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Exposure Levels of Adult Patients during Radiographic Examinations: Sinuses and Coastal Grill Cases at the Ngaoundere Regional Hospital, Cameroon

Exposure Levels of Adult Patients during Radiographic Examinations: Sinuses and Coastal Grill... Hindawi Radiology Research and Practice Volume 2019, Article ID 5452149, 5 pages https://doi.org/10.1155/2019/5452149 Research Article Exposure Levels of Adult Patients during Radiographic Examinations: Sinuses and Coastal Grill Cases at the Ngaoundere Regional Hospital, Cameroon 1,2 3 4 1,5 Guiswe Gnowe , Fouda H. P. Ekobena, Amvene J. Mbo, and Guena M. Neossi Department of Biomedical Sciences, Faculty of Sciences, University of Ngaoundere, Cameroon Higher Institute of Sciences, Health Technics and Management of Garoua, Cameroon University Institute of Technology, University of Ngaoundere, Cameroon Faculty of Medicine and Biomedical Sciences of Garoua, Cameroon Department of Radiology and Medical Imaging,RegionalHospitalof Ngaoundere, Cameroon Correspondence should be addressed to Guiswe Gnowe; gnoweguiswe@gmail.com Received 29 October 2018; Revised 28 February 2019; Accepted 13 March 2019; Published 30 April 2019 Academic Editor: Paul Sijens Copyright © 2019 Guiswe Gnowe et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. eTh purpose of this study was to estimate the doses delivered to adult patients during explorations of the sinuses and coastal grill whose attention in dosimetric terms is neglected because of the low demand for diagnosis. But yet dosimetric values are very high. Materials and Methods. eTh present study was transversely descriptive and was conducted between April and July 2016. The data were collected on 50 adult patients of mass of 70 ±10kg at the Regional Hospital of Ngaoundere (HRN). eTh dose at the entrance of the patients' skin was evaluated through the theoretical methods derived from the Davies model according to the 75th percentile calculations. Results and Discussion. eTh entrance skin doses obtained in mGy were, respectively, of 7.2± 0.2 for sinuses and 5.27±0.1 for coastal grill. The present study found many variations in doses during radiological investigations. es Th e variations allowed us to understand that the notions of quality of the radiographic image, insurance, and quality control of the radiological equipment are tributary, abstract, and oen ft theoretical because doses delivered are not sufficiently optimized. Conclusion.The dosimetric analysis remains very worrying because the various procedures show that an improvement of the practices especially with respect to the technical parameters and the protocols must be considered. er Th efore a strengthening of radiological protection skills of radiological manipulators (continuing education and retraining) would contribute to a better protection of patients. 1. Introduction clinic and make the diagnosis [1]. These large variations in the doses delivered to patients for the same examination also In radiology, patient dosimetry is a good match between show a crucial importance for the study of dose variations [2], image quality and the low dose process. Continuous eval- for quality assurance and standardization of protocols [3], in uation by means of periodic inspections and the fight to order to guarantee the optimization of doses to patients. We reduce the doses delivered should be at the center of the must give ourselves the means to measure and to evaluate this activities (after the structure in charge through effective energy and to verify that patients are not overexposed during monitoring in the eld fi and in all structures equipped with standard radiography. X-ray tubes). In fact, the doses delivered to patients during Patient dosimetry is a functional operation parameter medical imaging examinations are not sufficiently controlled such as high voltage or kilovolt (kV), current intensity or and the working protocols for a given examination differ from milliamperage (mAs), morphotype, posteroanterior (PA), one hospital service to another. These variations indicate anteroposterior (AP), focus-skin distance (FSD), and el fi d that good imaging technique is needed to reduce the dose and lt fi ration [4]. It should be noted that the diagnosis to patients at the lowest practicable level to respond to the is dependent on the quality of the radiological image and 2 Radiology Research and Practice therefore of the dose at the entrance surface of the skin. In processed and analyzed with the strictest anonymity. The radiology, the dosimetric quantities selected for the Diag- calculations, the output of the tube, and the entrance skin nostic Reference Levels (DRLs) determinations are the input dose (ESD) patients were donned by Sphinx Plus V.5.1.0.6 dose (ESD in mGy) and the Dose-Area Product (DAP in and Excel 2010. Gy.cm )[5]. The entrance skin dose (ESD) in conventional radiog- 2.3. Calculation of the Dose. The irradiation and geometric parameters involved in the calculation of the dose at the raphy can be obtained by calculation from mathematical th methods or measured by a thermoluminescent dosimeter entrance of the skin were calculated (by means of 75 (TLD) [6]. These methods have relatively small differences. percentiles, standard deviations). The calculation of the dose The calculation or mathematical method appears reliable and at the entrance of the skin began by calculating the output is an effective alternative for measuring