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Diagnostic reference levels (DRLs) for chest radiography, non-contrast head computed tomography and mammography examinations in Nigeria: review of national data

Abstract

Aims and objectives

To establish the national diagnostic reference levels (DRLs) for chest radiography, non-contrast head computed tomography (CT) and mammography examinations of adults in Nigeria.

Materials and methods

The study consisted of review of published studies on DRLs in Nigeria found in the internet using Google search engine from 2005 to 2019. Only publications containing substantial parts of the exposure parameters were used for the studies.

Result

For chest radiography, the mean parameters for posterior–anterior (PA) view were, tube voltage 80 (33–100) kV, tube current 30.8 (0.05–100) mAs, film–focus distance (FFD) 140 (62–178) cm, mean entrance dose 2.6 (0.12–7.7) mGy and mean effective dose (MED) 0.05 (0.018–0.16) mSv. For head CT, tube voltage 120 (100–140) kV, tube current 390 (215–550) mA, CT dose index (CTDI vol) 67 (25–88) mGy, dose length product (DLP) 1410 (320–1903) mGy cm and MED 2.8 (1.8–3.99) mSv. For breast mammography, tube voltage 23.90 (20.5–31) kV and 23.80 (20.03–31) kV, tube current 110.54 (60–417) mA and 110.46 (35–417) mA, entrance skin dose 0.83 (0.08–5.36) mSv and 3.12 (0.26–21.26) mSv, and mean glandular dose (MGD) 1.32 (0.02–6.41) mGy and 2.03 (0.07–8.59) mGy for craniocaudal and mediolateral views, respectively. For both breasts combined, the mean entrance skin dose is 2.5 (0.30–5.1) mSv while the MGD is 1.66 (0.31–2.5) mGy.

Conclusion

Patients in Nigeria receive comparative higher radiation doses for chest radiography and head CT but are exposed to lower radiation doses for breast mammography than obtained in the European Union (EU).

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References

  1. Sharifat I, Oyeleke OI. Patient entrance skin doses at Minna and Ibadan for common diagnostic radiological examinations. Bayero J Pure Appl Sci. 2009;2(1):1–5. https://doi.org/10.4314/bajopas.v2i1.58447.

    Article  Google Scholar 

  2. Ibrahim U, Daniel IH, Ayaninola O, Ibrahim A, Hamza AM, Umar AM. Determination of entrance skin dose from diagnostic X-ray of human chest at Federal Medical Centre Keffi, Nigeria. Sci World J. 2014;9(1):14–8.

    Google Scholar 

  3. Osahon OD, Ojo OA, Ushie PO. Estimation of radiation absorbed dose to patients undergoing chest X-ray examination in four government own hospitals in (Benin City) Nigeria. Int J Biophys. 2017;7(2):24–32. https://doi.org/10.5923/j.biophysics.20170702.02.

    Article  Google Scholar 

  4. Usen NU, Obed RI. Doses received by patients during thorax X-ray examinations. Iran J Med Phys. 2012;9(4):245–51. https://doi.org/10.22038/IJMP.2013.467.

    Article  Google Scholar 

  5. Jibiri NN, Olowookere CJ. Patient dose audit of the most frequent radiographic examinations and the proposed local diagnostic reference levels in South-western Nigeria: imperative for dose optimization. J Radiat Res Appl Sci. 2016;9(3):274–81.

    Article  Google Scholar 

  6. Obed RI, Ademola AK, Adewonyi KA, Okunade OA. Doses to patients in routine X-ray examinations of chest, skull, abdomen and pelvis in nine selected hospitals in Nigeria. Res J Med Phys. 2007;1(4):209–14.

    Google Scholar 

  7. Nwokorie E, Akpa TC, Mallam OP, Akpan E, Ibinaye PO, Obiako OR, Ugwu AC. Entrance surface dose of the common radiological investigations in ABUTH, Zaria. East Afr J Public Health. 2011;8(3):205–6.

    PubMed  Google Scholar 

  8. Olowookere CJ, Obed RI, Babalola IA, Bello TO. Patient dosimetry during chest, abdomen, skull and neck radiography in SW Nigeria. Radiography. 2011;17:245–9. https://doi.org/10.1016/j.radi.2010.05.009.

    Article  Google Scholar 

  9. Paulo G, Damilakis J, Tsapaki V, Schegerer AA, Repussard J, Jaschke W, Frija G, European Society of Radiology. Diagnostic reference levels based on clinical indications in computed tomography: a literature review. Insights Imaging. 2020;11(1):96. https://doi.org/10.1186/s13244-020-00899-y.

