THE STUDY OF PATIENT DOSES IN DIAGNOSTIC RADIOLOGY FOR ESTABLISHMENT OF NATIONAL DIAGNOSTIC REFERENCE LEVELS

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1 THE STUDY OF PATIENT DOSES IN DIAGNOSTIC RADIOLOGY FOR ESTABLISHMENT OF NATIONAL DIAGNOSTIC REFERENCE LEVELS Larysa Stadnyk, Pylypenko M., Shalepa O., Nosyk O. Grigorev Institute for Medical Radiology, Kharkov, Ukraine

2 Network of X-ray Diagnostic care in Ukraine In according to information of the Ministry of Health there are: X-ray Diagnostic machines for conventional Diagnostic Radiology; 2100 fluorography units; 150 CT; 350 mammography units;3804 users of RS medical use (74 %) 80 X-ray units for interventional non medical procedures. WWER 440 WWER RBMK 1000 RR RW Uranium

3 Network of X-ray Diagnostic care in Ukraine In 2010 X-ray examinations - about 42 million, population of Ukraine million people The contribution of doses due to Xray diagnostic procedures into collective effective dose of the population from man-made radiation sources are reached 80-

4 Radiological Protection for Medical Exposure in Ukraine There are a net of services for control of technical parameters of X-ray Units There is not national quality assurance program for control of radiation output and other parameters which influence to form of patient doses

5 Radiological Protection for Medical Exposure in Ukraine In accordance with the Medical Directive 43/97 Euratom all European countries should establish a national DRLs for control patient doses; IAEA BSS-115 published the guidance levels of patient doses for diagnostic radiography, different countries can use these levels until national diagnostic reference levels are accepted In Ukraine, the national diagnostic reference levels (DRLs) has not yet been established, despite the need for approval under the National Standards of Radiation Safety in Ukraine (1997).

6 Radiological Protection for Medical Exposure in Ukraine During in Ukraine the first investigations of patient doses for the most common types of X-ray Diagnostic Investigations have been organized by Grigorev Institute of Medical Radiology (Kharkov) due to the national program of Ministry of Health. Institute had developed the questionnaire that allows assessment of the structure and frequency of Diagnostic investigations and procedures using X-rays. The questionnaire 45 most common types of X-ray examinations and procedures.

7 маммографія; флюороскопія; The structure of X-ray diagnostic imaging procedures in Ukraine рентгенографія;

8 Selected X-ray procedures for establishing of DRLs On the survey it was found: the most widespread type of x-ray examinations are; - fluorography of the chest 43.4%; - radiography of chest % - radiography of cervical, thoracic and lumbar spine and pelvis 12.4 %.

9 Methods and materials of patient dose investigations - The radiation measurements of radiation output of Xray units were carried out for 92 X-ray diagnostic Units from 40 hospitals of 8 Ukrainian Regions using dosimeter TRIAD model 10100А (Kethly, USA); - The entrance surface doses were performed for more than 3500 patients with TL-detectors LiF type MTS-N (Poland) and TLD-reader PCL3 for fluorography and 9 main radiography examinations: chest; cervical spine, thoracic spine, lumber spine, pelvis (for PA, AP, LAT projections).

10 Radiation outputs of different X-Ray Diagnostic Units

11 Entrance surface doses for main radiography examinations Imaging procedures Values of parameters Weight, kg Entrance surface doses, mgy Guidance levels BSS-115, mgy Fluorography film (380 measurements) Min - Max M±m 3 quartile ± ± Chest, PA (770 measurements) Min - Max M±m 3 quartile ± ± Thoracic spine, spine, AP (180 measurements) Min - Max M±m 3 quartile ± ,7 0, ± Thoracic spine, spine, LAT (170 measurements) Min - Max M±m 3 quartile ± ,4 1, ± Lumbar spine, spine, AP (450 measurements) Min - Max M±m 3 quartile ± 1,6 1, ± 2.2± 1,6 1, Lumbar spine, spine, LAT (380 measurements) Min - Max M±m 3 quartile ± 1,7 1, ± Pelvis, elvis, AP (150 measurements) Min - Max M±m 3 quartile ± ±

12 Comparison of DRLs from the patient dose study in Ukrainian hospitals with the guidance levels (BSS-115) for some X-ray radiography procedures % % 0.4 mgy mgy mgy 15 mgy Thoracic spine (AP) Chest (PA) Entrance surface doses > 2.0

13 Main results of investigations of national DRLs in X-ray radiography For almost all studied X-ray procedures third quartile of ESD s distributions was times higher than Guidance levels of IAEA (BSS-115). Only for radiography of the thoracic spine (LAT), third quartile amounted to 18 mgy, which almost corresponds to the recommended level by IAEA - 20 mgy.

14 The main task for optimization of radiation protection of X-ray diagnostic exposure Development and introduction of measures to optimization of radiation protection in medical exposure by implementation of quality assurance programs in diagnostic radiology departments Development guidance for the optimal conditions of X-ray diagnostic procedures

15 WELCOME TO UKRAINE!

16 THANK YOU FOR YOUR ATTENTION!