the entrance skin dose (output) of the X-ray tube according to the model of [8]: [7]. The determination of patient doses is an essential part of the optimization process, such as the adequacy of the image 𝑂 𝑚𝑅 −1 −4 2 2 (𝑚𝑅 )=𝐴×6,53×10 ( )(𝑘𝑉 ) ×𝑘𝑉 and radiation in radiological examination. The optimization 𝑃 𝑚𝐴𝑠 (1) of doses delivered during the radiological examinations, by ×𝑚𝑠𝐴 the determination of the DRLs, the control of the quality of the installations, and radiological procedure, makes it where A is a constant equal to 0.5; 0.8 and 1 are for single- possible to minimize the risk related to these irradiations phase, three-phase, and high frequency tubes generators. As by reducing the dose received by the patient. The concept part of our study, the X-ray tube was three phases. The of DRL is specific to medical exposures and should not be −1 yields obtained in (mR) were converted to mGy, mAs by confused with that of “individual dose limit” which is applied multiplication at a factor of 0.00877/mAs [9]. in these areas of radiation protection of workers and the Then, the calculation of the dose at the entrance of the public. Reference levels are tools for improving practices and skin proper for each patient was according to the Davies optimizing doses. These levels exist only for routine explo- model [10]. Thisisthanks tothe values of irradiation param- rations in radiological examination. Respect for the reference eters and geometric and output values. We chose this model levels is not, by itself, a criterion of good practice. The primary because it integrates all the elements directly, involved in the goal, inseparable from dosimetry, is the diagnostic quality of realization of radiographic examinations and the definition low dose images [5]. of the dose at the entrance of the skin [11]. The logic of Our objectives were the following: the arrangement of radiographic parameters in this formula (i) Determine the sociodemographic profiles of the obeys well to that realized during the obtaining of the patients received for these particular examinations. radiographic images. (ii) Determine the dose levels delivered to adult patients based on radiological exploration by theoretical mod- 𝑂 𝑘𝑉 𝐷(𝑦)𝑚𝐺 =( )×( ) ×𝑚𝑠𝐴 els of dose calculation. 𝑃 80 (2) (iii) Compare the results obtained with those obtained elsewhere according to our realities. ×( ) ×𝐵𝐹𝑆 2. Materials and Methods Only images of good qualities accepted for interpretation were considered. The study was authorized by the ethics The study was monocentric, descriptive, and transversal. committee of the hospital structure. It took place between April and July 2016 (four months), in the Radiology and Medical Imaging Department of the Ngaounder ´ e´ Regional Hospital. This department is equipped 3. Results with a GENERAL ELECTRIC X-ray tube, model 5192454, The results obtained only were presented in Table 4. whose maximum voltage was around 150 kV. 3.1. Sociodemographic Data. For 50 subjects, men were more 2.1. Target. Included in this study were all adult subjects represented than women (66%), with a sex ratio (H/F=1.94). irrespective of sex and age who had undergone a blondeau radiographic examination and coastal grill during the period. Regarding the male sex: the mean age was 40.33 and the standard deviation was 8.54 years; the range of age was 26-48 The data collected include age, sex, and anthropometric data years for sinuses. of patients with weights between 60 and 80 kg. The mean age was 27.2 and the standard deviation was 2.2. Collection and Statistical Analysis. The information was 6.64 years; the range of age was 20-38 years for coastal grill. collected using a sheet adapted according to the model of With regard to the female sex: the mean age of the women the Institute of Radiation Protection and Nuclear Safety was 27.2 and the standard deviation was 6.64 years; the range (IRNS) dosimetric evaluation. The irradiation parameters of age was between 20 and 38 years for sinuses. The mean age used (kV, mAs), the geometric parameters (FFD, FSD), was 33.16 and the standard deviation was 6.22 years; the range and the anthropometric data (age, sex, and weight) were of age was between 32 and 41 years for coastal grill. 𝐹𝑆𝐷 𝐸𝑆 Radiology Research and Practice 3 3.2. Yield of X-Ray Tube. The different values of the output Table 1: Sociodemographic characteristics. are essential for the process of optimizing the dose delivered Radiography Sex Amount Age (years) Weight (kg) and the quality of the images. They are directly a function 26-48 65-78 of the high voltage (kV) and the load (mAs). For sinuses, in M14 −1 40.33±8.54 71.33±5.77 mGy. (mAs) , the output ranged from 0.19 to 0.29 in PA. For Sinuses −1 26-54 61-78 coastal grill, in mGy (mAs) , output ranged from 0.19 to 0.25 F11 33.57±9.04 69.42±5.02 in AP. 20-38 63-78 M19 27.2±6.64 68.5±3.62 3.3. Overall Knowledge of the Irradiation Parameters Used Coastal grill 32-41 65-76 during Exams. The parameters presented in this study are F6 33.16±6.22 70.33±4.52 thosethat made itpossibletoobtain good quality according M: male, F: female. to the different morphotypes of the patients. These param- eters are very important in the process of optimizing the −1 Table 2: Output of X-ray tube in mR and mGy.(mAs) . dose delivered and improving the quality of the images. After calculation (mGy), the third quartile was 7.02 and standard Output deviation was 0.2 for sinuses. The minimum and maximum Output(mR) −1 Radiography Projection mGy.