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Medical Exposure to X-Radiation in Poland

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Medical Exposure to X-Radiation in Poland IL9806323 MEDICAL EXPOSURE TO X-RADIATION IN POLAND Jerzv Jankowski, Maria Anna Staniszewska The Nofer Institute of Occupational Medicine, Lodz, Poland Introduction Risk to patient in medical exposures has been under discussion for a number of years, as it is main man-made source of irradiation for population in the most of countries advanced in technology; especially, medical X-rays are the major contributor to population dose. This paper presents the results of national survey of X-ray diagnostics, which was based on data of 1995. For the most frequent examinations the doses to patients have been evaluated by means of theoretical computational method - Monte Carlo simulation. A special problem is interventional radiology procedures during which patients can receive high doses. Frequency and type of X-ray examinations in Poland The data on the number and type of X-ray examinations were collected sending a questionnaire to the clinics and outpatient departments performing X-ray examinations in their practice. (The days of inquiry were selected with regard to seasonal variation in the number of X-ray examinations during particular months of the year). The forms were returned by 73 % of laboratories covered by the questionnaire. It was estimated that 27.6 million X-ray examinations were performed in Poland in 1995, i.e. 715 examinations per 1000 inhabitants. The percentage of particular types of examinations with the patients divided according to gender are presented in Table 1. The percentage of patients from particular age groups for given types of examinations are presented in Table 2. Analyses of results make it possible to observe that the majority were adult patients of both genders, the mean age being 40 y. Taking into consideration the number of inhabitants it can be seen that the most frequently are those examined individuals aging 45-54; in this group ab. 1300 examinations per 1000 inhabitants are performed. -72- Table 1. Distributions of X-ray examinations in Poland with reference to patients' gender Annual number Percentage share Type of examinations In thousands % total Of females Of males number Basic X-ray examinations: head 1772.26 6.42 48.4 51.6 dental 2835.87 10.27 55.5 44.5 photofluorography of chest 6988.60 25.32 40.9 59.1 remaining chest examin. 5755.78 20.85 51.7 48.3 abdomen and GI tract 909.66 3.28 47.4 52.6 - stomach and duodenum 397.62 1.44 49.3 50.7 - barium enema 89.88 0.33 50.3 49.7 genital - urinary system 304.88 1.10 48.3 51.7 - urography 226.70 0.82 47.6 52.4 spine 3616.57 13.10 54.6 45.4 upper limbs 2164.90 7.81 44.8 55.2 lower limbs 2572.08 9.32 47.7 52.3 - hip-joint radiography 584.67 2.12 57.3 42.7 Basic exam.-on the whole 26920.60 97.46 47.3 52.7 In this number: fluoroscopies 594.08 2.16 47.1 52.9 Specialistic examinations: with contrast application 108.57 0.37 45.0 55.0 (angiographies etc.) CT 170.63 0.62 48.3 51.7 interventional radiology 31.67 0.11 41.4 58.6 mammography 283.34 1.03 100 - bone densitometry 36.67 0.13 95.7 4.3 Specialistic exam.-on the whole 630.88 2.26 73.7 26.3 X-ray examinations - on the whole 27 600 100 48 52 -73- Table 2. Age structure of patients subjected to diagnostic X-ray examinations in Poland Percentage share of the age groups Type of examinations < 1 1-4 5-9 10-14 15-19 Adults Basic X-ray examination on the whole 0.5 0.6 0.9 1.9 2.4 93.7 In this number: chest photofluorography 0 0 0 0 1.0 99.0 remaining chest exam. 1.0 1.3 1.3 2.5 2.8 91.1 dental 0 0 1.5 5.0 5.0 88.5 abdomen and GI tract 1.0 0.3 0.8 0.5 1.3 96.1 urinary system 7.3 9.0 10.0 9.0 1.0 63.7 - cystography 20.0 25.0 26.0 20.0 1.0 8.0 spine radiographies 1.2 1.0 3.4 5.2 5.0 84.2 hip joint radiography 13.0 6.0 3.0 3.0 4.0 71.0 Specialistic examinations with contrast 3.5 0.3 0 1.1 0 95.1 CT 2.3 1.3 2.5 2.8 1.9 89.3 X-ray examinations on the whole 1.0 1.0 1.9 3.6 4.8 87.7 