International Conference held in Málaga, Spain, 26–30 March 2001 Organized by the International Atomic Energy Agency and co-sponsored by the European Commission, the Pan American Health Organization and the World Health Organization
Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy
I N T E R N A T I O N A L A T O M I C E N E R G Y A G E N C Y
Radiation Safety Section International Atomic Energy Agency
Wagramer Strasse 5 P.O. Box 100 A-1400 Vienna, Austria
RADIOLOGICAL PROTECTION OF PATIENTS IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY,
NUCLEAR MEDICINE AND RADIOTHERAPY IAEA, VIENNA, 2001
IAEA-CSP-7/P ISSN 1563–0153
© IAEA, 2001
Printed by the IAEA in Austria March 2001
An International Conference on the Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy organized by the International Atomic Energy Agency and co-sponsored by the European Commission, the Pan American Health Organization and the World Health Organization was held in Málaga, Spain, from 26 to 30 March 2001. The Government of Spain has hosted this Conference through the Ministerio de Sanidad y Consumo, the Consejo de Seguridad Nuclear, the Junta de Andalucía, the Universidad de Málaga and the Grupo de Investigación en Protección Radiológica de la Universidad de Málaga (PRUMA).
The Conference has been organized in co-operation with the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), the International Commission on Radiological Protection (ICRP) and the following professional societies: International Organization of Medical Physicists (IOMP), International Radiation Protection Association (IRPA), International Society of Radiation Oncology (ISRO), International Society of Radiology (ISR), International Society of Radiographers and Radiological Technologists (ISRRT) and World Federation of Nuclear Medicine and Biology (WFNMB).
This publication contains contributed papers submitted to the Conference Programme Committee. The papers are in one of the two working languages of this Conference, English and Spanish. The IAEA is planning to issue proceedings of this Conference containing selected presentations.
The topics covered by the Conference are as follows:
• Radiological protection of patients in general diagnostic radiology (radiography)
• Radiological protection of patients in general diagnostic radiology (fluoroscopy)
• Radiological protection issues in specific uses of diagnostic radiology, such as mammography and computed tomography (with special consideration of the impact of digital techniques)
• Radiological protection in interventional radiology, including fluoroscopy not carried out by radiologists
• Radiological protection of patients in nuclear medicine
• Developing and using dose guidance (reference) levels in radiology and nuclear medicine examinations
• Radiological protection of the embryo and foetus in pregnant patients
• Radiological protection of paediatric patients
• Radiological protection of patients in radiotherapy: external beam
• Radiological protection of patients in radiotherapy: brachytherapy
• Radiological protection of patients in biomedical research
• Influence of standardization in the design and development of medical radiological equipment on the radiological protection of patients
• Education, training and continuous professional development in the radiological protection of patients
• Topics for research and development in the radiological protection of patients
• Implementation of regulations on the radiological protection of patients
This publication has been prepared from the original material as submitted by the authors. The views expressed do not necessarily reflect those of the IAEA, the governments of the nominating Member States or the nominating organizations.
The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries.
The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA.
The authors are responsible for having obtained the necessary permission for the IAEA to reproduce, translate or use material from sources already protected by copyrights.
RADIOLOGICAL PROTECTION OF PATIENTS IN GENERAL DIAGNOSTIC RADIOLOGY (RADIOGRAPHY) (Topical Session 1a)*
Swiss nation-wide survey on radiation doses in diagnostic radiology (IAEA-CN-85-82) ... 3 A. Aroua, J.F. Valley, J.-P. Vader, B. Burnand
Evaluation of patient skin dose equivalent due to diagnostic procedures with x-rays in
Lagos State, Nigeria (IAEA-CN-85-149)... 7 M.A. Aweda
Entrance surface dose measurement for some of the radiological patients in Bangladesh
(IAEA-CN-85-193) ... 9 Z. Begum
The first trial patient dose survey in diagnostic radiology in Viet Nam (IAEA-CN-85-206)... 13 Dang Thanh Luong, Duong van Vinh, Ha Ngoc Thach, Phan Tuong Van,
Nguyen Phuong Dung, Pham Quang Dien, Nguyen Manh Phuc, Nguyen Manh Truong Radiation doses to patients in diagnostic radiology in Romania; comparison with guidance levels
and possibilities of reduction (IAEA-CN-85-5)... 17 C. Milu, A. Dumitrescu, R. Marin, F.S. Popescu
Patient’s dose assessment during sinus X-rays radiography at “Hopital du Point G”
(IAEA-CN-85-14) ... 21 S. Sidibe, B.Y. Sacko, M. Doucoure, B. Traore, I. Traore
Trends and the determination of effective doses for standard x-ray procedures
(IAEA-CN-85-29) ... 25 H.M. Johnson, C. Neduzak, J. Gallet, J. Sandeman
A project: “Radiological protection in radiology”, IAEA–Universidad Central de Venezuela
(IAEA-CN-85-33) ... 30 A.R. Díaz, G. Salazar, R. Fermín, M. González
Ionizing radiation used in medical diagnostics as a sourse of a radiation exposure of the patient with occupational diseases. Analysis and problems (IAEA-CN-85-42)... 35 D.B. Apostolova, Z.D. Paskalev
Patient’s and occupational dose exposure in roentgen examinations (IAEA-CN-85-47)... 39 L. Qafmolla, G. Shehi
Indonesia’s experience on IAEA-CRP on radiation protection in diagnostic radiology
(IAEA-CN-85-81) ... 44 Nasukha
Radiation protection of patients in general diagnostic radiology in Lithuania (IAEA-CN-85-99) ... 48 G. Morkunas, J. Ziliukas
Doses to patients from diagnostic radiology in Romania (IAEA-CN-85-105) ... 53 O. Iacob, C. Diaconescu
Some experiences from radiation protection of patients undergoing X-ray examinations
in Tanzania (IAEA-CN-85-113)... 58 J.E. Ngaile, W.E. Muhogora, A.M. Nyanda
Medical exposure in Russia (IAEA-CN-85-136) ... 64 S.A. Kalnitsky, A.B. Bazukin, M.M. Vlasova, S.I. Ivanov, E.V. Ivanov,
Y.O. Jakubovskiy-Lipsky, A.A. Gontsov
Radiation dose in radiography and methods for dose reduction (IAEA-CN-85-142)... 67 B. Yue, K. Wei, Q. Zhou, Y. Cheng, C. Hou, L. Ge, X .Qi
* For technical reasons, paper IAEA-CN-85-301 could not be included with the papers of this session, but can be found on page 909.