(mAs) entrance skin dose ranged from 5.8 to 12.2 in PA. The third Min Max Min Max quartile was 5.27 and standard deviation was 0.1 for coastal Sinuses PA 22.07 33.43 0.19 0.29 grill. The minimum and maximum entrance skin dose skin ranged from 4.98 to 7.67 in AP. Coastal grill AP 22.07 29.38 0.19 0.25 PA: posteroanterior, AP: anteroposterior, Min: minimum, max: maximum. 3.4. Study of Comparative Values. The values obtained (mGy) were compared with those obtained elsewhere by the same environment are not always able to accurately age [12]. Much approaches. The entrance skin dose was 7.02 ±0.2 for sinuses in PA. Theentrance skin dosewas 5.27 ±0.1 for coastal grill in more according to [13], the level of awareness of clinicians AP. in Cameroon is very low and supercial, fi which aec ff ts the quality of their imaging demands. Despite the compliance of certain test reports, it should be noted that contact with 4. Discussion the patient during imaging examinations should allow us to The population of our study consisted of patients admitted complete the missing parameters. to the Radiology Department of the Regional Hospital of Ngaoundere. The study included 50 adult patients of more 4.2. Importance of X-Ray Tube Performance. Table 2 presents than 20 years, both sexes, with a weight between 60 and the estimation of the X-ray tube yielding from the theoretical 80 kg. X-ray examinations were performed by manipulators model proposed by [8]. It is important to consider tube of dieff rent rank and seniority. The parameters used for efficiencies for each specific run to control tube power and the same examination were variable according to the habits to take corrective action if deviations from normal are noted. of each manipulator. Many manipulators do not have the Obtaining a quality image is the primary function of the same rules of good practice. These different parameters were efficiency of the X-ray tube. The power of the tube becomes observable on the quality of the snapshots and the disparity an optimization factor in the evaluation of the “dead” of the input doses delivered to the patients. The results performance of the X-ray tube. The devices are calibrated th beforehand by the manufacturers and the parameters applied obtained were calculated using the75 percentile method. The good practicing in radiographic involves a permanent on the console for any examination are not the same at the exit of the tube. adaptation of the technical procedure related to the equip- ment, the choice of parameters (irradiation and geometry), and possible accessories, which constantly influence the dose 4.3. State of Exposure and Context. Table 3 presents the following: received by the patient. The resumption of radiographic examinations is an important preventable or at least reducible (i) The result of the exploration of the sinuses was in the order of 7.02-0.2 mGy. This result was greater than 3.2 mGy factor of overexposure of patients. Effective remediation estimated by [14], but similar to 5.06 mGy, estimated by [15]. and reduction measures such as periodic assessment and dosimetric testing must be considered. Mali and Cameroon share some common points of delay in the radiation protection of patients. 4.1. Perception of Sociodemographic Data. Table 1 presents (ii) At the end of the exploration of the coastal grill, the sociodemographic data of the patients. Ages, sex, and we obtained 5.27±0.1mGy. This result appears very high to weight of the patient are the most important parameters in our knowledge because the thoracic framework is a bone considering the interpretation of radiological images. The structure. It can be explored from low settings. According technical choices of performing an examination are also a to [16], the reduction in voltage and charge (mAs) has been function of the morphotype of the patient. Therefore, some showntobeeeff ctive inreducing the dosedelivered by40% clinicians would ignore the importance of these parameters without impairing the diagnostic quality of images, especially for imaging, coupled with the fact that some patients in our for bone structures. 4 Radiology Research and Practice Table 3: Technical parameters used. ESD rd Radiography Projection 3 quartile SD mmAs DFF FSD Min Max 65-80 32-50 1.3-1.5 1.0-1.3 Sinuses PA 5.8 12.2 7.02 0.2 66.1±1.5 41.9±2.4 1.2±0.04 1.1±0.04 65-75 40-55 1.5-1.8 1.2-1.5 Coastal grill AP 4.98 7.67 5.27 0.1 66.7±2.0 43.2±2.1 1.6±0.07 1.3±0.06 kV: kilovolt, mAs: milliampere second, FFD: focus-film distance, FSD: focus-skin distance, ESD: entrance skin dose, SD: standard deviation. Table 4: Comparison between our values and some of them. more than the manipulation console oer ff s a platform for adjustment irradiation parameters and therefore dosimetric DRL Mali Saudi Arabia controls. As imaging spreads to the most remote areas of the Radiography Projection Our study Europe [15] [14] country, there is an urgent need to optimize work protocols. Sinuses PA 7.02±0.2 - 5.06 3.2 This optimization of the protocols could be achieved by Coastal grill AP 5.27±0,1 - - - continuous training; the display in the examination rooms of the working protocols and a permanent comparison of the values to the references and permanent correction measures could partly reduce the observed radiology differences. 