title: Patient doses in radiographic examinations in 12 countries in Asia, Africa, and Eastern Europe: initial results from IAEA projects.
abstract: OBJECTIVE
  The purpose of this study was to survey image quality and the entrance surface air kerma for patients in radiographic examinations and to perform comparisons with diagnostic reference levels.
  
  
  METHODS
  In this multinational prospective study, image quality and patient radiation doses were surveyed in 12 countries in Africa, Asia, and Eastern Europe, covering 45 hospitals. The rate of unsatisfactory images and image quality grade were noted, and causes for poor image quality were investigated. The entrance surface doses for adult patients were determined in terms of the entrance surface air kerma on the basis of X-ray tube output measurements and X-ray exposure parameters. Comparison of dose levels with diagnostic reference levels was performed.
  
  
  RESULTS
  The fraction of images rated as poor was as high as 53%. The image quality improved up to 16 percentage points in Africa, 13 in Asia, and 22 in Eastern Europe after implementation of a quality control (QC) program. Patient doses varied by a factor of up to 88, although the majority of doses were below diagnostic reference levels. The mean entrance surface air kerma values in mGy were 0.33 (chest, posteroanterior), 4.07 (lumbar spine, anteroposterior), 8.53 (lumbar spine, lateral), 3.64 (abdomen, anteroposterior), 3.68 (pelvis, anteroposterior), and 2.41 (skull, anteroposterior). Patient doses were found to be similar to doses in developed countries and patient dose reductions ranging from 1.4% to 85% were achieved.
  
  
  CONCLUSIONS
  Poor image quality constitutes a major source of unnecessary radiation to patients in developing countries. Comparison with other surveys indicates that patient dose levels in these countries are not higher than those in developed countries.
authors.affiliation: Tanzania Atomic Energy Commission, Arusha, Tanzania.
authors.forename: Wilbroad E
authors.initials: WE
authors.lastname: Muhogora
authors.forename: Nada A
authors.initials: NA
authors.lastname: Ahmed
authors.forename: Aziz
authors.initials: A
authors.lastname: Almosabihi
authors.forename: Jamila S
authors.initials: JS
authors.lastname: Alsuwaidi
authors.forename: Adnan
authors.initials: A
authors.lastname: Beganovic
authors.forename: Olivera
authors.initials: O
authors.lastname: Ciraj-Bjelac
authors.forename: Francois K
authors.initials: FK
authors.lastname: Kabuya
authors.forename: Anchali
authors.initials: A
authors.lastname: Krisanachinda
authors.forename: Milomir
authors.initials: M
authors.lastname: Milakovic
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mukwada
authors.forename: Marie J
authors.initials: MJ
authors.lastname: Ramanandraibe
authors.forename: Madan M
authors.initials: MM
authors.lastname: Rehani
authors.forename: Jalil
authors.initials: J
authors.lastname: Rouzitalab
authors.forename: Cyril
authors.initials: C
authors.lastname: Shandorf
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D001822:Body Burden; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011859:Radiography / Q000706:statistics & numerical data*; D011874:Radiometry / Q000706:statistics & numerical data*; D012062:Relative Biological Effectiveness