Patient Radiation Dose Assessment During Fluoroscopic Procedures: A Survey To Propose Local Diagnostic Reference Levels For Selected Facilities

ABSTRACT

The primary aim of this work was to propose local diagnostic reference levels for fluoroscopic examinations in some selected radiological imaging facilities in Ghana. The work also aimed at investigating the distribution levels of patient radiation dose received during fluoroscopic examinations for subsequent improvement of optimization. Prior to the starting of this research a series of quality control tests were performed using the Piranha kit to assess the machine output. The patient data and dose descriptors collected during the work included, gender, age, Kerma-Area Product, number of images and screening time. The Diagnostic Reference Levels (DRLs) was estimated for each facility using the 75% percentile. A total of two hundred and forty nine (249) patient dose data were collected for this study. DRLs was established for the frequently performed procedures which includes, hysterosalpingogram (HSG), urethrogram and barium swallow (BaS) examinations. The DRLs for KAP and screening time values estimated for hysterosalpingography was 6.0 Gy.cm2 and 0.60 minutes, Barium swallow was 12.1 Gy.cm2 and 1.4 minutes and urethrogram studies was 7.0 Gy.cm2 and 0.7 minutes for Facility A respectively. The DRLs for KAP and screening time values estimated for hysterosalpingography was 4.1 Gy.cm2 and 0.50 minutes, Barium swallow was 11.2 Gy.cm2 and 1.2 minutes and urethrogram studies was 6.5 Gy.cm2 and 0.7 minutes for Facility B respectively. The standard errors for KAP values from the proposed DRLs for facilities A and B were found to be 0.23 and 0.22 for hysterosalpingography examination, barium swallow studies was 0.89 and 0.58 and urethrogram examination was 0.35 and 0.28 respectively. There were variation of values observed across facilities and were attributed mainly to difference in protocols and techniques used in the two facilities.

Proposed KAP DRLs for hysterosalpingography, barium swallow and urethrogram examinations for facility B was lower than facility A by factors of 1.46, 1.08 and 1.08 respectively. Due to the variations in DRL values, standardization of protocols across facilities as a means to increase optimization is recommended.