4.4. Knowledge of Radiation Protection during Standard Radiological Examinations. Table 4 presents a comparative statement between our results and others elsewhere. This 5. Conclusion table indicates that the values are obtained by [14, 15]. The risk of irradiation is potentiated by the nonobservance of These differences were specifically associated with exceeding nominal values as proposed by the manufacturer despite the the basic principles of patient protection. Far from trivializing the exposure of patients to the ionizing radiation, we must absence of protocols. This study is devoted to examinations instead be vigilant and educate staff about it and we are that are weakly “realized” and whose evaluation in dosimetric proposing the measures to reduce the skin entrance doses. terms is often not considered. Yet, they are strongly radiating. However, the dosimetric analysis remains very worrying. We note that these results cannot be extrapolated to all radiology departments in Cameroon because the study was The analysis of the different procedures shows that an improvement of the practices especially with respect to the based on the principle of voluntary. Nevertheless, these values technical parameters and the protocols, combined with a are indicatives from the dosimetric point of view. Despite the existence of a law governing radiation protection and reinforcement of the radioprotection competences of the radiology manipulators (continuous training and recycling), an agency in charge of radiation protection, the absence of will contribute to a better radioprotection of the patients. technical protocols in the examination room makes it difficult to control the doses delivered to patients. As observed The creation of a regulatory framework allowing not only the radiation protection of the patients but also the personnel elsewhere, the absence of texts in favor of radioprotection must be effective on the ground, by means of the periodic and or extracts in this radiology department proves the controls and the evaluations of the professional practices. embryonic state of radiation protection of patients in this This work is also an essential call to work in the mastery department. In practice, it is possible to avoid unnecessary radiation despite attendance routine trainees and make good of technical and standardization of examination protocols to control and optimize the doses delivered to patients for a quality pictures. But this observation is still very alarming, better match of the image quality and the low dose over the when X-rays are carried out daily by some caregivers who have no background profile of the efi ld but rather converted area. into radiology manipulators. The latter then have no idea or then a rough knowledge of the texts in favor of radiation pro- Data Availability tection. All these observations point to [17]; unlike developed countries, in the sub-Saharan African countries, particularly The data used to support the findings of this study are in Cameroon, legislative and regulatory frameworks are available from the corresponding author upon request. either nonexistent or are implemented in an approximate manner and the practices of radiation protection of patients Conflicts of Interest are poorly documented in a context of expanding medical imaging. If the report is real, it is necessary to note the The authors declare that they have no conflicts of interest. embryonic and precarious state of the standards and devices in favor of the radioprotection of the patients. Moreover, References the lack of qualified personnel in radiation protection and the lack of resources and continuing training in radiological [1] D. Z. Joseph, O. Chinedu, N. Favious, G. Luntsi, L. Shem, and protection should only lead to approximate visions of radia- Y. Dlama, “Rationale for implementing dose reference level as a tion protection if the manipulators were recycled; endowing quality assurance tool in medical radiography in Nigeria,” IOSR Radiology Research and Practice 5 JournalofDentaland Medical Sciences,vol.13, no. 12,pp. 41–45, [17] Z. P. Ongolo, B. S.Nguehouo, J. Yomi,and S.et Nkoo Amvene, 2014. “Connaissances en matier ` e de radioprotection: enquete ˆ aupres ` des personnels des services hospitaliers de radiodiagnostic, [2] J. Gray, “Reference values-what are they?” American Association radiothera ´ pie et med ´ ecine nuclea ´ ire aY ` aounde,´” Communica- of Physicist in Medicine,vol.24,pp.9-10,1999. tion orale Journ´ees Franc¸aises de Radiologie, pp. 21–25, 2011. [3] O.E. Kwasi,D. N. Scutt, W. Matt, H.V. Kwaku,and D.T. Klenam, “Evaluation of patient radiation dose from skull X- ray examinations in Ghana,” Journal of Medical and Biomedical Science,vol.12, 2012. [4] A. Nasr, N. Khidir, Y. Mohamed et al., “A review study on patients radiation dose from diagnostic radiography,” Interna- tional Journal of Science and Research, vol.2,pp.372–378,2013. [5] Y. S. Cordoliani, P. Grenier, H. Beauvais, J. E. Grellet, D. E. Marshall, and M. Bourguignon, “Le point sur les proced ´ ures en radiologie conventionnelle et en tomodensitometrie, ´ ” M´edecine Nucl´eaire Imagerie Fonctionnelle et M´etabolique, vol.26,no.5, pp. 241–246, 2002. [6] C.J. Olowookere,I.A.Babalola, N. N.Jibiri, R. I.Obed,L.L. Bamidele, and E. O. A. Jetumobi, “A preliminary radiation dose audit in some nigerian hospitals : need for determination of national diagnostic reference levels (NDRLs),” The Pacific Jour- nal of Science and Technology, vol.13,no.1,pp. 487–495,2012. [7] V.Tsapaki,I.A. Tsalafoutas, I.Chinofotiet al.,“Radiation doses to patients undergoing standard radiographic examinations: a comparison between two methods,” British