Valuation of Radiation Dosage Received in CT scan For Traumatic Patients in King Khalid Hospital-Majmaah, Saudi Arabia
Introduction: Trauma considers one of the most common reasons for morbidity and fatal disease amongst the elderly
Background: The aim of this study is to measure of radiation dose received in computed tomography Majmaah Area, KSA this study conducted to assess the stroke silhouette patients admitted to CT investigations to nationwide healthcare institutes along with appraising issues that might enhance trauma management.
Objectives: The purpose of this study was to estimate the radiation dose received in CT scans for traumatic patients.
Methods: Patient imaging acquisition data were collected from the radiology department. In each centre, CT radiation dose (CTDI) was measured using the ionization chamber. Then the other radiation doses quantities (CTDIW, CTDIvol, and DLP) were calculated. The average patient age for adults was 45.4+14.6 with the range of (30-80 years).
Results: The measured dose (CTDIw and DLP) for brain, chest, and abdomen were (617 mGy-36.3 mGy cm), (8.1 mGy -386 mGy cm) and (11.8 mGy-309 mGy cm) respectively. The DRLs of the brain, chest, and abdomen were 49.7, 8.2 and 10 mGy, respectively.
Conclusion: The study was concluded that computed tomography could expose the patients to high doses in the brain, chest, and abdomen. The measured dose in all centers in this study was lower than the international references limits.
Severe acute malnutrition, Complications, Children, Nutritional stabilization unit, Weight gain, Marasmus
Trauma occurrences might be fatal; they can also have long-lasting psychological and physical repercussions. Traffic accidents have increased dramatically in Saudi Arabia during the last many years [1-6]. There is presently no standard procedure for assessing the amount of radiation exposure received by a patient during radiation testing. Every day, the majority of people are exposed to between 10 and 100 mGy of radiation, increasing their chance of acquiring cancer [7-11]. This is especially true for persons who are frequently exposed to radioactive substances at high dosages. The use of trauma x-ray imaging to diagnose and monitor disease is common. It benefits patients since it is capable of administering a high dose of radiation. With the growing field of traumatic radiology, it is vital to examine and limit exam radiation doses [12-16]. All patients who visited the radiology department were asked to provide demographic information and had their exposure to radiation evaluated. The greatest risk of radiation exposure occurs during a medical x-ray. [17-21]. These types of exposures are caused by inefficient equipment use and high exposure factors. This issue has come to light as a result of the release of multiple dosage guidelines for the same medical condition. Radiation has been linked to the development of cancer and other major health concerns. Medical imaging using radiation is routinely used to check injuries. Doctors use these imaging tests to ensure they are making the correct diagnoses for a variety of conditions. Patients who have difficult-to-diagnose injuries can benefit from their assistance in diagnosing the cause of the injury. Radiation exposure has the potential to cause both immediate and long-term health problems. Excessive doses may result in acute organ damage, and maybe death. Due to the minimal dose of radiation used in radiographic testing, patients are not at risk of being damaged during the treatment (less than 10 mGy). In the long run, radiation exposure may result in the development of cancer and other genetic problems. Radiation doses associated with trauma radiological examinations have been determined worldwide .
Materials And MethodsSpecification of imaging scanner
The CT scanner used in this study was Toshiba Aquilon 128 slice, Toshiba. Including patients, the dose levels of republished radiation were collected by form of examination (head, chest and abdominal CT) and age group.Study protocol
Identiﬁcation of cases: ICD-9 procedural codes identify patients who are scanned for CT scan. Patients under 20, people with CT scans and those without registered medical weight in referring facilities were excluded. All patients' data were saved securely in pass-worded PC. The collected data included patient age, weight, sex, and examination time, cause of examination (e.g. trauma), application of contrast, DLS, scan length and automatic scale. Patient imaging protocols and CT scanner information data were collected such as (KVp, mAs, machine type, types of detectors and slice thickness).
Radiation Dose measurement: For computed tomography scan, the CTDIw, CTDIvol, and DLP were measured. The CTDIvol is a standardized radiation output estimation parameter. The CTDI finds the principal principle for dosage measurement in CT to be:
D (z)=Z-axis radiation-dose profile,
N=number of the tomography parts of the individual axial scan.