Doses to patients Absorbed doses received by patients during X-ray examinations have been evaluated theoretically, using Staniszewska computer code for Monte Carlo simulation, for six age groups, i.e. 0,1,5,10,15 years and adults. Reference patients were represented by mathematical human phantoms. A description of the computation method and the results have already been published . The computations were performed for the most frequently performed procedures. The data concerning the exposure conditions were collected from a number of diagnostic units in Poland. Effective doses for particular examinations were evaluated on the basis of ICRP 60 recommendations. The doses received by adult patients during the most frequent examinations are presented in Table 3. Table 3. Mean values of effective doses received by standard adult patient during X-ray examinations in Poland Type of examination Effective dose [mSv] Head radiography 0.03 Thoracic spine radiography 3.00 L-S spine radiography 3.00 Pelvis radiography 0.50 Urography 3.50 Abdomen radiography 0.80 Chest radiography (PA) 0.11 Photofluorography of chest 1.00 Stomach and oesophagus 5.60 Barium enema 8.00 -74- Taking into consideration the data concerning frequency of examinations and evaluated values of effective doses is possible to perform an approximative estimation of average annual per caput dose from X-ray diagnostics in Poland as: 0.9 mSv per one examination, 0.6 mSv per one inhabitant. Collective effective dose as result of X-ray diagnostics in Poland in 1995 were about 23 000 manSv. The first estimation shows that the major contributors to this value are common examinations of spine (ab. 40 %) and photofluorography of chest (ab. 30 %). Interventional radiology procedures present a separate problem: although these practices do not contribute significantly to the total number of X-ray examinations in Poland (ab. 0,1 % of 27.6 million), a specific character and aim of these exposures are the reason for great variation in dose, which may be very high (especially, the entrance skin dose). Below there are presented the results of investigations which were performed in three hospitals, using devices made by Siemens: two of these were Polydoros (with pulsed generators), and the third - the oldest one - was Angiotron CMP (with constant potential, conventional generator). Entrance surface doses to patients were measured and - after that - the absorbed and effective doses were computed using Monte Carlo simulation. Detailed analysis of doses were performed for six patients: five undergoing coronarography and one subjected to renal arteries catheterization. As it can be seen in Table 4, the effective doses during coronarography are rather law, despite of high values of the entrance surface doses. Effective dose during renal arteries catheterization is higher, but the oldest X-ray device were used, which resulted in long real time of exposure. Table 4. Doses to patients during some interventional radiography procedures in Poland Type of Hospital Patient Projections Total entrance Total effective procedure number number performed**' surface dose dose X-ray limit [mGy] [mSv] Coronaro- I 1 PA,RPO,LPO 54.7 0.73 graphy (Polydoros) 2 PA,RPO,LPO 37.1 0.43 II 1 PA,RPO,LPO,LLAT 23.0 0.23 (Polydoros) 2 PA,RPO,LPO,LLAT 13.2 0.20 3 PA,RPO,LPO,LLAT 33.5 0.42 Renal III 1 PA,RPO,LPO 172.9 2.29 arteries (Angiotron) catheteriza tion PA postero - anterior, RPO - right postero - oblique, LPO - left postero - oblique, LLAT - left lateral. Conclusion The main problem in medical exposure of Polish population is to decrease the number and the doses received by patients during common X-ray examinations. The more specialized procedures should also receive some attention, especially when these can result in a high dose for an individual patient. The present aim of radiological protection in Poland is to introduce a quality assurance system, which will cover all fields of practices in X-ray diagnostics. -75-.
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