G. Massillon J., C. Borrás
Medical radiation exposure and usage for diagnostic radiology in Malaysia (IAEA-CN-85-209) ... 75 Kwan-Hoong Ng, Premavathy Rassiah, Hwee-Beng Wang, Ahmad Shariff Hambali,
Pirunthavany Muthuvelu, B.J.J. Abdullah, S. Sivalingam
Patient dose surveys for radiological examinations in Dutch hospitals between 1993 and 2000
(IAEA-CN-85-217) ... 79 F.M. Spoelstra, J. Geleijns, J.J. Broerse, W.M. Teeuwisse, D. Zweers
Patient doses and examination frequency for diagnostic radiology in Iceland 1993–1998
(IAEA-CN-85-263) ... 84 G. Einarsson, S.M. Magnusson
Can patient positioning using an ultrashort fluoroscopic pulse be justified? (IAEA-CN-85-91)... 89 T. Deprez, L. Schrijvers, H. Pauwels, H. Bosmans, G. Marchal
Development of an international code of practice for dosimetry in x-ray diagnostic radiology
(IAEA-CN-85-269) ... 93 F. Pernicka, G.A. Carlsson, D.R. Dance, L.A. DeWerd, H.M. Kramer, K.-H. Ng
Quality control and patient doses for x-ray examinations in some hospitals in Thailand
(IAEA-CN-85-288) ... 99 P. Plainoi, W. Diswath, N. Manatrakul
Quality control of diagnostic x-ray units (IAEA-CN-85-205) ... 104 O.T. Marinkovic, S. Milacic, D. Jovicic, I. Tanaskovic
Digital technology influence on patient dose in radiological examination of the upper
digestive apparatus (IAEA-CN-85-107)... 106 E. Núñez, X. Pifarré, J. Ruiz, C. Escalada, M.C. Paredes
Radiation protection and quality assurance in dental radiology: I. Intraoral radiography
(IAEA-CN-85-257) ... 110 Y. Martinez-Beneyto, M. Alcaraz, S. Jódar-Pórlan, A.M. Saura-Iniesta,
E. Velasco-Hidalgo
Radiation protection and quality assurance in dental radiology: II. Panoramic radiology
(IAEA-CN-85-258) ... 114 S. Jódar-Pórlan, M. Alcaraz, Y. Martinez-Beneyto, A.M. Saura-Iniesta,
E. Velasco-Hidalgo
RADIOLOGICAL PROTECTION OF PATIENTS IN GENERAL DIAGNOSTIC RADIOLOGY (FLUOROSCOPY) (Topical Session 1b)
Fluoroscopy without image intensifier (IAEA-CN-85-152) ... 121 L.V. Canevaro, G. Drexler
Evaluation of the dosimetric performance characteristic of fluoroscopy system used in
medicine (IAEA-CN-85-157)... 126 Qi Xuesong, Wei Kedao, Cheng Yuxi, Zhou Qifu, Ge Lijuan, Hou Changsong
Patient dose measurements in fluoroscopic examinations, aiming to the establishment of
reference levels in Brazil (IAEA-CN-85-93) ... 130 L.V. Canevaro, G. Drexler
Patient and staff dose during hysterosalpingography (IAEA-CN-85-73) ... 135 N. Buls, M. Osteaux
Patient dosimetry in histerosalpingography (IAEA-CN-85-94)... 139 H.J. Khoury, A. Maia, M. Oliveira, R. Kramer, G. Drexler
Dosimetric assessment of swallowing examinations with videofluoroscopy (IAEA-CN-85-67)... 143 M.M.B. Costa, L.V. Canevaro, A.C.P. Azevedo
RADIOLOGY, SUCH AS MAMMOGRAPHY AND COMPUTED TOMOGRAPHY (WITH SPECIAL CONSIDERATION OF THE IMPACT OF DIGITAL TECHNIQUES) (Topical Session 2)
Evaluation of diagnostic radiology services in five Latin American countries:
Results for mammography (IAEA-CN-85-103)... 151 M.E. Brandan, C.E.M. Caspani, R. de la Mora, A.A. Miranda, M.-C. Plazas, C. Borrás
Study about diagnostic quality in a public-center of mammography of Santa Fe – Argentina
(IAEA-CN-85-144) ... 154 R. Lescano, J. Kiguen, L. Gaitán, C. Caspani
Benefit and risk in breast screening (IAEA-CN-85-166)... 159 J. Law, K. Faulkner, F. Neilson
Quality assurance programme in mammography of the Sociedad Española de Diagnósticos
por Imagen de la Mama (SEDIM) (IAEA-CN-85-235) ... 164 B. Fernández, C. González, I. Hernando, M. Iríbar, J. A. López, R Salvador,
A. Vega, I. Vizcaíno
Image quality and patient dose optimization in mammography in Hungary (IAEA-CN-85-108) ... 169 S. Pellet, A. Motoc, F. Giczi, E. Vano, C. Maccia, M. Gödény, B. Kovács, G. Forray
A review of the role of radiation metrology in the safety of diagnostic radiology patients
(IAEA-CN-85-305) ... 174 J.G.P. Peixoto, C.E. de Almeida
Image quality and dose in mammographic images obtained in Mexico City hospitals
(IAEA-CN-85-210) ... 179 C. Ruiz-Trejo, M.-E. Brandan, M. Verdejo, A. Flores, M. Guevara, J. Martín,
L. Madero-Preciado
A comparison of two different processing chemicals for mammography: Repercussion on
dose to patients (IAEA-CN-85-171) ... 183 F. Sendra-Portero, E. Ristori-Bogajo, P. Buch-Tomé, M. Martínez-Morillo, E. Nava-Baro
Study of radiological risk in breast cancer screening programme at Comunidad Valenciana
(IAEA-CN-85-234) ... 188 J.I. Villaescosa, A. León, G. Verdú, M.D. Cuevas, M.D. Salas
Mammography quality assurance in Morocco (IAEA-CN-85-128)... 193 F. Zaoui, K. Talsmat, K. Lalaoui
Organ doses in CT of thorax: Sequential slices versus helical slices (IAEA-CN-85-201)... 198 C. Bodineau Gil, J. Macías Jaén, I. Tort Ausina, R. Ruiz-Cruces, P. Galán Montenegro,
A. Díez de los Ríos
How will the introduction of multi-slice CT affect patient doses? (IAEA-CN-85-63)... 202 W. Huda, P.J. Mergo
Dual-slice spiral scanner: doses delivered during thoracic and abdominal examinations
(IAEA-CN-85-174) ... 206 G. Marinello, M.C. Besse, N. Vasile, M.C. Anglade
Patient doses for computed tomography in Hungary (IAEA-CN-85-39)... 210 S. Pellet, L. Ballay, A. Motoc, D. Heissler, A. Temesi, F. Giczi
Radiation dose and quality control in fluoroscopy and computed tomography scanning
(IAEA-CN-85-141) ... 214 K. Wei, B. Yue, Q. Zhou, Y. Cheng, C. Hou, L. Ge, X. Qi
Patient doses from computed tomography in northeast region of Ukraine (IAEA-CN-85-116) ... 219 N. Pylypenko, V. Kornyeyeva, H. Gur
Use of the EC quality criteria as a common method of inspecting CT laboratories —
A pilot project by the Nordic radiation protection authorities (IAEA-CN-85-175) ... 223 C.G. Torp, H.M. Olerud, G. Einarsson, P. Grøn, W. Leitz, A. Servomaa
V. Tsapaki, E. Kyrozi, T. Syrigou, I. Mastorakou, S. Kottou
Radiation protection of patients during CT fluoroscopy (IAEA-CN-85-10) ... 233 J.E. Aldrich, B.B. Forster
RADIOLOGICAL PROTECTION IN INTERVENTIONAL RADIOLOGY, INCLUDING FLUOROSCOPY NOT CARRIED OUT BY RADIOLOGISTS (Topical Session 3)
Patient dose in interventional radiology (IAEA-CN-85-85-190) ... 239 M. Fernández Bordes, R. Berenguer, P. Gómez, M.J. Béjar, S. González
Patient doses in interventional cardiology (IAEA-CN-85-200) ... 244 F. Carrera, C. Ojeda,A. Sánchez,I. Tort,R. Ruiz-Cruces,J. Francisco Díaz
Radiation risk evaluation and reference doses in interventional radiology (IAEA-CN-85-76) ... 250 K. Faulkner, E. Vano, R. Padovani, J. Zoetelief
An assessment of methods for monitoring entrance surface dose in fluoroscopically guided
interventional procedures (IAEA-CN-85-61) ... 254 J.C. Waite, M. Fitzgerald
Radiation dose during angiographic procedures (IAEA-CN-85-85-69) ... 259 Ch. Lavoie, P. Rasuli
Radiological protection in interventional cardiology in Chile (IAEA-CN-85-80) ... 263 A. Ramírez, E. Vañó, F.A. Leyton, C. Oyarzún, J. Gamarra, E. Farias, A.M. Silva, P. Ortiz
Absorbed doses to patients from angioradiology (IAEA-CN-85-111) ... 267 R.Rodríguez-Romero, F. Díaz-Romero, J. Hernández-Armas