N may be equal to or under the full number of system data channels and
T=as shown by a single data channel, the width of the tomographic segment on the z-axis. A single multi-detector data source can be combined with several detector components.
- C represents the tube current rate (mAs)
- CTDI100, p represents an average of amounts at four different sites everywhere the edge of the phantom .
The Dose Length Product (DLP) of the scanned area was collected from the CT scanner. DLP is the resultant of the length of the exposed scan volume and the mean CTDIvol over that distance. DLP calculated as;
DLP (mGy-cm)=CTDIvol (mGy) × scan length (cm)
Patient imaging protocols and CT scanner information data were collected such as (KVp, mAs, machine type, types of detectors and slice thickness).
Table 1 showed the imaging protocol details for the CT scanning in both hospitals. The scan factors are dissimilar form radiology department to another. Although the tubes voltages (KVp) are approximately alike, the variations of rest radiation exposure factors are significant. The KVp of the brain and chest investigation in this study is lower than similar studies. Those KVp cause increasing of patient dose in those examinations. Similar differences were observed for mAs used for brain, chest and abdomen examinations. The scan area lengths for brain, chest examination were 14.9+5.14 and 25.3+7.4.
Table 1 shows the characteristics of patient x-ray imaging for all investigations in King Khalid-Majmaah hospitals. As shown in Table 1, protocols conditions differ from department to department for scanning the same investigations. Although KVps are approximately equal, the variations between mAs are significant.
Table 1: Patient x-rays image acquisition features.
|Brain CT scan||kVp||120|
|Scan area length (cm)||14.9+5.14|
|Chest CT scan||kVp||120|
|Scan area length (cm)||25.3+7.4|
|Abdomen CT scan||kVp||120|
|Scan area length (cm)||43.6+10.6|
Table 2: The measured CTDIW (mGy) and DLP (mGy cm) of the study.
|Investigations type||CDTIw (mGy)||DLP (mGy cm)|
|Brain CT scan||36.3+6.1||617.8+198.8|
|Chest CT scan||8.1+3.6||386.1+114.6|
|Abdomen CT scan||11.8+4.3||309.6+101.9|
Table 3: The 3rd quartile values of this study compared with international values.
|Investigations type||Present study||EC ||Karim et al. ||UK 2005 [21,22]||Malaysia |
|Brain CT scan||49.7||617||60||1050||63||1015||57||690||46.8||1050|
|Chest CT scan||8.2||386||30||650||15||450||14||400||19.9||600|
|Abdomen CT scan||10.0||309||35||780||16||590||16||350||12.8||450|
Figure 1:The correlation between the body mass index (BMI) and measured dose.
For example, in the case of abdominal imaging, the brain and chest procedure are similar in the kVp, but the mAs are different from hospital to other. For three other examinations, comparable differences were noted. The length of scanning often differs between hospitals, particularly in chest studies (between 13 and 30 cm). Figure 1 revealed the correlation of the Body Mass Index (BMI) and the measured dose for all patients. A correlation exists between BMI and the dose measured. Tables 2 and 3 indicate each of the hospital inquiries assessed CTDIW, CTDIvol, and DLP. The values of CTDIW, CTDIvol, and DLP values in hospitals are very different. The values of CTDIvol are almost the same as the CTDIw values (see Tables 2 and 3). In almost all hospitals, this was attributed to pitching level of 1 or almost 1 (0.80 to 1.0).
Table 3 indicates the measured CTDIW and DLP measured. Table 4 refers nationally and globally to the CTDI mean value with CT departments. Average CTDI values are smaller than global values for all studies. As illustrated in Table 3, CTDIW used to cover the brain, chest, and abdomen (17.7-51), (4.02-12.3) and (4.23-13.7) respectively. The third quartile of measured dosage is generally accepted as the permissible dose. As DRLs for the head, chest and abdomen, values of 49.7, 8.2 and 10 mGy are recommended.The DRL measured in comparison with global reference levels. As shown in Table 4, DRLs were less than global values for all studies in this study. CTDI values of CT procedures include mAs and kVp exposure variables. In addition, the increase in the number of slices and the duration of scans increases DLP. DLPs are therefore lower than head studies in the abdominal and chest trials. On the other hand, as the area under consideration rises, DLP and CTDI increase the mean CTDIw, DLP values of this research have been lower than the European Guidelines (EG), and Shrimpton et al. Overall DRLs were smaller than global values for all research studies. This reference dose is suggested as a recommended dose for the guidelines to be optimized until further studies and details are obtained for all the CT studies.