Journal of Radiology, vol. 80,no. 950, pp.107–112, 2007. [8] K. Suchart and T. Montree, “An estimation of X-radiation output using mathematic model american,” Journal of Applied Sciences,vol. 8,no. 9, pp.923–926, 2011. [9] K. Faulkner, D. A. Broadhead, and R. M. Harrison, “Patient dosimetry measurement methods,” Applied Radiation and Iso- topes, vol.50,pp.113–123,1999. [10] M. Davies, H. Mc Callum, G. White, J. Brown, and M. Hlem, “Patient dose audit in diagnostic radiography using custom designed sow ft are,” Radiography,vol. 3, pp. 17–25, 1997. [11] C. J. Olowookere, I. A. Babalola, M. O. Olayiwola, G. Odina, R. I. Obed, and T. O. Bello, “Comparison of five models for assessing patient dose from radiological examinations,” African Journal Medical Physik, Biomed Eng & Sc,vol.1, pp.21–29,2009. [12] B. Moifo, M. Kamgnie, N. Ndeh Fointama, J. Tambe, H. Tebere, and F.J.Gonsu,“Evaluation de la conformite´ des demandes d’examens d’imagerie med ´ icale : une experienc ´ e en Afrique subsaharienne,” M´edecine et Sant´eTropicales,vol.24, pp. 392– 396, 2014. [13] B. Moifo, U. Tene, J. R. Moulion Tapouh et al., “Knowledge on irradiation, medical imaging prescriptions, and clinical imaging referral guidelines among physicians in sub-saharan African country (Cameroon),” Radiology Research and Pratice,pp.1–7, [14] J. George,J. P.Eatough, P. J.Mountford,C. J.Koller, J.Oxtoby, and G. Frain, “Patient dose optimization in plain radiography basedon standardexposure factors,” British Journal of Radiol- ogy,vol.77,no.922,pp. 858–863, 2004. ´ ` [15] T. Sounkalo, Etude Comparative de la Dose Patient Ala Dosede R´ef´erence Dans le Service de Radiologie et d’Imagerie M´edicale de L’Hop ˆ ital Gabriel Tour´e(HGT) APropos de70Cas [Th `ese de M´edecine],Universited ´ e Bamako, Faculted ´ e Med ´ ecine, de Pharmacie et d’Odontostomatologie (FMPOS), 2006. 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Exposure Levels of Adult Patients during Radiographic Examinations: Sinuses and Coastal Grill Cases at the Ngaoundere Regional Hospital, Cameroon

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Hindawi Radiology Research and Practice Volume 2019, Article ID 5452149, 5 pages https://doi.org/10.1155/2019/5452149 Research Article Exposure Levels of Adult Patients during Radiographic Examinations: Sinuses and Coastal Grill Cases at the Ngaoundere Regional Hospital, Cameroon 1,2 3 4 1,5 Guiswe Gnowe , Fouda H. P. Ekobena, Amvene J. Mbo, and Guena M. Neossi Department of Biomedical Sciences, Faculty of Sciences, University of Ngaoundere, Cameroon Higher Institute of Sciences, Health Technics and Management of Garoua, Cameroon University Institute of Technology, University of Ngaoundere, Cameroon Faculty of Medicine and Biomedical Sciences of Garoua, Cameroon Department of Radiology and Medical Imaging,RegionalHospitalof Ngaoundere, Cameroon Correspondence should be addressed to Guiswe Gnowe; gnoweguiswe@gmail.com Received 29 October 2018; Revised 28 February 2019; Accepted 13 March 2019; Published 30 April 2019 Academic Editor: Paul Sijens Copyright © 2019 Guiswe Gnowe et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. eTh purpose of this study was to estimate the doses delivered to adult patients during explorations of the sinuses and coastal grill whose attention in dosimetric terms is neglected because of the low demand for diagnosis. But yet dosimetric values are very high. Materials and Methods. eTh present study was transversely descriptive and was conducted between April and July 2016. The data were collected on 50 adult patients of mass of 70 ±10kg at the Regional Hospital of Ngaoundere (HRN). eTh dose at the entrance of the patients' skin was evaluated through the theoretical methods derived from the Davies model according to the 75th percentile calculations. Results and Discussion. eTh entrance skin doses obtained in mGy were, respectively, of 7.2± 0.2 for sinuses and 5.27±0.1 for coastal grill. The present study found many variations in doses during radiological investigations. es Th e variations allowed us to understand that the notions of quality of the radiographic image, insurance, and quality control of the radiological equipment are tributary, abstract, and oen ft theoretical because doses delivered are not sufficiently optimized. Conclusion.The dosimetric analysis remains very worrying because the various procedures show that an improvement of the practices especially with respect to the technical parameters and the protocols must be considered. er Th efore a strengthening of radiological protection skills of radiological manipulators (continuing education and retraining) would contribute to a better protection of patients. 