Optimizing Patient Protection During Diagnostic Procedures -Developing Diagnostic Reference Levels at the Dr George Mukhari Hospital

Abstract

Key words: Diagnostic reference levels (DRL), entrance surface dose (ESD), thermoluminescence dosimetry (TLD) Introduction: Diagnostic reference levels (DRL‟s) are defined as a dose level set for standard sized patients or standard phantoms and are not for individual exposures and individual patients and are an efficient standard for optimizing the radiation protection of patients and are practically useful for more common examinations. The International Atomic Energy Agency (IAEA) recommends entrance surface dose (ESD) as DRL‟s in diagnostic radiology and are establish using a TLD on a patient/phantom surface. Aim: To estimate entrance surface dose for different X-ray procedures. Objectives: The objective of this study is to develop the diagnostic reference levels by assessing the dose received by a patient in radiographic exposure. This was achieved using different X-ray techniques to estimate the entrance surface dose for different examinations. Method: The study was conducted at the Dr George Mukhari hospital using 5 different X-ray machines. Before the study commenced quality assurance was done on the machines. The following examinations were considered: Cervical spine (AP), cervical spine (LAT), Skull (AP), Skull (PA), Abdomen (AP), Pelvis (AP), Lumber spine (AP), Lumber spine (LAT), Chest (PA) and Chest (LAT). Thermoluminescence lithium fluoride (LiF) (TLD-100, 3.16 X 3.16 X 0.9 mm3, Harshaw) and the Rando phantom were used to estimate the ESD‟s in mGy. Three TLD‟s were mounted on the top of the phantom in the centre of X-ray beam, external to the organ/tissue being imaged. The average dose was calculated for each radiograph and for each examination. The following technique factors were recorded: tube kilovoltage, focus-to-surface distance, focus-to-film distance, time and mA. vi Results: The mean ESD‟s measured at the centre of X-ray beam on the surface of the phantom for the following examinations are: Cervical spine (AP), 2.99 (± 0.26) mGy; Cervical spine (LAT), 3.23 (± 0.34) mGy; Skull (PA), 3.50 (±0.37) mGy; Skull (LAT), 2.60 (± 0.26) mGy; Abdomen (AP), 4.18 (± 0.40) mGy; Pelvis (AP), 3.96 (± 0.33) mGy; Lumber spine (APS), 4.72 (± 0.39) mGy; Lumber spine (LAT), 8.56 (± 0.67) mGy Chest (PA), 0.72 (± 0.27) mGy and Chest (LAT), 1.03 (± 0.45) mGy. Conclusion: The results of the individual exposure and the overall results of each examination were lower than reported in the literature except for the chest (PA). The determination of patient dose and the comparison with the international DRL‟s are an important factor in the optimization process in diagnostic radiology and it is of special concern for the patient‟s protection. The baseline of diagnostic reference levels for the Dr George Mukhari hospital has been established and the results obtained could be useful for future patient dose measurements in diagnostic radiology Department at the Dr George Mukhari hospital.