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 Table of Contents 
ORIGINAL ARTICLE
Year : 2019  |  Volume : 42  |  Issue : 4  |  Page : 159-167  

A survey of X-ray diagnostic services in Imo State, Nigeria


1 Department of Physics, School of Physical Sciences, Federal University of Technology, Owerri, Nigeria
2 Department of Physical and Mathematical Sciences, Faculty of Science, Crown-Hill University, Ilorin, Nigeria
3 Department of Physics, Alvan Ikoku Federal College of Education, Owerri, Nigeria

Date of Submission21-Oct-2018
Date of Decision27-Nov-2019
Date of Acceptance01-Dec-2019
Date of Web Publication27-Jan-2020

Correspondence Address:
Mr. Idowu Richard Akomolafe
Department of Physical and Mathematical Sciences, Faculty of Science, Crown-Hill University, Ilorin
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/rpe.RPE_74_18

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  Abstract 


A survey was conducted on the technical parameters (exposure factor) used on some X-ray examinations (skull posteroanterior printarticle.asp?issn=0972-0464;year=2019;volume=42;issue=4;spage=159;epage=167;aulast=Eke, skull anteroposterior [AP], skull lateral [LAT], chest posteroanterior printarticle.asp?issn=0972-0464;year=2019;volume=42;issue=4;spage=159;epage=167;aulast=Eke, chest lateral [LAT], abdomen anteroposterior [AP], and pelvis anteroposterior [AP]) in six hospitals across the three senatorial zones (Owerri, Orlu, and Okigwe) in Imo State, Nigeria. A total of 100 patients were included in the survey. For each patient, the technical parameters (mAs and kVp) were recorded during the specific medical examination. Patients' information such as age, mass, and height was also taken. The results showed that the kVp mean values obtained were 80.00, 75.00, 75.00, 73.58, 83.36, and 75.08 for skull PA, skull LAT, chest PA, chest LAT, abdomen AP, and pelvis AP examination, respectively, and the mAs mean values obtained were 26.30, 30.00, 31.29, 32.76, 41.46, and 29.00 for skull PA, skull LAT, chest PA, chest LAT, abdomen AP, and pelvis AP examinations, respectively. These values are lower than international standards which imply that the personnel at the X-rays diagnostic center visited are doing fine.

Keywords: Abdomen (AP), chest (PA/LAT), diagnostic, Imo State, pelvis (AP), X-rays


How to cite this article:
Eke BC, Akomolafe IR, Emelue HU. A survey of X-ray diagnostic services in Imo State, Nigeria. Radiat Prot Environ 2019;42:159-67

How to cite this URL:
Eke BC, Akomolafe IR, Emelue HU. A survey of X-ray diagnostic services in Imo State, Nigeria. Radiat Prot Environ [serial online] 2019 [cited 2020 Feb 20];42:159-67. Available from: http://www.rpe.org.in/text.asp?2019/42/4/159/276926




  Introduction Top


The discovery of X-rays no doubt has brought a quantum leap to science in nearly all sectors where scientific application is being employed. With the discovery of X-rays over decades ago, ionizing radiation began to be used in revealing the parts of the human body that previously could not be seen, thereby improving the diagnostic techniques available to the medical profession. This X-rays belongs to the group of radiation called ionizing radiation. Ionizing radiation is a radiation which has enough energy to eject electron through the material it traverses, and in the human tissue or cell, this ionization results in the dissociation of water molecule and subsequent production of reactive species, which when they react with DNA molecules causing biological damage. There are two types of biological effects it can cause: somatic and genetic. The somatic effect affects only the exposed person, whereas the genetic effect affects the offspring of the exposed person.[1]

Moreover, the properties that make ionizing radiation so effective for diagnostic and therapeutic purposes, namely its ability to penetrate tissue and to kill and transform tissue cells, can also make it hazardous to health. Despite development in variety of modern imaging techniques such as ultrasound and magnetic resonance imaging which do not make use of radiation, conventional radiography has remained an important diagnostic imaging method not only because of the oldest form of diagnostic imaging technique but also because of certain benefits it has over the modern techniques. Therefore, great concern must be shown to avoid unnecessary exposure to radiation during diagnostic radiology. Using radiation in diagnostic radiology, two principles must be concerned with: principles of justification and optimization. The justification for the use of ionizing radiation in diagnostic radiology must outweigh the detrimental effect and the exposure must be optimized to as low as reasonably achievable to minimize its deleterious effects. That is, there is a need to optimize the technical parameter to identify the radiation parameter that will give the lowest achievable doses and quantitative image simultaneously. These optimization procedures include the manipulation of radiological parameters that are involved in the form of image in diagnostic radiology.[2]