1. Introduction clinic and make the diagnosis [1]. These large variations in the doses delivered to patients for the same examination also In radiology, patient dosimetry is a good match between show a crucial importance for the study of dose variations [2], image quality and the low dose process. Continuous eval- for quality assurance and standardization of protocols [3], in uation by means of periodic inspections and the fight to order to guarantee the optimization of doses to patients. We reduce the doses delivered should be at the center of the must give ourselves the means to measure and to evaluate this activities (after the structure in charge through effective energy and to verify that patients are not overexposed during monitoring in the eld fi and in all structures equipped with standard radiography. X-ray tubes). In fact, the doses delivered to patients during Patient dosimetry is a functional operation parameter medical imaging examinations are not sufficiently controlled such as high voltage or kilovolt (kV), current intensity or and the working protocols for a given examination differ from milliamperage (mAs), morphotype, posteroanterior (PA), one hospital service to another. These variations indicate anteroposterior (AP), focus-skin distance (FSD), and el fi d that good imaging technique is needed to reduce the dose and lt fi ration [4]. It should be noted that the diagnosis to patients at the lowest practicable level to respond to the is dependent on the quality of the radiological image and 2 Radiology Research and Practice therefore of the dose at the entrance surface of the skin. In processed and analyzed with the strictest anonymity. The radiology, the dosimetric quantities selected for the Diag- calculations, the output of the tube, and the entrance skin nostic Reference Levels (DRLs) determinations are the input dose (ESD) patients were donned by Sphinx Plus V.5.1.0.6 dose (ESD in mGy) and the Dose-Area Product (DAP in and Excel 2010. Gy.cm )[5]. The entrance skin dose (ESD) in conventional radiog- 2.3. Calculation of the Dose. The irradiation and geometric parameters involved in the calculation of the dose at the raphy can be obtained by calculation from mathematical th methods or measured by a thermoluminescent dosimeter entrance of the skin were calculated (by means of 75 (TLD) [6]. These methods have relatively small differences. percentiles, standard deviations). The calculation of the dose The calculation or mathematical method appears reliable and at the entrance of the skin began by calculating the output is an effective alternative for measuring the entrance skin dose (output) of the X-ray tube according to the model of [8]: [7]. The determination of patient doses is an essential part of the optimization process, such as the adequacy of the image 𝑂 𝑚𝑅 −1 −4 2 2 (𝑚𝑅 )=𝐴×6,53×10 ( )(𝑘𝑉 ) ×𝑘𝑉 and radiation in radiological examination. The optimization 𝑃 𝑚𝐴𝑠 (1) of doses delivered during the radiological examinations, by ×𝑚𝑠𝐴 the determination of the DRLs, the control of the quality of the installations, and radiological procedure, makes it where A is a constant equal to 0.5; 0.8 and 1 are for single- possible to minimize the risk related to these irradiations phase, three-phase, and high frequency tubes generators. As by reducing the dose received by the patient. The concept part of our study, the X-ray tube was three phases. The of DRL is specific to medical exposures and should not be −1 yields obtained in (mR) were converted to mGy, mAs by confused with that of “individual dose limit” which is applied multiplication at a factor of 0.00877/mAs [9]. in these areas of radiation protection of workers and the Then, the calculation of the dose at the entrance of the public. Reference levels are tools for improving practices and skin proper for each patient was according to the Davies optimizing doses. These levels exist only for routine explo- model [10]. Thisisthanks tothe values of irradiation param- rations in radiological examination. Respect for the reference eters and geometric and output values. We chose this model levels is not, by itself, a criterion of good practice. The primary because it integrates all the elements directly, involved in the goal, inseparable from dosimetry, is the diagnostic quality of realization of radiographic examinations and the definition low dose images [5]. of the dose at the entrance of the skin [11]. The logic of Our objectives were the following: the arrangement of radiographic parameters in this formula (i) Determine the sociodemographic profiles of the obeys well to that realized during the obtaining of the patients received for these particular examinations. radiographic images. (ii) Determine the dose levels delivered to adult patients based on radiological exploration by theoretical mod- 𝑂 𝑘𝑉 𝐷(𝑦)𝑚𝐺 =( )×( ) ×𝑚𝑠𝐴 els of dose calculation. 𝑃 80 (2) (iii) Compare the results obtained with those obtained elsewhere according to our realities. ×( ) ×𝐵𝐹𝑆 2. Materials and Methods Only images of good qualities accepted for interpretation were considered. The study was authorized by the ethics The study was monocentric, descriptive, and transversal. committee of the hospital structure. It took place between April and July 2016 (four months), in the Radiology and Medical Imaging Department of the Ngaounder ´ e´ Regional Hospital. This department is equipped 3. Results with a GENERAL ELECTRIC X-ray tube, model 5192454, The results obtained only were presented in Table 4. whose maximum voltage was around 150 kV. 3.1. Sociodemographic Data. For 50 subjects, men were more 2.1. Target. Included in this study were all adult subjects represented than women (66%), with a sex ratio (H/F=1.94). irrespective of sex and age who had undergone a blondeau radiographic examination and coastal grill during the period. Regarding the male sex: the mean age was 40.33 and the standard deviation was 8.54 years; the range of age was 26-48 The data collected include age, sex, and anthropometric data years for sinuses. of patients with weights between 60 and 80 kg. The mean age was 27.2 and the standard deviation was 2.2. Collection and Statistical Analysis. The information was 6.64 years; the range of age was 20-38 years for coastal grill. collected using a sheet adapted according to the model of With regard to the female sex: the mean age of the women the Institute of Radiation Protection and Nuclear Safety was 27.2 and the standard deviation was 6.64 years; the range (IRNS) dosimetric evaluation. The irradiation parameters of age was between 20 and 38 years for sinuses. The mean age used (kV, mAs), the geometric parameters (FFD, FSD), was 33.16 and the standard deviation was 6.22 years; the range and the anthropometric data (age, sex, and weight) were of age was between 32 and 41 years for coastal grill. 