Towards the establishment of national diagnostic reference levels for abdomen, KUB, and lumbar spine x-ray examinations in Sri Lanka: A multi-centric study

Welarathna, S; Velautham, S; Sarasanandarajah, S

Author(s): Welarathna, S; Velautham, S; Sarasanandarajah, S;
Details: Publication Year 2024-03-27,Volume 44,Issue #2,Page 021506
Journal Title: Journal of Radiological Protection
Publication Type: Research article
Abstract: Diagnostic reference levels (DRLs) and achievable doses (ADs) provide guidance to optimise radiation doses for patients undergoing medical imaging procedures. This multi-centre study aimed to compare institutional DRLs (IDRLs) across hospitals, propose ADs and multi-centric DRLs (MCDRLs) for four common x-ray examinations in Sri Lanka, and assess the potential for dose reduction. A prospective cross-sectional study of 894 adult patients referred for abdomen anteroposterior (AP), kidney-ureter-bladder (KUB) AP, lumbar spine AP, and lumbar spine lateral (LAT) x-ray examinations was conducted. Patient demographic information (age, sex, weight, BMI) and exposure parameters (tube voltage, tube current-exposure time product) were collected. Patient doses were measured in terms of kerma-area product (PKA) using a PKA meter. IDRLs, ADs, and MCDRLs were calculated following the International Commission on Radiological Protection guidelines, with ADs and MCDRLs defined as the 50th and 75th percentiles of the median PKA distributions, respectively. IDRL ranges varied considerably across hospitals: 1.42-2.42 Gy cm2 for abdomen AP, 1.51-2.86 Gy cm2 for KUB AP, 0.83-1.65 Gy cm2 for lumbar spine AP, and 1.76-4.10 Gy cm2 for lumbar spine LAT. The proposed ADs were 1.82 Gy cm2 (abdomen AP), 2.03 Gy cm2 (KUB AP), 1.27 Gy cm2 (lumbar spine AP), and 2.21 Gy cm2 (lumbar spine LAT). MCDRLs were 2.24 Gy cm2 (abdomen AP), 2.40 Gy cm2 (KUB AP), 1.43 Gy cm2 (lumbar spine AP), and 2.38 Gy cm2 (lumbar spine LAT). Substantial intra- and inter-hospital variations in PKA were observed for all four examinations. Although ADs and MCDRLs in Sri Lanka were comparable to those in the existing literature, the identified intra- and inter-hospital variations underscore the need for dose reduction without compromising diagnostic information. Hospitals with high IDRLs are recommended to review and optimise their practices. These MCDRLs serve as preliminary national DRLs, guiding dose optimisation efforts by medical professionals and policymakers.
Publisher: IOP Publishing
Keywords: KUB radiography; abdominal radiography; achievable doses (ADs); dose optimisation; kerma-area product (PKA); lumbar spine radiography; multi-centric diagnostic reference levels (MCDRLs)
Department(s): Physical Sciences
Publisher's Version: https://doi.org/10.1088/1361-6498/ad3837
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-05-07 04:32:42

Last Modified: 2024-05-07 04:39:44