Speaker
Description
Background:
Diagnostic Reference Levels (DRLs) are an optimization tool for medical imaging procedures using ionizing radiation. DRLs indicate whether the dose to the patient in a specified imaging procedure is unusually high or low for that procedure. DRLs can be established either locally, nationally, or regionally, usually on the basis of surveys of median or third quartile doses representing standard practice for a particular procedure. DRLs have been proven to be an effective dose optimization tool and can be used as a regulatory benchmark.
Method:
An extensive and country-specific literature search was done to collate DRL data from sub-Saharan Africa in order to establish what work has already been done, what countries have attempted to set national DRLs (NDRLs), and what efforts are underway to set regional DRLs (RDRLs). The search was conducted in English, and only full-length manuscripts were included.
Results:
132 full-length manuscripts were found from 18 of the 46 sub-Saharan countries included in the search. Nigeria had the most publications (31), followed by South Africa (20), Ghana (12) and Kenya, Côte d’Ivoire, and Ethiopia (9 each).
68 manuscripts were on DRLs for computed tomography, 26 on fluoroscopically guided procedures, 30 on general X-ray rooms, and six on DRLs for mammography. Two publications were also found on DRLs in nuclear medicine.
Five countries proposed NDRLs.
Three studies included data from multiple countries; however, only one of these studies proposed RDRLs.
Discussion and Conclusion:
One of the roles of an imaging medical physicist is the optimization of dose that a patient receives during an imaging procedure. There is a very large variability in the published DRL data from Africa. Some imaging centers have made clear progress in their dose optimization efforts, while in some countries doses for the same procedure can differ by an order of magnitude, indicating a clear need for harmonization of imaging protocols. Regional efforts, particularly under the umbrella of the International Atomic Energy Agency, have helped to establish networks that can be leveraged to improve and expand on both NDRLs and RDRLs.