This has been a comprehensive study of CT patient doses in Majmaah, Saudi Arabia and the DRL has been configured for four CT tests. As reported in the reports, the doses for the same tests varied from department to department. This incoherence was perhaps due to different protocol types, user setup parameters such as (slice thickness, pitch, kVp, and mAs) and seller inconsistencies in the CT product design. Studies are performed in Saudi Arabia and some reference dosages have been suggested. As the Saudi DRL for head, chest and abdominal investigations , Qurashi et al. reported DRL (CTDI) in Saudi for the same examinations. The chest (17.4 vs.8.2 mGy ) and the abdomen (16.71 vs. 10 mGy) were higher than those of this study were. For DLP, the values were higher than this study (414 vs. 386.1 mGy cm) for chest and the largest difference was found in abdomen (646 vs. 309.6 mGy cm).. In the current analysis, the values were lower than Qurashi et al  study. Foley et al  have suggested local DRL (CTDI) in Irish for the same examinations. The head (66 vs. 49.7 mGy), chest (9/11 vs. 8.2 mGy) and the abdomen (12 vs. 10 mGy) were higher than those of this study were. For DLP, the values were higher than this study (940 vs. 617.8 mGy cm) for head, (390 vs. 386.1 mGy cm) and the largest difference was found in abdomen ( 600 vs. 309.6 mGy cm). In some European countries, national adult DRLs were established [20,23,24,25]. The CTDI DRLs between Majmaah, Saudi Arabia and Greece (49.7 vs. 69.9) and DLP DRLs between Majmaah, Saudi Arabia and EC (750 vs. 1050) were substantially differentiated in the case of brain examination. The highest disparities in other measurements are also found in Majmaah, Saudi Arabia and EC (Table 4). While the proposed DRL is smaller than national and foreign benchmarks. The maximum CTDIW and CTDIvol values in this study were above the international minimum values during the brain, chest and abdomen scan. This may have been due to high mAs in this facility. Reducing mA before medical diagnosis is affected is a practical way of reducing radiation exposure. In all cases, the standards of CTDIW and CTDIvol were lesser than the amounts that suggested by international scientists. In all tests, DLP values had significant differences between hospitals. This was because of differences in CTDIW and the length of the hospital scan. Test length affects patient dose and it must be restricted to desired areas. Adjusting the kVp, adjusting the pitch factor, or utilizing the AEC is all possible techniques of regulating exposure. The level of care provided to the patient is affected by training and awareness of the functional requirements of CT scanning. It is believed that the findings of this study would aid hospitals and CT facilities worldwide in their efforts to better understand how they operate and what they do. The dose should be compared to that utilized in the current experiment at the appropriate time. In this study, the evaluation of all three CT pictures required an inordinate amount of time. Additional CT scan research is needed to make sure that the doses of CT scans are the same across the board[26-41].
To perform the study, patient CT dose data from King Khalid Hopsital was obtained, including CTDIw, DLP, and effective dosage values. The usage of local DRLs established the EU's 2004 definition of multi-slice CT reference rates as valid. This study included a discussion of CTDIvol in its assessment of MSCT literature, which was published by a third party. In order to account for changes to CT, the CTDIvol must be included in DRLs. This is especially true because newer CT scanners have been introduced.
The authors are thankful to the Deanship of Scientific Research, at Majmaah University for funding this research. [Porject No: R-2022-129]
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Citation: Yousif Abdallah, Valuation of Radiation Dosage Received in CT scan For Traumatic Patients in King Khalid Hospital-Majmaah, Saudi Arabia , J Res Med Dent Sci, 2022, 10(05): 141-145.
Received: 23-Feb-2022 Editor assigned: 25-Feb-2022 Reviewed: 11-Mar-2022 Revised: 25-Apr-2022 Published: 05-May-2022