Patient dose and lifetime cancer risk from contrast-enhanced radiography examination in a tertiary health institution in Delta State, South-South, Nigeria

• Authors: Ebube Mmeli Eze , Hycainth Uche Chiegwu , Joseph Dlama Zira , Akintayo Daniel Omojola , Obiora Chijioke Asogwa , Esu Esu Okon , Chidimma Ihefobi
• Languages of publication: EN

Abstracts

EN

Contrast-enhanced radiography examination requires multiple exposures and may sometimes involve the patient receiving a higher radiation dose than expected. The study was aimed at determining the mean entrance skin doses (ESDs), dose area products (DAPs) and effective doses (Eff) for 6 interventional procedures. The study was compared to similar guidelines and articles, with the aim of fashioning out a local diagnostic reference level in the region and it also determined the lifetime cancer risk for 3 out of the 6 contrast-enhanced procedures. The study used a 3-phase ceiling-mounted digital radiography (DR) X-Ray Unit (POLYRAD PREMIUM CS-Radiologia). A total of 140 investigations were carried out and the average patient age was 45.35 years. Patient doses were estimated using thermoluminescent dosimeters (TLDs) [Lithium Fluoride doped with Magnesium and Titanium (LiF: Mg, Ti)]. Patient ESDs and DAPs for barium enema (BE), barium meal (BM), barium swallow (BS), hysterosalpingogram (HSG), intravenous urogram (IVU) and micturating cystourethrogram (MCU) ranged from 7.51-12.01 mGy and 7.25-13.65 Gy.cm2, while the effective doses (Eff) ranged from 1.45-4.10 mSv. The DAP for BE, BM, BS and IVU was lower compared to the United Kingdom (UK), Ireland and Japan but HSG and MCUG were higher compared to the UK reports. The lifetime cancer risk for BS (46 per million) and IVU (114 per million) was comparable to the United Kingdom (UK) Health Protection Agency (HPA), while the lifetime cancer risk was doubled for BE compared to the UK HPA report. The study proved useful in areas where the use of contrast-enhanced radiography is still in use. The study has demonstrated that lower ESD and DAP can be achieved, which is comparable to the fluoroscopy modality.

Keywords

EN

Contrast-Enhanced Radiography; Dose Area Product (DAP); Entrance Skin Dose (ESD); Ionization Chamber (IC); Thermoluminescent Dosimeter (TLD)

Discipline

• PHYSICS: PHYSICS

• Publisher: Scientific Publishing House „DARWIN”
• Journal: World News of Natural Sciences
• Year: 2023
• Volume: 46
• Pages: 87-100

Contributors

author

Ebube Mmeli Eze

• Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria

author

Hycainth Uche Chiegwu

• Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria

author

Joseph Dlama Zira

• Department of Radiography, Federal University of Lafia, Nasarawa State, Nigeria

author

Akintayo Daniel Omojola

• Department of Radiology, Medical Physics Unit, Federal Medical Centre Asaba, Asaba, Delta State, Nigeria