𝐹𝑆𝐷 𝐸𝑆 Radiology Research and Practice 3 3.2. Yield of X-Ray Tube. The different values of the output Table 1: Sociodemographic characteristics. are essential for the process of optimizing the dose delivered Radiography Sex Amount Age (years) Weight (kg) and the quality of the images. They are directly a function 26-48 65-78 of the high voltage (kV) and the load (mAs). For sinuses, in M14 −1 40.33±8.54 71.33±5.77 mGy. (mAs) , the output ranged from 0.19 to 0.29 in PA. For Sinuses −1 26-54 61-78 coastal grill, in mGy (mAs) , output ranged from 0.19 to 0.25 F11 33.57±9.04 69.42±5.02 in AP. 20-38 63-78 M19 27.2±6.64 68.5±3.62 3.3. Overall Knowledge of the Irradiation Parameters Used Coastal grill 32-41 65-76 during Exams. The parameters presented in this study are F6 33.16±6.22 70.33±4.52 thosethat made itpossibletoobtain good quality according M: male, F: female. to the different morphotypes of the patients. These param- eters are very important in the process of optimizing the −1 Table 2: Output of X-ray tube in mR and mGy.(mAs) . dose delivered and improving the quality of the images. After calculation (mGy), the third quartile was 7.02 and standard Output deviation was 0.2 for sinuses. The minimum and maximum Output(mR) −1 Radiography Projection mGy.(mAs) entrance skin dose ranged from 5.8 to 12.2 in PA. The third Min Max Min Max quartile was 5.27 and standard deviation was 0.1 for coastal Sinuses PA 22.07 33.43 0.19 0.29 grill. The minimum and maximum entrance skin dose skin ranged from 4.98 to 7.67 in AP. Coastal grill AP 22.07 29.38 0.19 0.25 PA: posteroanterior, AP: anteroposterior, Min: minimum, max: maximum. 3.4. Study of Comparative Values. The values obtained (mGy) were compared with those obtained elsewhere by the same environment are not always able to accurately age [12]. Much approaches. The entrance skin dose was 7.02 ±0.2 for sinuses in PA. Theentrance skin dosewas 5.27 ±0.1 for coastal grill in more according to [13], the level of awareness of clinicians AP. in Cameroon is very low and supercial, fi which aec ff ts the quality of their imaging demands. Despite the compliance of certain test reports, it should be noted that contact with 4. Discussion the patient during imaging examinations should allow us to The population of our study consisted of patients admitted complete the missing parameters. to the Radiology Department of the Regional Hospital of Ngaoundere. The study included 50 adult patients of more 4.2. Importance of X-Ray Tube Performance. Table 2 presents than 20 years, both sexes, with a weight between 60 and the estimation of the X-ray tube yielding from the theoretical 80 kg. X-ray examinations were performed by manipulators model proposed by [8]. It is important to consider tube of dieff rent rank and seniority. The parameters used for efficiencies for each specific run to control tube power and the same examination were variable according to the habits to take corrective action if deviations from normal are noted. of each manipulator. Many manipulators do not have the Obtaining a quality image is the primary function of the same rules of good practice. These different parameters were efficiency of the X-ray tube. The power of the tube becomes observable on the quality of the snapshots and the disparity an optimization factor in the evaluation of the “dead” of the input doses delivered to the patients. The results performance of the X-ray tube. The devices are calibrated th beforehand by the manufacturers and the parameters applied obtained were calculated using the75 percentile method. The good practicing in radiographic involves a permanent on the console for any examination are not the same at the exit of the tube. adaptation of the technical procedure related to the equip- ment, the choice of parameters (irradiation and geometry), and possible accessories, which constantly influence the dose 4.3. State of Exposure and Context. Table 3 presents the following: received by the patient. The resumption of radiographic examinations is an important preventable or at least reducible (i) The result of the exploration of the sinuses was in the order of 7.02-0.2 mGy. This result was greater than 3.2 mGy factor of overexposure of patients. Effective remediation estimated by [14], but similar to 5.06 mGy, estimated by [15]. and reduction measures such as periodic assessment and dosimetric testing must be considered. Mali and Cameroon share some common points of delay in the radiation protection of patients. 