Over the years, medical application represents largest artificial source of exposure to ionizing radiation.[1],[3] This medical exposure accounts for 98% of the contribution to the population dose worldwide, representing approximately 20% of the total.[4] It was estimated that diagnostic radiology and nuclear medicine contributed 96% to the collective effective dose from artificial source in the UK.[5],[6] It is estimated that diagnostic radiology and nuclear medicine contributed 88% to the collective effective dose from artificial source in the US, whereas in the UK similar contribution was 96%.[5],[6],[7] There have been efforts on how to reduce radiation exposure in diagnostic radiology and these efforts have produced substantial reductions in radiation doses to patients resulting from radiographic procedures in many countries.[2]

A number of national and regional dose survey and image quality reports have revealed large patient dose variations for patients undergoing the same type of diagnostic X-ray examination.[8] Furthermore, many of the measured doses in the upper part of the dose range may represent radiation levels that are unnecessarily high. On the other hand, doses in the lower part may result in poor image quality. It is, therefore, important to assess the levels of image quality in relation to patient dose levels that will produce images of acceptable quality. Such results can allow comparison of performance among laboratories within a region or country. In developing country, Nigeria in particular, monitoring of X-ray technical parameters has not received much attention and this may affect the way personnel adhere to standard practices. The efforts of regulatory bodies such as the Nigerian Nuclear Regulatory Authority (NNRA) to regularize radiological practices are scarcely felt largely due to poor funding by the government.[1] Thus, there is high possibility that the personnel may sometime deviate from the best practices. The aim of this study is to carry out a survey and on-spot assessment of technical parameters used in X-ray diagnostic in selected centers within Imo state, Nigeria. This will help us know how conformity is the dose received by patients, in order to obtain qualitative and superior diagnostic image, to the international standards.


  Materials and Methods Top


This survey was carried out on 100 patients and four selected X-ray examinations (six projections) in Imo State, Nigeria. The map in [Figure 1] shows the sampling areas. The state included three senatorial zones, and six hospitals were selected across the zones. The hospitals participated in the survey were Federal Medical Centre (FMC), Owerri; Umezurike Hospital Owerri (UHO); Imo State University Teaching Hospital (ITH), Orlu; General Hospital Okigwe (GHO); Holy Rosary Hospital (HRH), Emekuku; and St. Christina Specialist Hospital (CSH), Egbu, Owerri. The selection of these hospitals to participate in the survey is largely due to their patients' population and their location in the senatorial zones. The distribution of X-ray personnel in the selected hospitals is presented in [Table 1]. For each hospital, specific data such as name of X-ray machine, manufacturer of X-ray machine, year of manufacture, and filtration used on each X-ray machine were recorded as presented in [Table 2]. The weighing scale was used to determine each patient's mass, whereas the meter tape was used to determine each patient's height.
Figure 1: Map of Imo State showing the sampling areas

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Table 1: Distribution of X-ray personnel

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Table 2: Specific data on X-ray machines used at the selected hospitals

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The patients' information and exposure and technical parameters (mAs, kVp, and focus film distance [FFD]) for the six projections considered are tabulated according to the age groups and are presented in [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], and [Table 8]. The mAs and kVp were read directly from the control panel of the X-ray machines, whereas the FFD was measured using a centimeter tape attached to the X-ray machines. Besides, some patients' information such as age, mass, and height was collected. The mass of each patient was measured using a weighing scale, whereas the height of each patient was determined using a meter tape. With the mass and height of each patient, we were able to determine the body mass index (BMI) using the equation below:
Table 3: Summary of radiographic data and patients information for skull posteroanterior/anteroposterior examination in three different age groups

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Table 4: Summary of radiographic data and patients information for skull lateral examination in three different age groups

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Table 5: Summary of radiographic data and patients information for abdomen anteroposterior examination in three different age groups

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Table 6: Summary of radiographic data and patients information for chest lateral examination in three different age groups

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Table 7: Summary of radiographic data and patients information for pelvis anteroposterior examination in three different age groups

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Table 8: Summary of radiographic data and patients information for chest posteroanterior examination in three different age groups

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The BMI determined in this survey was for those patients whose images were diagnostically accepted. The distribution of radiographic data and patient information is presented in [Table 4].


