Management of patient doses and diagnostic reference levels in X-ray radiography in Lithuania

Abstract

Management of patient doses and determination of national or local diagnostic reference levels (DRLs) are important parts of a quality control program in X-ray diagnostics. In Lithuania, national DRLs for specific radiographic examinations are comparatively higher than those recommended by the European Commission (EC) and the International Atomic Energy Agency (IAEA). A survey of entrance surface doses (ESDs) was performed to investigate the reasons for exceeding the European and the IAEA DRLs. The first measurements showed that the average ESD for standard patients and for all examinations exceeded DRLs at approximately 25 % of the hospitals. The main problems were the use of low kilovolt technique, the lack of automatic exposure control systems or improper adjustment of them as well as inadequate training of the staff. After corrective actions, the ESD measurements were repeated. The results showed that the average patient doses were reduced almost everywhere. An additional patient dose survey for establishing new DRLs in radiography taking into account the advantages of new equipment to indicate directly the kerma area product (KAP) values was done. The ESD values were calculated from the KAP-values. The data were analysed, and the average and third quartile values were calculated. The new DRLs, in terms of ESDs, were reduced significantly in almost all radiography examinations. They are equal or lower than the IAEA and EC DRLs. Especially at thorax spine LAT, lumbar spine LAT, hip joint AP, pelvis AP and abdomen AP they are half the IAEA DRLs.

Assessment of the radiation dose associated with X-ray examinations using the DoseCal and CALDose_X software packages

“…For the sake of clarification, the mean ESD values found in the present study were lower than those in other investigations in India (24) , Korea (25) , Iran (26) , Malaysia (28) , Switzerland (29) , Bangladesh (30) , Bulgaria (31) , Nigeria (34) , Lithuania (35) and Russia (36) . One possible explanation for this is that the reference dose levels of some of these countries are based on data collected several years ago and using older, less efficient technology.…”

“…In figure 4(a-c), a comparison is established between the average ESD, ESAK and exposure factor values obtained in this study and the ESD values reported in previous studies from India (24) , Korea (25) , Iran (26) , the United Kingdom (UK) (27) , Malaysia (28) , Switzerland (29) , Bangladesh (30) , Bulgaria (31) , Italy (32) , Sudan (33) , Nigeria (34) , Lithuania (35) and Russia (36) . It can be observed that the mean ESD values of the skull LAT exami- nation in this study were higher than those reported in the UK (27) but less than those in several other countries (24,(28)(29)(30)(31)(34)(35)(36) . In this study, we chose to compare our mean ESD values with the internationally reported dose metrics, but the recent recommendations favour median values.…”

Proposed diagnostic reference levels for general radiography and mammography in Japan

“…Table 7 shows a comparison of the values for our proposed DRLs and DRLs in foreign countries (included our data of 2014) [11][12][13][14][15][16][17][18][19][20]. DRL which we proposed this time is not so high in comparison with foreign countries either.…”

“…Examinations This Study Asada et al [11] Uniyal et al [12] Metaxas et al [13] Ireland [14] Bulgaria [15] UK [16] Lithuania [17]…”

Continuous Improvement of the Diagnostic Reference Levels for Medical X-Ray Radiography

“…医疗照射是最大的人工电离辐射源， 而 X 射线诊 断频率占比最高 [1] 。随着国民经济和社会的发展，一 方面，人们使用医用 X 射线诊断检查的应用频率不断 增加 [2,3] ； 另一方面人们又更加关注自身的放射防护问 [14,15,19] ，立陶宛在 2010 年 [23] 与 2005 年的值 [22] 相比 降低；其次，制订 DRL 的部位和类别逐渐增多；另 外，很多地区根据本地情况，在国家水平的基础上还 不断完善的医用 X 射线摄影诊断指导水平 …”