Investigation of radiation skin dose in interventional cardiology (IAEA-CN-85-71) ... 272 C.M. Webster, D. Hayes, J. Horrocks
Patient doses in digital cardiac imaging (IAEA-CN-85-64) ... 277 W. Huda, K. Phadke, K. M. Ogden, M.L. Roskopf
Radiation doses to patients in haemodynamic procedures(IAEA-CN-85-110) ... 281 B. Cañadillas-Perdomo, C.Pérez-Martín, A.Catalán-Acosta, D.de Armas-Trujillo,
J. Hernández-Armas
Comparison between thermoluminiscence dosimetry and transmission ionization
chamber measurements (IAEA-CN-85-177)... 286 I. Hernando, R. Torres
Radiofrequency catheter ablation: relationship between fluoroscopic time and skin doses according to diagnoses. Basis to establish a quality assurance programme
(IAEA-CN-85-168) ... 291 E. Cotelo, J. Pouso, W. Reyes
Estimation of skin dose in interventional neuro and cardiac procedures (IAEA-CN-85-62) ... 297 P.J. Marsden, Y. Washington, J. Diskin
Patient radiation doses from neuroradiology procedures (IAEA-CN-85-112) ... 301 M.J.García-Román, E.Prada-Martínez, J.Abreu-Luis, J.Hernández-Armas
Radiation doses in interventional neuroradiology (IAEA-CN-85-68) ... 306 C. Theodorakou, P. Butler, J.A. Horrocks
Radiation injury of the skin following diagnostic and interventional fluoroscopic procedures
(IAEA-CN-85-38) ... 312 T.R. Koenig, L.K. Wagner, F.A. Mettler
Iodine visibility in coronary angiography using copper filtration(IAEA-CN-85-78) ... 317 A.T. Rogers, M.E. Holloway
The use of constancy checks to optimise patient dose in interventional radiology systems
(IAEA-CN-85-196) ... 320 E. Vaño, J.M. Fernandez, L. Lopez, J.I. Ten, L. Gonzalez, E. Guibelalde
Organ doses in interventional radiology procedures: Evaluation of software (IAEA-CN-85-226).... 325 I. Tort, R. Ruiz-Cruces, M. Pérez-Martínez, F. Carrera, C. Ojeda, A. Díez de los Ríos
Doses to patients and staff from endovascular treatment of abdominal aortic aneurysms –
preliminary results (IAEA-CN-85-129) ... 332 E.G. Bjørklund, A. Widmark, T. Gjølberg, D. Bay, J.J. Jørgensen , L.E. Staxrud
Optimisation of patient and staff exposure in interventional cardiology (IAEA-CN-85-147) ... 338 R. Padovani, M.R. Malisan, G. Bernardi, E. Vaño, V. Neofotistou
Occupational exposures from selected interventional radiological procedures (IAEA-CN-85-51) ... 343 J. Janeczek, A. Beal, D. James
A study on the annual equivalent doses received by cardiologists in a UK hospital
(IAEA-CN-85-72) ... 347 R.Y.L. Fong, E. Ryan, S. Alonso-Arrizabalaga
Staff dosimetry and risk assessment during digestive and angiographic examinations
(IAEA-CN-85-49) ... 352 J. Pages, M. Osteaux
RADIOLOGICAL PROTECTION OF PATIENTS IN NUCLEAR MEDICINE (Topical Session 4)
Doses of ionising radiation received by patients diagnosed at the Nuclear Medicine
Department in Warsaw from 1985 to 1999 (IAEA-CN-85-86) ... 359 J.Chaœ, M. Marciniak, E. Dziuk, M.K. Janiak
Doses from nuclear medicine examinations: A 25-year follow-up study (IAEA-CN-85-114)... 365 K.J.A. Kairemo, H. Korpela
General comments on radiological patient protection in nuclear medicine (IAEA-CN-85-183) ... 369 M. Téllez de Cepeda, R. Plaza, E. Corredoira, L.M. Martín Curto
Patient dose assessment in different diagnostic procedures in nuclear medicine
(IAEA-CN-85-192) ... 374 E. de Sena, M.J. Béjar, R. Ruano, R. Berenguer, P. Tamayo
Radiation protection of thyroid cancer patients receiving I-131 therapy: Some considerations
(IAEA-CN-85-202) ... 379 S. Kottou, D. Papadimitriou, M. Molfetas, A. Samartzis, P. Mavrokephalos, A. Perris,
C.C. Alevizaki
Current trends on internal dosimetry for patient protection in nuclear medicine
(IAEA-CN-85-219) ... 383 A.M. Rojo, P.A. Gisone, J.J. Kunst
Internal radiation dosimetry, pharmacokinetics and biodistribution of the 99mTc labeled
IOR egf/r3 monoclonal antibody (IAEA-CN-85-254) ... 387 L.A. Torres, A. Perera, M. Ramos, A. Hernández, N. Iznaga, M.E. Solano, I. Alvarez,
J.L. Rodríguez
A protocol to determinate the situation of nuclear medicine in Venezuela, 1999–2000
(IAEA-CN-85-267) ... 392 L. Carrizales, G. Leandro
Parameter estimation and compartmental modelling for individualization of therapeutic
dosage of radiopharmaceuticals (IAEA-CN-85-164)... 397 A. Giussani, C. Cantone
DEVELOPING AND USING DOSE GUIDANCE (REFERENCE) LEVELS IN RADIOLOGY AND NUCLEAR MEDICINE EXAMINATIONS (Topical Session 5) Practical implementation of the medical exposure directive (97/43) in Luxembourg with
special reference to diagnostic reference levels (IAEA-CN-85-53) ... 403 A. Schreiner-Karoussou, C. Back, N. Harpes, F. Shannoun
Diagnostic radiography dose and guidance levels (IAEA-CN-85-176) ... 411 M. Cuadros, A. Augusto
Results of the study of entrance surface dose from conventional examinations in
diagnostic radiology (IAEA-CN-85-281)... 414 A. Martínez, L. Jova, R. de la Mora, C. Guevara, I. Fleitas, J. Carrazana, E. Díaz
A trial to establish diagnostic reference levels for radiological examinations in Greece
(IAEA-CN-85-95) ... 419 E. Papageorgiou, P. Dimitriou, E. Vardalaki, C.J. Hourdakis, L. Vlahos
Patient exposures from diagnostic radiological procedures in India (IAEA-CN-85-21) ... 424 J.B. Sasane, S.G. Sawant, V.K. Shirva, P.K. Dash Sharma, K. Chhokra, V. Jayalakshmi,
K.N. Govindarajan, R.N. Kulkarni, K.S. Parthasarathy , A.S. Pradhan, B.C. Bhatt Need for harmonisation in the establishment and use of reference dose levels in radiology
(IAEA-CN-85-15) ... 429 J. Zoetelief
Patient dose surveys and the use of local and national diagnostic reference levels
(IAEA-CN-85-248) ... 434 M.L. Ramsdale, D. Peet, P. Hollaway, A. Rust
An approach to local diagnostic reference levels (DRL’s) in the context of national and
international DRL’s (IAEA-CN-85-77) ... 440 A.T. Rogers
Dimond: A European approach to establish and use reference levels in fluoroscopy guided
Procedures (IAEA-CN-85-194) ... 444 E. Vano, K. Faulkner, R. Padovani, J. Zoetelief, M. Toivonen, V. Neofotistou
Reference dosimetry for CT in the UK (IAEA-CN-85-57)... 449 P.C. Shrimpton, B.F. Wall
The establishment and use of dose reference levels in general paediatric radiology
(IAEA-CN-85-59) ... 453 P.J. Marsden, J. Hardwick, C. Mencik, C. McLaren, C. Young, P. Mashford
Introduction of guidance dose levels in paediatrics CT (IAEA-CN-85-139)... 458 F.R. Verdun, M. Bernasconi, P. Schnyder, J.F. Valley, F. Gudinchet
Implementation of diagnostic reference levels for X-ray examinations in the UK
(IAEA-CN-85-55) ... 462 B.F. Wall
Diagnostic reference activities for nuclear medicine in Australia and New Zealand
(IAEA-CN-85-259) ... 466 J.E. Towson, R.C. Smart
Nuclear medicine and its radiological protection in China (IAEA-CN-85-28) ... 472 J. Wu
Preliminary results of the analysis of the administered activities in diagnostic studies of
nuclear medicine (IAEA-CN-85-280)... 475 G. López Bejerano, L.J. Sed
Administered activity and estimated radiation doses from nuclear medicine diagnostic