    Article  PubMed  PubMed Central  Google Scholar 

  10. European Commission. Diagnostic reference levels in thirty-six European countries part 2/2. European Union, 2014. https://ec.europa.eu/energy/sites/ener/files/documents/RP180%20part2.pdf. Accessed 22 Nov 2021.

  11. Abdullahi M, Shitu H, Dlama J, Aribisala A, Eshiett P, Itopa R, Kpaku G. Diagnostic reference level for adult brain computed tomography scans: a case study of a tertiary health care centre in Nigeria. J Dent Med Sci. 2015;14(1):66–75.

    Google Scholar 

  12. Ogbole GI, Obed R. Radiation doses in computed tomography: need for optimization and application of dose reference levels in Nigeria. West Afr J Radiol. 2014;21:1–6. https://doi.org/10.4103/1115-1474.128072.

    Article  Google Scholar 

  13. Adejoh T, Nzotta CC, Nkubli FB, Dlama JZ. Effective dose levels from computed tomography of the head during contrast studies in Nigeria. Health. 2015;7:915–9.

    CAS  Article  Google Scholar 

  14. Abdulkadir MK, Schandorf C, Hasford F. Determination of computed tomography diagnostic reference levels in north-central Nigeria. Pac J Sci Technol. 2016;17(2):341–8.

    Google Scholar 

  15. Nzotta CC, Egbe N, Adejoh T, Nkubli BF, Ezeador IS. Radiation dose from exposure to computed tomography scan of the brain in a reference hospital in Nigeria. Pak J Radiol. 2016;26(2):77–80.

    Google Scholar 

  16. Okeji MC, Ibrahim NS, Luntsi G, Abubakar F, Ahmed A. Evaluation of absorbed dose and protocols during brain computed tomography scans in a Nigerian Tertiary Hospital. World J Med Sci. 2016;13(4):251–4. https://doi.org/10.5829/idosi.wjms.2016.251.254.

    Article  Google Scholar 

  17. Garba I, Engel-Hills P, Davidson F, Tabari AM. Computed tomography dose index for head CT in Northern Nigeria. Radiat Prot Dosimetry. 2015;165(1–4):98–101.

    CAS  Article  Google Scholar 

  18. Adejo T, Nzotta CC. Head computed tomography: dose output and relationship with anthropotechnical parameters. West Afr J Radiol. 2016;23(2):113–7. https://doi.org/10.4103/1115-3474.179256.

    Article  Google Scholar 

  19. Chiegwu HU, Enweani IB, Nzotta CC, Ogbu SO, Onyema AE, Ugwuanyi DC. Increasing radiation doses from computed tomography versus diagnostic reference levels: how compliance are we? Br J Med Med Res. 2015;9(9):1–15. https://doi.org/10.9734/BJMMR/2015/15123.

    Article  Google Scholar 

  20. Adejo T, Nzotta CC, Aronu ME, Dambele MY. Diagnostic reference level for computed tomography of head in Anambra State of Nigeria. West Afr J Radiol. 2017;24(2):142–6. https://doi.org/10.4103/1115-3474.206806.

    Article  Google Scholar 

  21. Zira JD, Nzotta CC, Skam JD. Diagnostic reference levels (DRLS) for computed tomography (CT) examinations in north eastern Nigeria. Pak J Radiol. 2017;27(4):364–9.

    Google Scholar 

  22. Muhogora W, Rehani MM. Review of the current status of radiation protection in diagnostic radiology in Africa. J Med Imaging (Bellingham). 2017;4(3):031202. https://doi.org/10.1117/1.JMI.4.3.031202.

    Article  Google Scholar 

  23. Joseph DZ, Nzotta CC, Skam JD, Umar MS, Musa DY. Diagnostic reference level for mammographic examinations in North Eastern Nigeria. Afr J Med Health Sci. 2018;17(1):54–9. https://doi.org/10.5897/AJMHS.9000004.

    Article  Google Scholar 

  24. Ogundare FO, Odita AN, Obed RI, Balogun FA. Mean glandular doses for women undergoing mammographic breast screening in Oyo state, Nigeria. Radiography. 2009;15(4):327–32. https://doi.org/10.1016/j.radi.2009.05.002.

    Article  Google Scholar 

  25. Joshua JI, Nzotta CC, Abubakar GM, Nkubli FB. Assessment of mean glandular doses in selected hospitals in Lagos state. Glob Sci J. 2018;6(7):932–7.

    Google Scholar 

  26. Chijioke WO, Adeniji-Sofoluwe AT, Jibiri NN. Evaluation of mean glandular dose and assessment of the risk of radiation induced carcinogenesis in women following screening mammography in a low resource setting. J Radiat Res Appl Sci. 2018;11(3):271–6. https://doi.org/10.1016/j.jrras.2017.07.002.

