Diagnostic reference levels in low- and middle-income countries: early “ALARAm” bells?

Abstract

Background: In 1996 the International Commission on Radiological Protection (ICRP) introduced diagnostic reference levels (DRLs) as a quality assurance tool for radiation dose optimization. While many countries have published DRLs, available data are largely from high-income countries. There is arguably a greater need for DRLs in low-and middleincome-countries (LMICs), where imaging equipment may be older and trained imaging technicians are scarce. To date, there has been no critical analysis of the published work on DRLs in LMICs. Such work is important to evaluate data deficiencies and stimulate future quality assurance initiatives. Purpose: To review the published work on DRLs in LMICs and to critically analyze the comprehensiveness of available data. Material and Methods: Medline, Scopus, and Web of Science database searches were conducted for English-language articles published between 1996 and 2015 documenting DRLs for diagnostic imaging in LMICs. Retrieved articles were analyzed and classified by geographical region, country of origin, contributing author, year of publication, imaging modality, body part, and patient age. Results: Fifty-three articles reported DRLs for 28 of 135 LMICs (21%), reflecting data from 26/104 (25%) middle-income countries and 2/31 (6%) low-income countries. General radiography (n ¼ 26, 49%) and computerized tomography (n ¼ 17, 32%) data were most commonly reported. Pediatric DRLs (n ¼ 14, 26%) constituted approximately one-quarter of published work. Conclusion: Published DRL data are deficient in the majority of LMICs, with the paucity most striking in low-income countries. DRL initiatives are required in LMICs to enhance dose optimization.

Bildgebung bei Kindern und Jugendlichen intraoperativ, bei ausgewählten Frakturen und im Verlauf nach konservativer und operativer Behandlung

“…Die Vorteile und Erfolge dieser Bildgebung sind anerkannt, es bedarf aber auch heute immer einer rechtfertigenden Indikation, auch zur Röntgendiagnostik. Der kindliche Organismus ist im Vergleich zum Erwachsenen strahlensensibler und damit anfälliger, durch ionisierende Strahlen Malignome zu entwickeln, auch weil die jungen Patienten eine längere Lebenserwartung und damit Zeitspanne haben [ 7 , 30 , 41 , 46 ].…”

Nigerian Radiographers Obligation to Diagnostic Reference levels (DRLs) in Medical Imaging

“…As a corollary, about 72% of European countries as well as the United States have established DRLs for some radiological examinations and subsequent reviews have demonstrated significant dose reductions (16%-30%) [8,13], such evidences are difficult to come by in Africa. Only about eight out of fiftyfour countries in Africa (15 %) have publications on DRLs, with no evidence linking any country to national DRLs [14]. Regulatory agencies have dual obligations with regards to the issue in focus.…”

Review of the current status of radiation protection in diagnostic radiology in Africa

“…Non-availability of national or local DRLs also contributes to this lack of optimization as few countries have developed such tools. 35…”