procedures to the Israeli population (IAEA-CN-85-65)... 479 J. Weininger, A.B. Shlomo, J.K.Y. Shamai, T. Schlesinger
Development of diagnostic reference levels in paediatric radiology (IAEA-CN-85-56)... 483 D. Hart, B.F. Wall
RADIOLOGICAL PROTECTION OF THE EMBRYO AND FOETUS IN PREGNANT PATIENTS (Topical Session 6)
Ten years investigation on radiological exposures to the embryo and fetus in pregnant women
of Iran (IAEA-CN-85-66)... 491 A. Arbabi
Programme for reducing the risk factors due to prenatal exposure (IAEA-CN-85-182) ... 499 L. Arranz, N. Ferrer, J.M. Sastre
Unjustified prenatal radiation exposure in medical applications (IAEA-CN-85-121) ... 503 J. Cárdenas Herrera, G. López Bejerano, A.I. Lamadrid, O. García Lima,
E. Díaz Bernal, V. Freixas, R. Sánchez
Radiation during pregnancy (IAEA-CN-85-75)... 507 K. Faulkner, J.F. Malone, R.H. Corbett, P. Craven, E.K. Osei
Experimental determination of fetal doses received during conventional X rays explorations of
Troncus. Influence of the lead apron (IAEA-CN-85-236) ... 512 X. Pifarré, L. Brualla, J. Ruiz, C. Escalada, D. Planes, M.C. Paredes
The software program Peridose to calculate the fetal dose or dose to other critical structures
outside the target area in radiation therapy (IAEA-CN-85-009)... 516 P.H. van der Giessen
Dose to the uterus from radiotherapy procedures for breast carcinoma (IAEA-CN-85-232)... 522 C. Martín Rincón, I. Jerez Sainz, I. Modolell Farré, M.L. España López, P. López Franco
Patient and fetal dose in diagnostic x-rays and radiotherapy in Bangkok, Thailand
(IAEA-CN-85-026) ... 527 J. Pataramontree, S. Wangsuphachar, J. Apaiphonlacharn, P. Chaichan, S. Sompradit,
K. Suteerakul, W. Thamwerawong
RADIOLOGICAL PROTECTION OF PAEDIATRIC PATIENTS (Topical Session 7)
The development of standard operating protocols for paediatric radiology (IAEA-CN-85-58)... 535 P.J. Marsden, C. Mencik, C. McLaren, C. Young, S. Scadden, P. Mashford,
K. McHugh, M. Beckett, M Calvert, J. Hardwick
Radiation doses to neonates and issues of radiation protection in a special care baby unit
(IAEA-CN-85-52) ... 539 C.I. Armpilia, I.A.J. Fife, P.L. Croasdale
Evaluation of the radiation dose in a paediatric x-ray department (IAEA-CN-85-41) ... 544 P.A. Kaplanis, S. Christofides, G. Christodoulides, K. Aristidou
Radiation exposure of children during radiodiagnostic examinations of chest in Slovakia
(IAEA-CN-85-207) ... 548 M. Horváthová, D. Nikodemová
Radiation detriment ascribable to infants and children undergoing micturating cystourethrograms — A review of studies in Spain, Britain, New Zealand and
Venezuela (IAEA-CN-85-172) ... 552 D.L. Evans, M.C. Canete
RADIOLOGICAL PROTECTION OF PATIENTS IN RADIOTHERAPY:
EXTERNAL BEAM (Topical Session 8a)
Radiological protection of the radiotherapy patient? (IAEA-CN-85-153) ... 561 M.P.R. Waligórski, J. Lesiak
High dose and low dose radiation exposure in the induction of breast cancer
(IAEA-CN-85-17) ... 564 E. Fernandez-Vicioso, R. Ruiz-Cruces, J.M. Pastor Vega
A computer tool for daily application of the linear quadratic model (IAEA-CN-85-181) ... 570 J. Macías Jaén, P. Galán Montenegro, C. Bodineau Gil, A. Wals Zurita, A. M. Serradilla Gil Tolerance of the different structures of the eye to therapeutic ionizing radiation
(IAEA-CN-85-197) ... 574 E. Fernandez-Vicioso, R. Ruiz-Cruces, K. Faulkner
M. Vilches, D. Guirado
Palliative radiation therapy for overloading radiotherapy centre, especially for developing
country (IAEA-CN-85-46) ... 586 M. Myo, Susworo, T. San
Dose distribution over the radiation field and organs of the body during radiotherapy
procedures (IAEA-CN-85-36)... 589 S. Roy, A.S.M. Ambia, S. Akhter, H. Banu, M. Begum
Peripheral dose in photon beams from a linear accelerator with a multileaf collimator
(IAEA-CN-85-97) ... 592 R. Lope Lope, F.Lozano Flores, J. Gracia Sorrosal, J.A. Font Gómez, A. Hernández Vitoria
Patient dose from photoneutrons in a 18 MV linac (IAEA-CN-85-251) ... 596 R. Barquero, R. Méndez, M.P. Iñiguez
Shielding for radiation scattered dose distribution to the outside fields in patients treated with
high energy radiotherapy beams (IAEA-CN-85-70) ... 601 Sung Sil Chu
Neutron dose to patients treated with high-energy medical accelerators (IAEA-CN-85-8) ... 605 P.H. McGinley
Radiological protection considerations during the treatment of glioblastoma patients by boron neutron capture therapy at the high flux reactor in Petten, the Netherlands
(IAEA-CN-85-298) ... 609 R.L. Moss, J.Rassow, E. Finke, F. Stecher-Rasmussen, W. Sauerwein
Quality control in radiotherapy treatment: Radiation induced myelopathy (IAEA-CN-85-255) ... 614 E. Fernández-Vicioso, R. Ruiz-Cruces
Quality assurance in radiotherapy (IAEA-CN-85-223) ... 618 S. Groth, A. Meghzifene, H. Tatsuzaki, V. Levin, J. Izewska
The estro-equal results for photon and electron beams checks in European radiotherapy beams
(IAEA-CN-85-48) ... 625 H. Ferreira, A. Dutreix, A. Bridier, D. Marre, J. Chavaudra, H. Svensson
Standard operating procedures for quality audits of 60Co external beam radiotherapy facilities
(IAEA-CN-85-120) ... 630 E.F. Larrinaga Cortina, L. Domínguez Hung, R. Campa Menéndez
Preliminary results of a national quality audit programme in radiotherapy services in Cuba
(IAEA-CN-85-247) ... 635 L. Domínguez Hung, E.F. Larrinaga Cortina, R. Campa Menéndez, J.L. Morales López,
A.F. García Yip
Error prevention in radiotherapy treatments using a record and verify system (IAEA-CN-85-170).. 640 S. Navarrete Campos, A. Hernández Vitoria, M. Canellas Anoz, E. Millán Cebrián,
A. García Romero
Manual cross check of computed dose times for motorised wedged fields (IAEA-CN-85-79)... 644 J. Porte
Quality assurance of the treatments performed with a linear accelerator by means of in vivo
dosimetry (IAEA-CN-85-239) ... 647 N. Jornet, M. Ribas, T. Eudaldo, P. Carrasco
IAEA Radiation Events Database (RADEV) (IAEA-CN-85-268) ... 652 J. Wheatley, P. Ortiz-Lopez
Methodology for the application of probabilistic safety assessment techniques (PSA) to the
cobalt-therapy units in Cuba (IAEA-CN-85-165)... 656 J.J. Vilaragut Llanes, R. Ferro Fernández, M. Troncoso Fleitas, B. Lozano Lima,
A. De la Fuente Puch, Y. Pérez Reyes, C. Duménigo González
Normal tissue damage in radiotherapy development of a clinical audit tool (IAEA-CN-85-265) ... 662 A. Barrett
BRACHYTHERAPY (Topical Session 8b)
Accurate assessment of the distortions produced by the transit dose in HDR brachytherapy
(IAEA-CN-85-06) ... 669 E.K. Nani, A.W.K. Kyere, K. Tetteh
Methodology for comprehensive patient, worker and public radiation protection
considerations while introducing new medical procedures (IAEA-CN-85-22)... 674 E. Neeman, M. Keren
Radiation safety program in a high dose rate brachytherapy facility (IAEA-CN-85-12) ... 678 L. V. Rodriguez, R.C. Solis, T.M. Hermoso
Radiation protection of patients in epiescleral brachytherapy (IAEA-CN-85-180) ... 682 J.M. de Frutos, G. Sánchez, J.R. Sendón, A. del Castillo, I. Hernando
