Patient doses in radiographic examinations in 12 countries in Asia, Africa, and Eastern Europe: initial results from IAEA projects.
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.
Muhogora
Wilbroad E
WE
Tanzania Atomic Energy Commission, Arusha, Tanzania.
Ahmed
Nada A
NA
Almosabihi
Aziz
A
Alsuwaidi
Jamila S
JS
Beganovic
Adnan
A
Ciraj-Bjelac
Olivera
O
Kabuya
Francois K
FK
Krisanachinda
Anchali
A
Milakovic
Milomir
M
Mukwada
Godfrey
G
Ramanandraibe
Marie J
MJ
Rehani
Madan M
MM
Rouzitalab
Jalil
J
Shandorf
Cyril
C
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