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

IF 1.4 4区 环境科学与生态学 Q4 ENVIRONMENTAL SCIENCES Journal of Radiological Protection Pub Date : 2024-04-05 DOI:10.1088/1361-6498/ad3837
Sachith Welarathna, Sivakumar Velautham, Sivananthan Sarasanandarajah
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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 dose indicators were measured in terms of kerma-area product (PKA) using a PKAmeter. 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 PKAdistributions, respectively. IDRL ranges varied considerably across hospitals: 1.42-2.42 Gy cm2for abdomen AP, 1.51-2.86 Gy cm2for KUB AP, 0.83-1.65 Gy cm2for lumbar spine AP, and 1.76-4.10 Gy cm2for 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 PKAwere 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.

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为斯里兰卡腹部、KUB 和腰椎 X 光检查建立国家诊断参考水平:一项多中心研究。
诊断参考水平(DRLs)和可达到剂量(ADs)为优化接受医学成像程序的患者的辐射剂量提供了指导。这项多中心研究旨在比较各家医院的机构诊断参考水平(IDRLs),为斯里兰卡的四种常见 X 光检查提出可达到剂量(ADs)和多中心诊断参考水平(MCDRLs),并评估降低剂量的潜力。这项前瞻性横断面研究针对 894 名转诊接受腹部正侧位 (AP)、肾-输尿管-膀胱 (KUB) AP、腰椎 AP 和腰椎侧位 (LAT) X 光检查的成年患者。收集了患者的人口统计学信息(年龄、性别、体重、体重指数)和照射参数(电子管电压、电子管电流-照射时间乘积)。使用 PKA 测量仪测量患者的剂量(以 Kerma 面积乘积 (PKA) 表示)。IDRL、AD 和 MCDRL 按照国际放射防护委员会的指导方针计算,AD 和 MCDRL 分别定义为 PKA 分布中位数的第 50 和第 75 百分位数。各医院的 IDRL 范围差异很大:腹部 AP 为 1.42-2.42 Gy cm2,KUB AP 为 1.51-2.86 Gy cm2,腰椎 AP 为 0.83-1.65 Gy cm2,腰椎 LAT 为 1.76-4.10 Gy cm2。建议的 AD 为 1.82 Gy cm2(腹部 AP)、2.03 Gy cm2(KUB AP)、1.27 Gy cm2(腰椎 AP)和 2.21 Gy cm2(腰椎 LAT)。MCDRL为2.24 Gy cm2(腹部AP)、2.40 Gy cm2(KUB AP)、1.43 Gy cm2(腰椎AP)和2.38 Gy cm2(腰椎LAT)。在所有四项检查中,均观察到医院内和医院间的 PKA 有很大差异。尽管斯里兰卡的 ADs 和 MCDRL 与现有文献中的数据相当,但已发现的医院内和医院间差异强调了在不影响诊断信息的情况下减少剂量的必要性。建议IDRL较高的医院审查并优化其做法。这些 MCDRL 可作为初步的国家 DRL,指导医疗专业人员和政策制定者的剂量优化工作。
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来源期刊
Journal of Radiological Protection
Journal of Radiological Protection 环境科学-公共卫生、环境卫生与职业卫生
CiteScore
2.60
自引率
26.70%
发文量
137
审稿时长
18-36 weeks
期刊介绍: Journal of Radiological Protection publishes articles on all aspects of radiological protection, including non-ionising as well as ionising radiations. Fields of interest range from research, development and theory to operational matters, education and training. The very wide spectrum of its topics includes: dosimetry, instrument development, specialized measuring techniques, epidemiology, biological effects (in vivo and in vitro) and risk and environmental impact assessments. The journal encourages publication of data and code as well as results.
期刊最新文献
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