Estimation of the transit dose component in high dose rate brachytherapy
(IAEA-CN-85-173) ... 687 A. García Romero, E. Millán Cebrián, F.J. Lozano Flores, R. Lope Lope,
M. Canellas Anoz
Patient dosimetry in intravascular radiation therapy (IAEA-CN-85-85) ... 691 S. Van de Putte, Y Taeymans, H. Thierens
Design and implementation of an intravascular brachytherapy installation in cardiology
(IAEA-CN-85-195) ... 696 C. Prieto, E. Vano, M. Sabate, J.M. Fernandez, Y.C. Galvan
Radiation risk to patient from intracoronary brachytherapy (IAEA-CN-85-127)... 701 A Hefner, C Kirisits, D. Georg, R Pötter
RADIOLOGICAL PROTECTION OF PATIENTS IN BIOMEDICAL RESEARCH (Topical Session 9)
No contributed papers have been received for this session
INFLUENCE OF STANDARDIZATION IN THE DESIGN AND
DEVELOPMENT OF MEDICAL RADIOLOGICAL EQUIPMENT ON THE RADIOLOGICAL PROTECTION OF PATIENTS (Topical Session 10)
Initial evaluation of a full breast digital system (IAEA-CN-85-233)... 709 E. Vañó, M. Chevalier, P. Morán, J.M. Fernández, T. Cepeda, A. Fabra,
C.S. Alvarez Pedrosa
Experimental determination of blurring in x-ray fluoroscopy last image hold due to patient
movement and its repercussion to patient doses (IAEA-CN-85-167)... 714 E. Guibelalde, E.Vañó, J.M. Fernández, L. González, J. Alberdi, A. Molinero
The Danube hospital project for automated transcription of X ray dose data from radiography, fluoroscopy and computed tomography (CT) into the electronic patient record
(IAEA-CN-85-246) ... 719 G. Pärtan, R. Mayrhofer, H. Mosser, A. Maltsidis, Th. Dechant, W. Honsal, W. Hruby
Dimond II: Measures for optimising radiological information content and dose in digital
imaging(IAEA-CN-85-261) ... 722 A. Dowling, J. Malone, D. Marsh
Implementation of “early alert system” area detector at patient from entrance in
afterloading brachytherapy (IAEA-CN-85-237) ... 726 R. Videla Valdebenito
IN THE RADIOLOGICAL PROTECTION OF PATIENTS (Topical Session 11) The new system of education and training of medical staff in radiation protection in Albania
(IAEA-CN-85-92) ... 735 B. Grillo, K. Preza, V. Titka, G. Shehi
Education and training of the radiation protection in the Spanish schools of medicine
(IAEA-CN-85-198) ... 739 R. Ruiz-Cruces, M.T. Delgado Macias, J.H. Armas, E. Vañó Carruana,
A. Diez de los Ríos, M. Martínez Morillo
The changing role of the radiographer under IR(ME)R 2000 (IAEA-CN-85-50) ... 743 S. Barlow
The education and training of professionals. The perspective of the Spanish Society of
Medical Physics (SEFM)(IAEA-CN-85-214)... 746 T. Eudaldo, E. Millán, M.C. Paredes, E. Vañó, F. Peinado, C. Nuñez de Villavicencio,
J.C. Mateos, J.J. Peña
Medical Radiation Physics Training Emerald (IAEA-CN-85-146) ... 750 S. Tabakov, C. Roberts, I.L. Lamm, F. Milano, C. Lewis, D. Smith, A. Litchev, B.A. Jonsson, M. Ljungberg, S.E. Strand, L. Jonsson, L. Riccardi, A. Benini, G. da Silva, N. Teixeira, A. Pascoal, A. Noel, P. Smith, L. Musilek, N. Sheahan
Education, training and continuing professional development for the medical physicist —
The EFOMP view in relation to EC Council directives (IAEA-CN-85-178) ... 755 I.L. Lamm
An interactive Web-based radiation protection course in fluoroscopy (IAEA-CN-85-11) ... 760 J. Aldrich
Patient dose optimisation in cardiology during fluoroscopy examinations (IAEA-CN-85-138)... 764 F.R. Verdun, S. Wicky, M. Narbel, P. Schnyder, J.F. Valley
CD-ROM training course in quality assurance in diagnostic imaging (IAEA-CN-85-156) ... 768 H.J. Khoury, P. Machado, G. Drexler
The reduction in DAP values possible with operator education and additional filtration in a
cardiac catheterisation laboratory (IAEA-CN-85-98)... 771 H.M. Warren-Forward, L. Duggan
Education for radiological protection in radiotherapy. ESTRO recommendations for
EU Euratom guidelines (IAEA-CN-85-266)... 776 A. McKenzie, A. Barrett
How changes in a radiologist’s technique can reduce patient dose in barium enema studies
(IAEA-CN-85-34) ... 780 R.H. Corbett
Using the BERT concept to promote public understanding of radiation (IAEA-CN-85-2)... 784 Kwan-Hoong Ng, J.R. Cameron
Communicating risks and benefits of medical exposures to patients (IAEA-CN-85-54) ... 788 B.F. Wall
TOPICS FOR RESEARCH AND DEVELOPMENT IN THE RADIOLOGICAL PROTECTION OF PATIENTS (Topical Session 12)
Drug interaction with radiopharmaceuticals and the importance for the radiation dose
to the patient (IAEA-CN-85-130) ... 795 D.M.M. Mattos, M.L. Gomes, R.S. Freitas, V.N. Cardoso, M. Bernardo-Filho
Protective effects of several plant polyphenols against chromosomal damage induced in vivo
by X-rays. Comparative study versus diosmin and rutin (IAEA-CN-85-154)... 799 M. Alcaraz, B. Rosa, J. Castillo, O. Benavente-García, J. Lorente, V. Vicente, M. Canteras
Cytokinesis block micronucleus in human lymphocytes: Effect of low dose radiation in
vascular radiology (IAEA-CN-85-256)... 803 M. Alcaraz, B. Rosa,J.L. Navarro,M.J. Dato, C. Acevedo, M. Canteras
OF PATIENTS (Topical Session 13)
Radiation protection in hospitals of Ecuatorial Guinea(IAEA-CN-85-25)... 809 P. Rabat Macambo
Strategic management of radiation protection programme in the Ministry of Health Malaysia — An approach based on MS ISO 9000 quality management system (IAEA-CN-85-124) ... 812 H.B. Wang
New perspective for radiation protection in diagnostic procedure in Paraguay
(IAEA-CN-85-90) ... 817 R.A. Sosky, M. Gamarra
Radiation protection infrastructure in the Republic of Croatia (IAEA-CN-85-44) ... 821 S. Grgic
Medical management of radiation safety and radiological protection of patients in Armenia
(IAEA-CN-85-40) ... 826 N.M. Hovhannisyan
Contribution of the ARCAL XX/IAEA project to improvement of radiation safety in medical
practices (IAEA-CN-85-148) ... 828 E. Medina Gironzini
Implementation of ICRP-60, BBS-115 and the patient directives in radiation safety regulations
of Taek (IAEA-CN-85-83) ... 833 H.B. Okyar, M. Vural
Protection of patients in the first radiotherapy standard in Peru (IAEA-CN-85-250) ... 838 R. Ramírez Quijada
The justification of a medical exposure — Who does it? (IAEA-CN-85-60) ... 842 P.J. Marsden, J. Hardwick, K. McHugh
The patient's radiological protection in medical practices: Legal support in the
Cuban legislation (IAEA-CN-85-306) ... 847 I.A. González, M. Durán Delgado
Radiation protection of patients in diagnostic radiology in Estonia (IAEA-CN-85-74)... 851 I. Filippova
Radiological procedures: Quality criteria and dose optimisation: French status
(IAEA-CN-85-211) ... 855 Ph. Grenier, M. Bourguignon, E. Marshall-Depommier, H. Beauvais-March,
M. Valero, J.F. Lacronique, G. Frijal
Ethical and legal aspects of medical exposure to ionizing radiation in the Netherlands
in the year 2000 (IAEA-CN-85-218) ... 859 J. Rijlaarsdam
Consequences and problems which arose from the application of the Spanish laws about quality criteria in radiodiagnostic, nuclear medicine and radiotherapy from the point of view of