author

Obiora Chijioke Asogwa

• Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria

author

Esu Esu Okon

• Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria

author

Chidimma Ihefobi

• Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria

References

• [1] Pomara C, Pascale N, Maglietta F, Neri M, Riezzo I, Turillazzi E. Use of contrast media in diagnostic imaging: medico-legal considerations. Radiol Med. 2015; 120 (9): 802-9
• [2] Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. Biomed Res Int. 2014; 2014: 741018
• [3] Sun J, Li Z. Study on the Correlation between Barium Radiography and Pulmonary Infection rate in the Evaluation of Swallowing Function. Clinics 2018; 73: e182
• [4] Wong VK, Ganeshan D, Jensen CT, Devine CE. Imaging and Management of Bladder Cancer. Cancers 2021; 13(6): 1396
• [5] Schankath AC, Fasching N, Urech-Ruh C, Hohl MK, Kubik-Huch RA. Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings. Insights Imaging. 2012; 3(5):475-83.
• [6] Sulieman A, Elzaki M, Kappas C, Theodorou K. Radiation dose measurement in gastrointestinal studies. Radiat Prot Dosimetry. 2011; 147(1-2): 118-21
• [7] Kasprzyk L, Chmaj-Wierzchowska K, Jurczyk MU. Physical parameters affecting the distribution of X-ray dose during hysterosalpingography. Clin. Exp. Obstet. Gynecol. 2020, 47(5), 729–735
• [8] Mahajan A, Desai S, Sable NP, Thakur MH. Status of barium studies in the present era of oncology: Are they a history? Indian J Med Paediatr Oncol. 2016; 37(4): 223-226
• [9] Faizah M, Kanaheswari Y, Thambidorai C, Zulfiqar M. Echocontrast cystosonography versus micturating cystourethrography in the detection of vesicoureteric reflux. Biomed Imaging Interv J. 2011; 7(1): e7
• [10] Wambani JS, Korir GK, Tries MA, Korir IK, Sakwa JM. Patient radiation exposure during general fluoroscopy examinations. J Appl Clin Med Phys. 2014; 15(2), 262-270
• [11] Buls N, Osteaux M. Patient and staff dose during hysterosalpinography. IAEA Publications. 2001: IAEA-CN-85-73
• [12] Bonilha HS, Huda W, Wilmskoetter J, Martin-Harris B, Tipnis SV. Radiation Risks to Adult Patients Undergoing Modified Barium Swallow Studies. Dysphagia. 2019; 34(6): 922-929
• [13] Iacob O, Diaconescu C. Doses to patients from diagnostic radiology in Romania. IAEA Publications. 2001; IAEA-CN-85-105: 53-57
• [14] Pataramontree J, Wangsuphachart S. Patient and fetal dose in diagnostic and radiotherapy in Bangkok, Thailand. IAEA Publications. 2001; IAEA-CN-85-26: 527-531
• [15] Milu C, Dumitrescu A, Marin R, Popescu FS. Radiation doses to patient in diagnostic radiology in Romania; comparison with guidance level and possibility of reduction. IAEA Publications. 2001; IAEA-CN-85-5: 17-20
• [16] Spoelstra FM, Geleijns J, Broerse JJ, Teeuwisse WM, Zweers D. Patient dose surveys for radiological examinations in Dutch Hospital between 1993-2000. IAEA Publications. 2001; IAEA-CN-85-217: 79-83
• [17] Einarsson G, Magnusson SM. Patient doses and examination frequency for diagnostic radiology in Iceland 1993-1998. IAEA Publications. 2001; IAEA-CN-85-263: 84-88
• [18] Axelsson B. Optimisation in fluoroscopy. Biomed Imaging Interv J. 2007; 3(2): e47
• [19] Crowhurst J, Whitby M. Lowering fluoroscopy pulse rates to reduce radiation dose during cardiac procedures. J Med Radiat Sci. 2018; 65(4): 247-249
• [20] Kolck J, Ziegeler K, Walter-Rittel T, Hermann KGA, Hamm B, Beck A. Clinical utility of postprocessed low-dose radiographs in skeletal imaging. Br J Radiol. 2022; 95(1130): 20210881
• [21] Idowu BM, Okedere TA. Diagnostic radiology in Nigeria: A country report. J Glob Radiol. 2020; 6(1): 1072
• [22] Ekpo EU, Egbe NO, Azogor WE, Inyang SO, Upeh ER. Challenges of radiological equipment management policies in some northern Nigerian hospitals. SAR. 2013; 51: 19-22
• [23] Sharma R, Sharma SD, Pawar S, Chaubey A, Kantharia S, Babu DA. Radiation dose to patients from X-ray radiographic examinations using computed radiography imaging system. J Med Phys. 2015; 40(1): 29-37