    Article  Google Scholar 

  27. UN Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation: UNSCEAR 2000 Report to the General Assembly, with Scientific Annexes. New York: United Nation Publication; 2000. P.5. https://www.unscear.org/docs/publications/2000/UNSCEAR_2000_Report_Vol.I.pdf.

  28. Goodman TR, Amurao M. Medical imaging radiation safety for the female patient: rationale and implementation. Radiographics. 2012;32:1829–37.

    Article  Google Scholar 

  29. Vañó E, Miller DL, Martin CJ, Rehani MM, Kang K, Rosenstein M, Ortiz-López P, Mattsson S, Padovani R, Rogers A. ICRP publication 135: diagnostic reference levels in medical imaging. Ann ICRP. 2017;46(1):1–144. https://doi.org/10.1177/0146645317717209.

    Article  PubMed  Google Scholar 

  30. Abdullahi AH, Umar I, Taofeeq AI, Joseph DZ, Bello AA, Rilwan U. Assessment of dose to patients undergoing computed tomography procedures at selected diagnostic centers in Kano, Nigeria. Afr J Med Phys. 2020;3(1):23–8.

    Google Scholar 

  31. Joshua J, Nzotta CC, Joseph DZ, Abubakar MG, Mohammed SU, Abdullahi HA, Bature SS. Estimation of mean glandular doses for patients undergoing mammography examination in some selected centers in Lagos state, Nigeria. Afr J Med Phys. 2020;3(1):10–3.

    Google Scholar 

  32. Tsapaki V, Aldrich JE, Sharma R, et al. Dose reduction in CT while maintaining diagnostic confidence: diagnostic reference levels at routine head, chest, and abdominal CT—IAEA coordinated research project. Radiology. 2006;240:828–34.

    Article  Google Scholar 

  33. Mulkens TH, Daineffe S, De Wijngaert R, et al. Urinary stone disease: comparison of standard-dose and low-dose with 4D MDCT tube current modulation. AJR Am J Roentgenol. 2007;188(2):553–62.

    Article  Google Scholar 

  34. Adejo T. Nigerian radiographers’ obligation to diagnostic reference levels (DRLs) in medical imaging. J Radiograph Radiat Sci. 2020;34(1):1–6.

    Article  Google Scholar 

  35. Ekpo EU, Adejoh T, Akwo JD, Emeka OC, Modu AA, Abba M, Adesina KA, Omiyi DO, Chiegwu UH. Diagnostic reference levels for common computed tomography (CT) examinations: results from the first Nigerian nationwide dose survey. J Radiol Prot. 2018;38(2):525–35. https://doi.org/10.1088/1361-6498/aaaaf8.

    Article  PubMed  Google Scholar 

  36. Berlan D, Shiffman J. Holding health providers in developing countries accountable to consumers: a synthesis of relevant scholarship. Health Policy Plan. 2012;27(4):271–80.

    Article  Google Scholar 

  37. Hafner T, Shiffman J. The emergence of global attention to health systems strengthening. Health Policy Plan. 2013;28(1):41–50.

    Article  Google Scholar 

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Acknowledgements

The authors are grateful to the following persons, Mr. Patrick Madubuko of Department of Haematology Nnamdi Azikiwe University, Nnewi Campus and Dr. Okechukwu Oguzie of Military Hospital Lagos who greatly assisted in this study. Mr. A.O. Eze who ensured that this study was concluded. The authors are also grateful to Chief Isaac Asomgba, Mrs Esther Asomgba, Mrs Medline Nwabueze and Mrs Jane Nkechinyere Eze for their numerous assistance that made the completion of this study possible. The assistance of the secretarial staff of Mr AC Daniel and company at Nnewi, Anambra State is also highly appreciated. The authors are also grateful to Mr Ozoemenam Ugochukwu of Department of History and International studies, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria, for his logistic assistance throughout this study.

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Correspondence to Kenneth Chukwudi Eze.

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The authors did not receive support from any organization for this work. The authors have no relevant financial or non-financial interests to disclose.

Research involving human participants and/or animals

This is an observational study consisting of a review of already published studies. The Nnamdi Azikiwe University, Awka, Research Ethics Committee confirmed that no ethical approval was required.

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Informed consent was waived or not required. This study consisted of secondary analysis of already existing data.

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Eze, K.C., Uduma, F., Omidiji, O.A. et al. Diagnostic reference levels (DRLs) for chest radiography, non-contrast head computed tomography and mammography examinations in Nigeria: review of national data. Chin J Acad Radiol 5, 99–106 (2022). https://doi.org/10.1007/s42058-022-00097-3

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  • DOI: https://doi.org/10.1007/s42058-022-00097-3

Keywords

  • Diagnostic
  • Reference Level
  • Radiography
  • Mammography
  • Computed Tomography