radiophysicists (IAEA-CN-85-117) ... 864 A. Hernández Vitoria, B. Fernández González, J. Martí Climent, J. Pérez Calatayud
Evaluation of the radiological protection in several departments of nuclear medicine
(IAEA-CN-85-279) ... 868 G. López Bejerano, L. Jova Sed
Radiotherapy practice in an unregulated environment: Call for joint action (IAEA-CN-85-283) ... 873 Sh. Elegba
Quality systems for radiotherapy: Impact by a central authority for improved accuracy, safety
and accident prevention (IAEA-CN-85-115) ... 878 H. Järvinen, P. Sipilä, R. Parkkinen, A. Kosunen, I. Jokelainen
Guidelines for the design of the working rules of the guarantee and quality control
in radiotherapy commission (IAEA-CN-85-272)... 883 J. Pardo, M.A. Galmés, J. Font, J. Caro, J. Serra, F. Mata, S. Bertán, A. Biete,
J.A. Carceller, R. Escó, A. Palacios, C. Veiras, M.G. Vazquez
Radiotherapy procedures quality control program: Guidelines established by the Spanish
Society of Radiotherapy and Oncology (IAEA-CN-85-273) ... 892 A. Palacios, J. Pardo, A. Valls, I. Petschen, A. Castell, A. Villar, B.A. Pedro Olivé,
V. Muñoz, J. Fernández, R. Rodríguez, C. Otón
Final report from the Spanish Society of Radiotherapy and Oncology Infrastructures Commission about department standards recommendable in radiation oncology (IAEA-CN-85-274)... 897 R. Escó, J. Pardo, A. Palacios, A. Biete, J. Fernández, A. Valls,
L. Herrazquin, P. Román, R. Magallón
Health regulations about radiation oncology in Spain: The legislative dilemma between
radiation protection and treatment of cancer (IAEA-CN-85-275) ... 902 R. Escó, A. Biete, J. Pardo, J.A. Carceller, C. Veiras, A. Palacios, M.G. Vazquez
Radiation protection problems in the practice of radiotherapy in Nigeria (IAEA-CN-85-284) ... 905 K.K. Ketiku, O.T. Oladeji
Radiological protection in medicine: Current problems in Indonesia (IAEA-CN-85-45) ... 908 E. Hiswara
Study on patient dose in diagnostic radiolgy in Japan: Investigation of entrance surface dose
of patient using direct measurement by TLD (IAEA-CN-85-301) ... 913 S. Iwanami, T. Ishiguchi, T. Ishigaki, S. Koga
Topical Session 1a
RADIOLOGICAL PROTECTION OF PATIENTS IN GENERAL DIAGNOSTIC RADIOLOGY
(RADIOGRAPHY)
.
SWISS NATION-WIDE SURVEY ON RADIATION DOSES IN DIAGNOSTIC RADIOLOGY
A. Aroua, J.F. Valley
Institut de Radiophysique Appliquée, Lausanne, Switzerland
J.-P. Vader, B. BurnandInstitut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland
Abstract
A nation-wide survey on radiation doses in diagnostic radiology was conducted in Switzerland in 1998-1999.
More than 250 types of examinations were considered, covering conventional and interventional radiology, angiography, CT, mammography, osteodensitometry, conventional tomography and dental radiology. This survey aimed at establishing the collective radiological impact of radiodiagnostics on the Swiss population. The methodology of the survey is described. The examnination frequencies and integral dosimetric results associated with diagnostic radiology in Switzerland are presented.
1. Introduction
At the international level there is a great interest for establishing the radiation doses due to medical exposure. This is due to the fact that medical exposure is the highest source of artificial irradiation. During the last two decades many national surveys of the frequencies and doses associated with medical examinations have been reported in the litterature. A comparative work regarding these surveys is published regularly by UNSCEAR (1).
Switzerland has a long tradition in surveying the medical exposure that started in the late 50s (2-5); the present work being the continuation of the previous studies. The aim of this work is to determine the collective radiological impact of radiodiagnostics on the Swiss population, to gather enough data in order to issue recommendations aiming at patient dose reduction and to set a comprehensive framework for future studies.
2. Material and methods
The methodology of the study is outlined in the diagram shown in figure 1. The frequential and dosimetric aspects were handled separately.
Concerning the dosimetric issue no measurements were performed. Rather, a standard technique was established for each type of examination (technical parameters, projections considered, number of films or CT slices, duration of fluoroscopy, etc.). After the validation of the technique, the dose indices (ESD, DAP) were modelled based on the conditions of the examination. The organ and tissue equivalent doses were then established using appropriate conversion factors. To this purpose, the programs ODS60 (6) and CTDOSE (7) were used for radiography/fluoroscopy and CT examinations respectively.
The second part of the study consisted in surveying the frequency of examinations in all the establishments who prescribe and perform radiological examinations in Switzerland:
hospitals, practitioners and other institutions (school, penitentiary and military medicine, etc.).
An information on the patient's age and gender and on the indication of the examination
(affection of the patient, aim of the examination, sevrity of the case) was collected, whenever
possible.
A convolution of the frequency and the dosimetric results was then performed, taking into account for each examination the patient's age and gender profiles, the film-screen sensitivity profiles and the corpulence profiles. For the age correction different models were used.
R a d i o l o g i c a l r i s k m o d e l
O r g a n d o s e s
I n d i v i d u a l i m p a c t D o s e i n d i c e s
V a l i d a t i o n s u r v e y
F r e q u e n c y s u r v e y E x a m i n a t i o n ' s
p a r a m e t e r s
C o l l e c t i v e i m p a c t D o s i m e t r i c mo d e l
C o n v e r s i o n f a c t o r s
A n n u a l n u mb e r i n S w i t z e r l a n d M e a n n u mb e r o f e x a m i n a t i o n s p e r e s t a b l i s h m e n t
P r o j e c t i o n m o d e l
A g e a n d g e n d e r p r o f i l e s
Figure 1 Methodology of the study
3. Results
The survey revealed that the total annual number of examinations (all types together) in Switzerland is about 9.5 millions (1.34 per inhabitant) and that the collective dose is 7100 Sv, corresponding to a mean annual effective dose of 1.0 mSv per inhabitant.
Table 1 presents the distribution of the annual number of examinations and the collective dose with the different categories of examinations. In terms of the number of examinations, the radiography and dental radiology have the highest contributions to the total number (47% and 42% respectively). The other modalities represent together 11% of the total. In terms of dose, radiography, tomodensitometry and conventional fluoroscopy have the highest contribution to the collective dose (42%, 28% and 17% respectively). The other modalities represent 13% of the collective dose.