• [24] Peacock NE, Steward AL, Riley PJ. An evaluation of the effect of tube potential on clinical image quality using direct digital detectors for pelvis and lumbar spine radiographs. J Med Radiat Sci. 2020;67(4): 260-268
• [25] International Atomic Energy Agency (IAEA). Patient dose optimization in fluoroscopically guided interventional procedures. Vienna: IAEA; 2010. IAEA-TECDOC-164
• [26] International Atomic Energy Agency, Dosimetry in diagnostic radiology: an international code of practice. Vienna: IAEA; 2007. Technical Reports Series No.: 457.
• [27] Han SC. Preliminary study for dose evaluation depending on dose range with optically stimulated luminescence dosimeter considering individual dosimeter sensitivity. PLoS One. 2022; 17(3): e0266110
• [28] Omojola AD, Adeneye SO, Akpochafor MO, Akala IO, Agboje AA. Comparison of entrance surface air kerma measurement with MTS-N (LiF: Mg, Ti) chips with a kilovoltage X-ray source. ASEAN J Radiol. 2021; 22(1): 20-34
• [29] Omojola AD, Akpochafor MO, Adeneye SO, Aweda MA. Calibration of MTS-N (LiF: Mg, Ti) chips using cesium-137 source at low doses for personnel dosimetry in diagnostic radiology. Radiat Prot Environ 2020; 43: 108-14
• [30] Yakoumakis E, Tsalafoutas IA, Nikolaou D, Nazos I, Koulentianos E, Proukakis C. Differences in effective dose estimation from dose-area product and entrance surface dose measurements in intravenous urography. Br J Radiol. 2001; 74(884): 727-34
• [31] Hart D, Wall BF. Radiation exposure of the UK population from medical and dental X-ray examinations. NRPB-W4. Didcot: Chilton; 2002.
• [32] Meiboom MF, Hoffmann W, Weitmann K, von Boetticher H. Tables for effective dose assessment from diagnostic radiology (period 1946–1995) in epidemiologic studies. PLoS ONE. 2021; 16(4): e0248987
• [33] American Association of Physicists in Medicine (AAPM). Quality control in diagnostic radiology. AAPM report no. 74. American Association of Physicists in Medicine 2002.
• [34] Institute of Physics and Engineering in Medicine (IPEM). Recommended standard for the routine performance testing of diagnostic X-ray imaging systems. York: IPEM; 2005.
• [35] Hart D, Hillier MC, Shirmpton PC. Doses to patients from radiographic and fluoroscopic X-ray imaging procedure in the UK-2010 report. Didcot: Chilton; 2012. (HPA-CRCE-034). Adopted 2016
• [36] Health Information and Quality Authority (HIQA). Diagnostic Reference Levels: Guidance on the establishment, use and review of diagnostic reference levels for medical exposure to ionising radiation. Dublin: HIQA; 2021.
• [37] National Diagnostic Reference Levels in Japan (NDRLJ). Japan Network for Research and Information on Medical Exposure (J-RIME). 2020
• [38] Zira JD, Nzotta CC, Skam JD. Diagnostic reference levels (DRLs) for contrast radiography examinations in North Eastern Nigeria. PJR. 2018; 28(1): 9-16
• [39] Delichas MG, Hatziioannou K, Papanastassiou E, Albanopoulou P, Chatzi E, Sioundas A, Psarrakos K. Radiation doses to patients undergoing barium meal and barium enema examinations. Radiat Prot Dosim. 2004; 109(3), 243–247
• [40] Nazlea BP. Determination of effective dose and entrance skin dose from dose area product values for barium studies in adult patients at a large tertiary hospital in the Western Cape. Cape Peninsula University of Technology. South Africa. Published dissertation/thesis. 2017
• [41] Ramsdale ML, Peet D, Hollaway P, Rust A. Patient dose surveys and use of local and national diagnostic reference levels. IAEA Publications. 2001; IAEA-CN-85-248: 434-439.
• [42] Ijabor BO, Nzottza CC, Omojola AD. Quality control test of conventional X-Ray systems in Delta State, South-South, Nigeria. World Scientific News 157 (2021) 140-153
• [43] Omojola AD, Akpochafor MO, Adeneye SO, Akala IO, Agboje AA. Chest X-rays of newborns in a medical facility: variation between the entrance skin dose measurements using the indirect and direct methods for clinical dose audit. Jpn J Radiol 40, 219–225 (2022)

• Document Type: article