  Results and Discussion Top


In this survey, a total of 100 patients were examined based on the acceptance of diagnostic images by the radiographers. The patients were grouped into three categories: 0–10 years (children), 11–18 years (young adults), and above 18 years (adults). A summary of radiographic data and patients' information for each examination in three different age groups (0–10, 11–18, and >18 years) is presented in [Table 3], [Table 4], [Table 5],[Table 6],[Table 7], and [Table 8]. The results of their statistical analysis (mean, minimum, maximum, and coefficient of variation [%]) for all the six projections considered across all the age range are also presented in the aforementioned tables. There is a slight variation in technical parameters (kVp and mAs) used in these hospitals, which shows that there is no uniformity in their procedure. For instance, mAs has a mean of 10 mAs for skull LAT in the age range of 0–10 years, mean of 25 mAs for skull LAT in the age range of 11–18 years, and mean of 30 mAs in the age range of 18 years and above. A similar pattern was observed in the remaining radiographic projections. However, there is a sharp gap in the chest PA mean value of 22.79 mAs in the age range of 11–18 and mean value of 31.29 mAs in the age range of 18 years and above. We made a comparison of our survey with the report from Ghana [Table 9],[Table 10],[Table 11],[Table 12],[9] from other part of Nigeria [Table 13], [Table 14], [Table 15], [Table 16], [Table 17],[1] Malaysia [Table 18],[10] and UK[11] [Table 19]. These are presented in [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18], [Table 19]. Moreover, [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18], [Table 19] enable us to compare the technical parameters (kVp and mAs) obtained in this study for six different examinations with other researchers. [Table 17] shows comparison between this study and Ng et al.'s study[10] whereas [Table 20] shows the interhospital dose variations.
Table 9: Summary of radiographic data used during chest posteroanterior examination of adult patients

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Table 10: Summary of radiographic data used during abdomen anteroposterior examination of adult pati

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Table 11: Summary of radiographic data used during pelvis anteroposterior examination of adult patients

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Table 12: Summary of radiographic data used during skull posteroanterior/anteroposterior examination of adult patients

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Table 13: Summary of radiographic data used during abdomen anteroposterior examination of adult patients

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Table 14: Summary of radiographic data used during skull posteroanterior/anteroposterior examination of adult patients

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Table 15: Summary of radiographic data used during chest posteroanterior examination of adult patients

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Table 16: Comparison of radiographic data with other part in Nigeria used during pelvis posteroanterior examination of adult patients

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Table 17: Comparison of exposure parameters in the present study with other part in Nigeria

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Table 18: Comparison of mean and range (in parentheses) exposure parameters in the present study with Malaysia

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Table 19: Comparison of mean and range (in parentheses) exposure parameters in the present study with the UK value

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Table 20: Intercomparison of adults patients mean exposure factors (kVp and mAs) for the six selected hospitals on different examinations

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From the results of our finding [Table 18], abdomen AP examination had the highest mean value of kVp for four hospitals/X-ray centers whereas data from the remaining two hospitals were not available. There was a little technical parameter variation in these hospitals. Similar thing was also recorded for mAs values in the four hospitals. In skull PA/AP examination, the mean value of mAs for ITH is 26.30, whereas FMC, UHO, GHO, HRH, and CSH mAs values were not available at the time of this work. Similarly, in skull LAT examination, only GHO disclosed information on the mean mAs which is 30.00, whereas FMC, UHO, ITH, HRH, and CSH were not available at the time of this work. A graphical representation of the kVp and mAs values are shown in [Figure 2] and [Figure 3] respectively. The bar charts provide the graphical interpretation for the kVp and mAs values of the studied hospitals.{Table 18}
Figure 2: Bar chart of kVP values of six radiographic projections for the selected X-ray centers

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Figure 3: Bar chart of mAs values of six radiographic projections for the selected X-ray centers