Table 1. Annual number of examinations and collective dose in mSv (rounded values) per category of examinations
Category Annual number
Fraction (%)
Collective dose
Fraction (%) Radiography 4'500'000 47 3'000'000 42.2 Dental radiology 4'000'000 42 70'000 1.0 CT (tomodensitometry) 300'000 3.2 2'000'000 28.1 Mammography 200'000 2.1 40'000 0.6 Radiography and fluoroscopy : non-angio 150'000 1.6 1'200'000 16.9 Radiography and fluoroscopy : angiography 70'000 0.7 500'000 7.0 Radiography and fluoroscopy : interventional 30'000 0.3 250'000 3.5 Osteodensitometry 30'000 0.3 40 0.0 Conventional tomography 10'000 0.1 50'000 0.7
Total 9'500'000 100 7'100'000 100
Table 2 presents the distribution of the annual number of examinations and the collective dose with the different categories of establishments. In terms of the annual number of examinations, the dentists are on top position with 42% of the total, followed by the hospitals with 31% and the general practitioners with 16%. The other categories contribute together for 11%. In terms of the collective dose, the hospitals alone contribute for about 73%. The general practitioners contribute for almost 10% and the radiologists for almost 7%. The contribution of the other categories all together is about 10%.
Table 2. Annual number of examinations and collective dose in mSv (rounded values) per category of establishments
Category Annual number
Fraction (%) Collective dose
Fraction (%)
General and internal medicine 1'500'000 15.8 670'000 9.4 Radiology 250'000 2.6 480'000 6.7 Small hospitals (< 500 beds) 2'000'000 21.1 3'300'000 46.2 Large hospitals (> 500 beds) 950'000 10.0 1'900'000 26.6 Dental medicine 4'000'000 42.1 70'000 1.0 Chiropractic 60'000 0.6 140'000 2.0 Others 700'000 7.4 580'000 8.1
Total 9'500'000 100 7'100'000 100
The distribution of the collective dose with the age of the patient is given in figure 2. The distribution peaks at age 65. If a correction for the age of the patient is performed according to an appropriate risk model we obtain a reduced mean annual effective dose of about 0.6 mSv per inhabitant.
0 2 4 6 8 10
< 1 1 - 4 5 - 910 - 14 15 - 19 20 - 24 25 - 29
30 - 34 35 - 39 40 - 44
45 - 49 50 - 54 55 - 59
60 - 64 65 - 69 70 - 74 75 - 79 80 - 84
85 - 89 90 - 94 > 95
Age Group
Fraction of the Dose (%)
Figure 2 Distribution of the collective dose with the age of the patient
4. Conclusion
The present survey allowed the establishment of an accurate picture regarding the exposure of
the Swiss population by diagnostic radiology. Both the frequencies and the doses associated
with the different types of examinations were investigated. The results of the study will be
used to elaborate recommendations in order to reduce the patient doses involved in diagnostic
radiology.
Acknowledgements
The authors are grateful to the Swiss Federal Office of Public Health who financed this survey under contract Nr. 316.96.0576.
References
[1] United Nations,
2000 Report of the United Nations Scientific Committee on the Effects of Atomic Radiation to the General Assembly, Volume I : Sources, New-York, USA(2000).
[2] Zuppinger, A., Minder, W., Sarasin, R. and Schär, M., Die Strahlenbelastung der
schweizerischen Bevölkerung durch röntgendiagnostische Massnahmen, Radiol. clin. 30(1961).
[3] Poretti, G., Ionesco, R. and Lanz, W., Erhebung über die Strahlenbelastung der Schweizer Bevölkerung infolge röntgendiagnostischer Untersuchungen, Hrsg., Schweiz.
Vereinigung für Atomenergie (1971).
[4] Mini, R. and Poretti, G., Die Bestimmung der Strahlenbelastung einer
Bevölkerungsgruppe gemäss ICRP26, Tagungsbericht der Schweizerischen Gesellschaftfür Strahlenbiologie und Strahlenphysik SGSP (1984).
[5] Mini, R.L.,
Dosisbestimmungen in der medizinischen Röntgendiagnostik, Verlag MaxHuber, ISBN 3 906401 14 6 (1992).
[6] Rannikko, S., Ermakov, I., Lampinen, J.S., Toivonen, M., Karila K.T.K. and Chervjakov, A., Computing Patient Doses of X-Ray Examinations Using a Patient Size-
and Sex-adjustable Phantom, Br. J. Radiol. 70, 708–718 (1997).[7] Baadegaard, N. and Jensen, L.C., Organ Doses in CT Calculated by Monte Carlo
Technique Based on Measured CT-Beam Profiles, Proceedings of the World Congress onMedical Physics and Biomedical Engineering, Nice, France (1997).
EVALUATION OF PATIENT SKIN DOSE EQUIVALENT DUE TO
DIAGNOSTIC PROCEDURES WITH X-RAYS IN LAGOS STATE NIGERIA M.A. Aweda
College of Medicine, Lagos University, Teaching Hospital, Lagos, Nigeria
Abstract
This paper reports the study of Patient Skin Dose Equivalents in Lagos State, Nigeria, as one of the strategies of patient protection and x-ray procedure quality assessment. 13 most frequent x-ray diagnostic procedures were studied. These were chest, skull, cervical spine, lumbosacral spine, sinusis, pelvis, plain abdomen, shoulder, foot, hysterosalpingography, intravenous urography, barium meal and barium enema. 1977 procedures were monitored for a period of 12 months in both private and public hospitals carefully selected from all over the state. The results obtained compared favorably well with those from similar studies reported in the literature. The slight differences observed have been ascribed to variations in the patient anatomy, exposure conditions and choice of radiographic parameters.
1. Introduction
The main radiation protection problem in the diagnostic applications of x-rays is the unnecessary irradiation of patients and staff. Exposures to ionizing radiation and the associated health hazards necessitate the need for justification, optimization and respect of norms as recommended by the relevant international organizations [1]. Patient exposures in most cases are justified having taken account of alternative diagnostic methods using non- ionizing radiation [2]. Optimization implies reduction of patient dose to minimum possible while still obtaining all the necessary diagnostic information according to the ALARA principle.
Evaluation of Patient Skin Dose Equivalent (PSDE) is an optimization process intended for monitoring and assessment of performance within a department as part of dose reduction and patient protection strategies. PSDE is useful in the assessment of the potential harms from a particular procedure and for intercomparison of quality and standards between departments at national and international levels. The various direct and indirect methods of patient dosimetry exist in the literature [3,4,5]. PSDE monitoring is of particular importance in third world countries where the larger percentage of the radiation facilities are old, many of them not regularly serviced and the quality control and recalibration of the electric, mechanical and dosimetric performance parameters are almost non existent as in the developed countries.
This paper reports the PSDE from 13 most frequent x-ray diagnostic procedures in Lagos state, Nigeria. Lagos, being the economic and the industrial nerve center of the country, is the most densely populated city in the West African subregion. The number of private hospitals in the state is far greater than public and they are of varying sizes and standards. Some of the public and private hospitals have been selected for this study. The results obtained were compared with similar studies reported in the literature. The goal is to improve the quality of radiodiagnostic procedures, the quality being defined in terms of qualitative image vis-à-vis the dose to patient.
2. Materials and methods
PSDE were monitored for a period of 12 months in 10 different public and private hospitals
distributed all over Lagos state. The criteria for selection of hospital included good
representation of type of diagnostic procedures studied, the geographical location, how busy
the hospital is and the facilities available. The 13 procedures studied were chest, skull,
cervical spine, lumbosacral spine (LSS), sinusis, pelvis, plain abdomen, shoulder, foot, hysterosalpingography (HSG), Intravenous Urography (IVU), Barium Meal (BM) and Barium Enema (BE). 1977 procedures were monitored out of which 1485 were common and 492 were special procedures.
