Interventional procedures are increasing in developing countries, not only for adults but also for pediatric patients. The situation with respect to staff protection is considered generally acceptable, but this is not the case for patient protection. Many patients exceeded the dose threshold for erythema. A substantial number (62%) of percutaneous transluminal coronary angioplasty procedures performed in developing countries in this study are above the currently known dose reference level and thus could be optimized. Therefore, this study has significance in introducing the concept of patient dose estimation and dose management.

Original ArticleAbstract Purpose: To assess the radiation doses to neonates from diagnostic radiography in order to derive the local diagnostic reference levels (LDRLs) for optimisation purposes. Methods: This study was carried out in the neonatal intensive care units (NICU) of two hospitals in Tunis. 134 babies, with weights ranging from 635 g to 6680 g, performed chest-abdomen X-ray examinations. Neonates were categorized into groups of birth weight. For each X-ray examination, patient data and exposure parameters were recorded. Dose area product (DAP) was measured and entrance surface dose (ESD) was estimated. Effective dose was calculated from the Monte Carlo simulation software PCXMC. Results: DAP values increased with neonatal weight and demonstrated a wide variation (5.0 -43.0 mGy.cm 2 , mean 23.4 mGy.cm 2 ) for patient weight from 600 g to 4000 g. A wide variation was also observed for ESD (14 -93 μGy, mean 55.2 μGy). The LDRLs expressed in term of DAP were estimated to be 17.6 mGy.cm 2 and 29.1 mGy.cm 2 for the first and the second NICU, respectively. In terms of effective dose, the average value was about 31.6 μSv single radiological examination. The results show the necessity to use a standardized protocol with high voltage technique combined to lower current time product (mAs) values and an adapted collimation which could lead to further reductions in the neonatal doses. Conclusion: This study presents the LDRLs and the effective doses for neonates in two NICUs and demonstrates the necessity to optimize patient protection for this category of patient.