irreparable damage of the human organism. This risk, especially for developing malign neoplasms, has particularly been investigated in the population surviving the atomic bombing of Hiroshima and Nagasaki, but also increasingly in persons with occupational or medical exposure to ionising radiation.

Methods: We conducted a systematic search for publications in English and German in relevant databases in March 2016. Retrievals were screened by two independent reviewers. We included examinations using imaging procedures with ionising radiation. The assessment of methodological quality was done concerning representativeness, risk of bias, and further limitations, and reporting quality was assessed using the RECORD checklist.

Results: The systematic searches identified seven cross-sectional, one register, and four cohort studies. An increase in collective effective doses analogue to the increase of computed tomography (CT) examinations could be observed. An increased risk of brain tumours in children after exposition to head CT and by an increase of the number of examinations was shown. For children with predisposing factors, an increased risk of tumours of the central nerve system, leukemia, and lymphoma was found. Furthermore, a general risk for malign neoplasms or haemoblastoma, and a specific risk for lymphoma after CT examinations of different parts of the body could be observed.

Discussion: Taking into consideration a mostly unclear representativeness of studies and an unclear or high risk of bias as well as lack of comparability due to different research questions, the validity of results is limited.

Conclusion: The risk of bias due to a large number of reference sources must be reduced in studies leading to realistic estimates of collective radiation doses. The risk of CT-induced radiation exposure for children should be investigated by further studies with a follow-up of at least ten years.

THE FREQUENCIES OF X-RAY EXAMINATIONS AND CT SCANS: FINDINGS FROM A SAMPLE INVESTIGATION IN JIANGSU, CHINA

OBJECTIVE

The present study was performed to evaluate the frequencies of two kinds of examinations using a proportional sample of 262 medical institutions and to observe the factors affecting the amount of examination-related exposure. The other aim of the present study was to observe the relationship between X-ray and CT frequency with GDP per capita, which could indicate the connection between medical exposure practice and economy.

METHODS

A random sample was taken from a pool of 316 medical institutions, and correlation analyses were performed to identify the factors affecting the amount of examination-related exposure. A representative sample of 262 medical institutions, proportional to the distribution of hospitals across grades, was used, and a multiple linear regression model was constructed.

RESULTS

The frequencies of X-ray examinations and CT scans were 523 per 1000 people and 223 per 1000 people, respectively. The two kinds of radio-diagnostic examinations showed different patterns in their relationships with GDP per capita. The factors correlated with the amounts of exposure due to the two kinds of examinations and the outpatient and equipment numbers showed distinctive patterns in the group of grade three institutions.

CONCLUSIONS

The improvement in the economy has caused a rapid increase in the use of radio-diagnostic examinations. The differences in factors correlated with the two types of examinations may stem from the workload statuses of CT scans and X-ray examinations in grade three hospitals.