Thermoluminescence Dosemeter (TLD) LiF chips were placed one on each side and one at the central axis of the rectangular x-ray beam on the patient skin. From reading the chips the average PSDE for each exposure was determined. The TLD reader was Tolede 654 from Vinten U.K. at the Federal Radiation Protection Service. The system had been pre-calibrated at the dosimetry laboratory of IAEA in Seibersdorf, Austria. A patient radiological examination conditions and radiological parameters.
3. Results and discussions
The number of exposures, the range of the PSDE and the mean values for the various procedures monitored are summarized in table 1 below.( Table not provided). The ranges of the PSDE from the literature are contained in the last column for comparison. The PSDE recorded cover a wide range and vary with patients. This observation is expected because each patient is unique in anatomy, age, weight, illness and exposure conditions. Patient dose depends on type of procedure, beam size or the volume of tissue in the beam, patient positioning as well as radiological parameters such as KV, mAs, type and speed of film, use of intensifier and grid, age, type and the output of the x-ray facility. These technical and patient anatomical difference have been identified to account for the wide PSDE ranges. Some procedures such as LSS, HSG, IVU, BM and BE gave PSDE values which are multiples of the means annual background dose limit. The range of the PSDE obtained compared with those by Roger R.T. [6] and the means PSDE values by Shrimpton et al.[7] show a good agreement.
The slight differences could be attributed to the patient anatomical and exposure parameter differences.
References
[1] INTERNATIONAL ATOMIC ENERGY AGENCY, Safety Standards. Safety Series No. 115, 1996, IAEA, Vienna.
[2] WORLD HEALTH ORGANISATION, A Rational Approach to Radiodiagnostic Investigations. Technical Report Series No. 689. 1983 WHO Geneva.
[3] NATIONAL RADIOLOGICAL PROTECTION BOARD, U.K. Doses to Patients from Medical x-ray Examinations in the U.K. 1995 Review. NRPB - R289, 1996 London.
[4] NATIONAL RADIOLOGICAL PROTECTION BOARD/DOSIMETRY WORKING PARTY OF THE INSTITUTE OF PHYSICAL SCIENCE IN MEDICINE, NationalProtocol for patient Dose Measurement in Diagnostic Radiology. NRPB, Didcot Oxon OxII ORG U.K. 1992 London.
[5] WALL B.F., HARRISON R.M., SPIERS F.W., Patient.
[6] Dosimentry Techniques in Diagnostic Radiological. Institute of Physical Science in Medicine Report No. 53 IPSM 1988 New York.
[7] ROGER R.T, Radiation Dose to the skin in Diagnostic Radiography Brit. J. Radiol. Vol.
42 pg. 511-518, 1969.
[8] SHRIMPTON P.C., WALL B.F., FISHER E., HILLER M.C., KENDALL G.M AND
HARRISON R.M., A National survey of Doses to patients undergoing a selection of
Routine x-ray Examinations in English Hospitals. NRPB - NR200, HMSO, 1986,
London.
ENTRANCE SURFACE DOSE MEASUREMENT FOR SOME OF THE RADIOLOGICAL PATIENTS IN BANGLADESH
Z. Begum
Bangladesh Atomic Energy Commission, Dhaka, Bangladesh
Abstract
ESD values were measured for the most common types of X-ray procedures in four of the main hospitals of Dhaka the Capital City of Bangladesh. Patients undergoing a variety of examination protocols such as Chest PA, Lumber Spine AP and Lateral, Skull AP and Lateral, Pelvis AP were studied in the four hospitals numbered as 1, 2, 3 and 4.Diagnostic Radiology is the largest contributor to the artificial sources of ionizing radiation. Since X- ray is a powerful technique of diagnostic imaging, a large number of patient’s (a part of total population) are availing this technique every day in all countries of the world including Bangladesh. But so far no attempt has been made in Bangladesh to find out the doses delivered to the patient undergoing different X-ray procedures.
So. in this study Entrance Surface Dose (ESD) values have been measured for about 196 patients undergoing different X-ray procedures. The observed ESD values in the different local hospitals were compared with the values within the hospitals and also with the International Reference ESD Values.
1. Introduction
Though a net benefit to health may be achieved by all increase in the provision of radiation services in medical fields yet it carries some risk. International Atomic Energy Agency has imposed no limit on medical exposures, the aim is to ensure that the doses are not only low enough to justify the particular diagnostic examination but are kept even lower when the objective is reasonably achievable.
Entrance Surface Dose is one of the basic dosimetric quantities for measuring the patient dose.
In connection with optimizing patient dose it is also the basic quantity for comparing with the International Reference Values which is also important from the point of view of radiation protection of the patients. Though ESD value measurement for the patient is an essential component of Quality Control programme for individual X-ray radiology departments but comparison of ESD values between different hospitals, showing the variation of ESD values and the ratio of maximum and minimum ESD values can picture out the overall situation of the radiology departments of the country and can help to take protective measures where necessary. So, such an attempt has been undertaken in the present study. The results of the patient dose measurement, presented here are the first reported works that have been done in Bangladesh.
2. Experimental procedure
Since Chest PA patients were easily available in the hospitals, 10 patients for this projection in all the hospitals were taken but the patient sample size had to be lowered because of lower availability of the patients for some of the other procedures. In order to obtain representative values of ESDs for each X-ray procedure at least five patients per type of radiograph has been studied to provide a good indication of typical clinical practice. Only adult patients are included in the sample for the assessment of general diagnostic radiology procedures. Both sexes have been included as long as extremes in physique are avoided. Patients with weight 60
±
10 kg. were considered in this study [1]. Since effects of field size on radiation output in air
has been found to be small and in fact negligible for field sizes used in radiograph [2}, the
effect of field size has been neglected in this study.
For each diagnostic procedure a batch of three TLD chips were attached to the skin as close as possible to the point where the central axis of the X-ray beam enters the patient. The exposure parameters of the patients such as kVp, mAs, time, FFD etc. were noted down. Following the X-ray procedure the chips were read by the Harshaw 3500 TLD Reader. The average of three chips was taken as the ESD value received by the patient for that particular procedure. For background one batch of chips was kept without exposure every time when the other chips were exposed.
3. Results and discussion
Patient data and exposure parameters are shown in Table I. The mean ESD values in different hospitals together with the reference ESD values and also the range factors (ratio between maximum and minimum ESD values) is shown in Table II.
Table I. Patient Data and Exposure Parameters for ESD Measurement Serial No.
of the hospitals
Type of X-ray Procedure
Range of Age of Patient
Range of Wt.
Of Patient
Range of kVp Range of FFD (cm) 1.
2.
3 4.
Chest PA 18-36
22-60 24-78 28-65
56-68 55-75 54-65 50-69
50-55 65-80 55-70 55-73
114-138 150-150 150-150 200-200 1.
2.
3.
4.
Lumber Spine AP
21-60 20-55 31-70 20-70
52-71 52-68 50-74 50-70
70-81 70-85 70-90 60-77
90-103 90-90 105-110
90-110 1.
2.
3.
4.
Lumber Spine Lateral
21-60 22-55 31-70 23-70
52-71 52-68 54-65 50-70
77-85 80-90 70-95 73-85
90-110 90-90 105-110
90-110 1.
2.
3.
4.
Skull AP 20-50
22-50 18-68 24-45
53-73 50-65 52-80 50-67
57-70 70-80 75-85 60-75
80-100 90-100 105-110 100-100 1.
2.
3.
4.
Skull Lateral 20-50 34-50 18-68 24-45
53-59 50-65 52-74 50-67
57-81 70-80 65-80 55-70
80-103 90-100 105-110 100-100 1.
2.
3.
4.
Pelvis AP 18-65 32-48 19-75 27-70
50-58 50-66 50-80 52-77
65-77 70-80 65-80 66-73
90-112 90-105 105-110
97-113