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Comparison of mean kVP values used in this study with the UK data (Hart et al., 2012) shows that the mean values chosen in chest PA, abdomen AP, pelvis AP, and skull AP in this study are comparable with the UK value. However, kVp data in chest LAT and skull LAT are not available at the time of study. The mean and range of exposure parameter values obtained from this study for the six radiographic projections are comparable with that obtained by Ng et al.[10] in Malaysia and Anomohanran et al.[12] in Delta State Nigeria. Moreover, the comparison of this work with international standard shows that the mean mAs values of this work are lower than the international variation dose values which causes poor image production quality and decrease the patient exposure and X-ray tube heating. Image formation in diagnostic radiology involves a complex interplay between many different parameters. Achieving the optimal system for any application requires an understanding of the way in which an image is formed and how different factors influence both quality and the radiation doses received by the patient. The kVp mean values obtained from this work were 80.00, 75.00, 75.00, 73.08, 83.36, and 75.08 for skull PA, skull LAT, chest PA, chest LAT, abdomen AP, and pelvis AP examinations, respectively, and the mAs mean values obtained from this work were 26.30, 30.00, 31.29, 32.76, 41.46, and 29.00 for skull PA, skull LAT, chest PA, chest LAT, abdomen AP, and pelvis AP examinations, respectively.


  Conclusions Top


The technical parameters of patients undergoing skull PA, skull LAT, chest PA, chest LAT, abdomen AP, and pelvis AP examinations in six hospitals in Imo State, Nigeria, have been monitored. The result of this finding implies that there is an urgent need for regular and effective monitoring of radiological practices by NNRA in the surveyed centers and cost-effective programs should be developed in Imo State, Nigeria, in order to harmonize radiation doses without loss of the diagnostic value of X-ray images. This monitoring program could include quality assurance, setting of guidelines for different exposure, regular assessment of technical parameters, organization of conferences, workshops, and courses in order to retrain the personnel, so they can be aware of latest developments in the field.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Eke BC, Orji CE, Obed RI. Entrance Skin Dose on Patients undergoing X-Ray Examinations at Yaba Lagos State Nigeria. Int J Nat Appl Sci 2011;7:275-80.  Back to cited text no. 1
    
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Martin CJ, Sharp PF, Sutton DG. Measurement of image quality in diagnostic radiology. Appl Radiat Isot 1999;50:21-38.  Back to cited text no. 2
    
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Milu C, Tomulescu V. Optimization of patient protection in diagnostic radiology by application of guidance levels. Vol. 5. Romania: International Radiation Protection Association; 1998. p. 7-10.  Back to cited text no. 3
    
4.
United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources, Effects and Risks of Ionizing Radiation. Report to the General Assembly, With Scientific Annexes; United Nations Scientific Committee on the Effects of Atomic Radiation; 2008. p. 2.  Back to cited text no. 4
    
5.
National Radiological Protection Board (NRPB). A National Survey of Doses to Patients Undergoing a Selection of Routine X-ray Examinations in English Hospitals. NRPB report 261. National Radiological Protection Board; 1993.  Back to cited text no. 5
    
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National Council on Radiation Protection and Measurements (NCRP). Ionizing Radiation Exposure of the Population of the United States. NCRP Report 93. National Council on Radiation Protection and Measurements; 1987.  Back to cited text no. 6
    
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Olowookere CJ, Obed RI, Babalola IA, Bello TO. Patient dosimetry during chest abdomen skull and neck radiography in SW Nigeria. Elsevier Int J Radiograph 2011;17:245-9.  Back to cited text no. 7
    
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Papadimitriou D, Perris A, Molfetas MG, Panagiotakis N, Manetou A, Tsourouflis G, et al. Patient dose, image quality and radiographic techniques for common X ray examinations in two Greek hospitals and comparison with European guidelines. Radiat Prot Dosimetry 2001;95:43-8.  Back to cited text no. 8
    
9.
Schandorf C, Tetteh GK. Analysis of dose and dose distribution for patients undergoing selected X-Ray diagnostic procedures in Ghana. Radiat Prot Dosim 1998;76:249-56.  Back to cited text no. 9
    
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Ng KH, Rassiah P, Wang HB, Hambali AS, Muthuvellu P, Lee HP. Doses to patients in routine X-ray examinations in Malaysia. Br J Radiol 1998;71:654-60.  Back to cited text no. 10
    
11.
Hart D, Hillier MC, Shrimpton PC. Doses to Patients from Radiographic and Fluoroscopic X-ray Imaging Procedures in the UK-2010 Review. Health Protection Agency (HPA-CRCE-034). HPA Center for Radiation, Chemical and Environmental Hazards; 2012.  Back to cited text no. 11
    
12.
Anomohanran O, Mokobia CE, Osakwe RA, Wawe MO. A survey of x-ray diagnostic services in Delta State, Nigeria (1991-1994). J Radiol Prot 2002;22:71-8.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18], [Table 19], [Table 20]



 

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