National indication-based diagnostic reference level values in computed tomography: Preliminary results from Ghana

Botwe, Benard Ohene; Schandorf, Cyril; Inkoom, Stephen; Faanu, A.; Rolstadaas, Linn; Goa, Pål Erik

doi:10.1016/j.ejmp.2021.03.012

Cited by 16 publications

(31 citation statements)

References 24 publications

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“…The scan length for PE was shorter than that for ILD/HRCT due to the exclusion of the most peripheral chest parts in which emboli are not generally seen within the terminal pulmonary arterioles. This trend was similar to that in a study within Ghana (10). This trend of scan length was largely within the recommended limits of the anatomical extent for PE examinations which extends from the aortic arch to the base of the hear (26).…”

Section: Discussionsupporting

confidence: 86%

“…The scan length for UC was shorter than that for ABDPL probably due the focus on calculi within the upper urinary system as per the scan request form with less inclusion of the most distal parts of the pelvis after the urinary bladder This was dissimilar to ndings in a study within Ghana (10) in which both ABDPL and kidney stones had similar scan lengths. This was also dissimilar to the recommendation by ESR that advises the scan length for UC to extend longer than that of ABDPL (appendicitis) i.e., from inferior margin of T10 to lower edge urinary bladder (approximately at lower edge of pubis symphysis) for UC and from inferior margin of T10 to superior border of pubis symphysis (26).…”

Section: Discussionmentioning

confidence: 57%

“…The CTDIvol DRLs were lower than Ghana's (10) in all indications (acute stroke, head trauma, PE, ABDPL and UC) and lower than Egypt's (11) in ILD/HRCT as presented in Fig. 1.…”

Section: Typical Ib-drlsmentioning

confidence: 84%

“…Scan length: The scan length for head trauma was longer than that for acute stroke due to the inclusion of a longer part of the neck to rule out concomitant cervical spine injury for early management to mitigate complications similar to a studies in Ghana and Uganda (10,15,16,19).…”

Section: Discussionmentioning

confidence: 99%

“…The IB-DRL is superior to a single anatomical DRL that cannot logically optimize doses for all the different indications with different image quality requirements in a body region as indicated by ICRP, IAEA and European Society of Radiology (4-6, 8). However, IB-DRLs are yet to be considered a priority by the Atomic Energy Councils in low Middle-Income Countries (LMICs) as evidenced by limited published data on IB-DRLs from some studies conducted in Ghana, Egypt and Nigeria (10)(11)(12). This current study was conducted in Uganda, a low-resource setting, but with increasing use of CT in patient care due to the availability, relative affordability, high resolution images and fast image acquisition of CT equipment (13).…”

Section: Introductionmentioning

confidence: 99%

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Typical Diagnostic Reference Levels of Common Indications for Computed Tomography Scans Among Adult Patients in Uganda: a Cross-sectional Study

Kiragga

Erem

Kisembo

et al. 2023

Preprint

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Background Medical exposure to ionizing radiation has increased due to an increase in the number of computerized tomography (CT) scan examinations performed. The International Commission on Radiological Protection (ICRP) recommends indication-based diagnostic reference levels (IB-DRLs) as an effective tool that aids in optimizing CT scan radiation doses. In many low-income settings, there is a lack of IB-DRLs to support optimization of radiation doses. Objective To establish typical DRLs for common CT scan indications among adult patients in Kampala, Uganda. Methodology: A cross sectional study design was employed involving 337 participants enrolled from three hospitals using systematic sampling. The participants were adults who had been referred for a CT scan. The typical DRL of each indication was determined as the median value of the pooled distribution of CTDIvol (mGy) data and the median value of the pooled distribution of total DLP (tDLP)(mGy.cm) data from three hospitals. Comparison was made to anatomical, and indication based DRLs from other studies. Results 54.3% of the participants were male. The following were typical DRLs for: acute stroke (30.17mGy and 653mGy.cm); head trauma (32.04mGy and 878mGy.cm); interstitial lung diseases/ high resolution chest CT scan (4.66mGy and 161mGy.cm); pulmonary embolism (5.03mGy and 273mGy.cm); abdominopelvic lesion (6.93mGy and 838mGy.cm) and urinary calculi (7.61mGy and 975mGy.cm). Indication based total Dose Length Product (tDLP) DRLs was lower than tDLP DRLs of a whole anatomical region by 36.4% on average. Most of the developed typical IB-DLP DRLs were lower or comparable to values from studies in Ghana and Egypt in all indications besides urinary calculi while they were higher than values in a French study in all indications besides acute stroke and head trauma. Conclusion Typical IB-DRLs is a good clinical practice tool for optimization of CT doses and therefore recommended for use to manage CT radiation dose. The developed IB-DRLs varied from international values due to differences in selection of CT scan parameters and standardization of CT imaging protocols may narrow the variation. This study can serve as baseline for establishment of national indication-based CT DRLs in Uganda.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 57%

“…The CTDIvol DRLs were lower than Ghana's (10) in all indications (acute stroke, head trauma, PE, ABDPL and UC) and lower than Egypt's (11) in ILD/HRCT as presented in Fig. 1.…”

Section: Typical Ib-drlsmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%