4.1. Perception of Sociodemographic Data. Table 1 presents (ii) At the end of the exploration of the coastal grill, the sociodemographic data of the patients. Ages, sex, and we obtained 5.27±0.1mGy. This result appears very high to weight of the patient are the most important parameters in our knowledge because the thoracic framework is a bone considering the interpretation of radiological images. The structure. It can be explored from low settings. According technical choices of performing an examination are also a to [16], the reduction in voltage and charge (mAs) has been function of the morphotype of the patient. Therefore, some showntobeeeff ctive inreducing the dosedelivered by40% clinicians would ignore the importance of these parameters without impairing the diagnostic quality of images, especially for imaging, coupled with the fact that some patients in our for bone structures. 4 Radiology Research and Practice Table 3: Technical parameters used. ESD rd Radiography Projection 3 quartile SD mmAs DFF FSD Min Max 65-80 32-50 1.3-1.5 1.0-1.3 Sinuses PA 5.8 12.2 7.02 0.2 66.1±1.5 41.9±2.4 1.2±0.04 1.1±0.04 65-75 40-55 1.5-1.8 1.2-1.5 Coastal grill AP 4.98 7.67 5.27 0.1 66.7±2.0 43.2±2.1 1.6±0.07 1.3±0.06 kV: kilovolt, mAs: milliampere second, FFD: focus-film distance, FSD: focus-skin distance, ESD: entrance skin dose, SD: standard deviation. Table 4: Comparison between our values and some of them. more than the manipulation console oer ff s a platform for adjustment irradiation parameters and therefore dosimetric DRL Mali Saudi Arabia controls. As imaging spreads to the most remote areas of the Radiography Projection Our study Europe [15] [14] country, there is an urgent need to optimize work protocols. Sinuses PA 7.02±0.2 - 5.06 3.2 This optimization of the protocols could be achieved by Coastal grill AP 5.27±0,1 - - - continuous training; the display in the examination rooms of the working protocols and a permanent comparison of the values to the references and permanent correction measures could partly reduce the observed radiology differences. 4.4. Knowledge of Radiation Protection during Standard Radiological Examinations. Table 4 presents a comparative statement between our results and others elsewhere. This 5. Conclusion table indicates that the values are obtained by [14, 15]. The risk of irradiation is potentiated by the nonobservance of These differences were specifically associated with exceeding nominal values as proposed by the manufacturer despite the the basic principles of patient protection. Far from trivializing the exposure of patients to the ionizing radiation, we must absence of protocols. This study is devoted to examinations instead be vigilant and educate staff about it and we are that are weakly “realized” and whose evaluation in dosimetric proposing the measures to reduce the skin entrance doses. terms is often not considered. Yet, they are strongly radiating. However, the dosimetric analysis remains very worrying. We note that these results cannot be extrapolated to all radiology departments in Cameroon because the study was The analysis of the different procedures shows that an improvement of the practices especially with respect to the based on the principle of voluntary. Nevertheless, these values technical parameters and the protocols, combined with a are indicatives from the dosimetric point of view. Despite the existence of a law governing radiation protection and reinforcement of the radioprotection competences of the radiology manipulators (continuous training and recycling), an agency in charge of radiation protection, the absence of will contribute to a better radioprotection of the patients. technical protocols in the examination room makes it difficult to control the doses delivered to patients. As observed The creation of a regulatory framework allowing not only the radiation protection of the patients but also the personnel elsewhere, the absence of texts in favor of radioprotection must be effective on the ground, by means of the periodic and or extracts in this radiology department proves the controls and the evaluations of the professional practices. embryonic state of radiation protection of patients in this This work is also an essential call to work in the mastery department. In practice, it is possible to avoid unnecessary radiation despite attendance routine trainees and make good of technical and standardization of examination protocols to control and optimize the doses delivered to patients for a quality pictures. But this observation is still very alarming, better match of the image quality and the low dose over the when X-rays are carried out daily by some caregivers who have no background profile of the efi ld but rather converted area. into radiology manipulators. The latter then have no idea or then a rough knowledge of the texts in favor of radiation pro- Data Availability tection. All these observations point to [17]; unlike developed countries, in the sub-Saharan African countries, particularly The data used to support the findings of this study are in Cameroon, legislative and regulatory frameworks are available from the corresponding author upon request. either nonexistent or are implemented in an approximate manner and the practices of radiation protection of patients Conflicts of Interest are poorly documented in a context of expanding medical imaging. If the report is real, it is necessary to note the The authors declare that they have no conflicts of interest. embryonic and precarious state of the standards and devices in favor of the radioprotection of the patients. Moreover, References the lack of qualified personnel in radiation protection and the lack of resources and continuing training in radiological [1] D. Z. Joseph, O. Chinedu, N. Favious, G. Luntsi, L. Shem, and protection should only lead to approximate visions of radia- Y. 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