Radiation doses for barium enema and barium meal examinations in Ireland: potential diagnostic reference levels

Abstract

Wide variations in patient dose for the same examinations have been demonstrated by several studies throughout Europe. By investigating patient dose, variations can be acknowledged, causal agents sought and the necessary adjustments made. Diagnostic reference levels (DRLs) provide a framework with which dose levels from individual hospitals are compared, and when exceeded, corrective actions can be taken where appropriate. This study aimed to establish DRLs for barium enema and barium meal examinations in Ireland. Measurements were recorded using a dose-area product meter in 12 hospitals representing 33% of relevant hospitals. Results demonstrated wide mean hospital dose variation, by up to a factor of 7.8 and 4.2 for barium enema and barium meal examinations, respectively. Minimum and maximum individual patient dose values varied by a factor of 45 for barium enemas and 90 for barium meal examinations. Reasons for dose variations were complex, but major factors for both examinations were fluoroscopy time, secondary radiation grid type and level of filtration. Some examination-specific factors were also noted. DRLs, established using the quantity dose-area product, were calculated to be 47 Gy cm(2) for barium enemas and 17 Gy cm(2) for barium meal examinations. Although the DRL value for barium meals was the same as the reference value established in the UK for that examination in 1996, the barium enema DRL in this study was 45% higher than the relevant UK value.

Neonatal Radiation Exposure

“…As seen in Table 2, a CT scan is equivalent to 7,800 chest radiographs. An estimation of equivalent number of chest radiographs with different radiological procedures was published recently by Malone et al (9) (25) 130 Gy cm 2 (28.6 mSv) 3.4 Gy cm 2 (mean 31) (0.78 mSv) or 6.62 mSv mean Martin et al (26) 3.5 D/L 0.7 mSv Conversions: 1 Gy cm 2 ¼0.22 mSv; 1,000 uSv¼1 mSv. CAXR¼chest and abdomen radiograph; CXR¼chest radiograph; plain radiographs¼radiographs of chest, chest and abdomen, and skeletal films; radiographs¼radiographs of chest, and chest and abdomen; UGI¼upper gastrointestinal study.…”

A pilot study exploring the possibility of establishing guidance levels in x-ray directed interventional procedures

“…[1][2][3][4] The application of guidance levels to certain frequently performed standard diagnostic fluoroscopic procedures ͑e.g., barium studies͒ is also generally accepted. [5][6][7] Investigations into the appropriateness of applying guidance levels to invasive diagnostic and therapeutic procedures such as coronary angiography ͑CA͒ and percutaneous coronary interventions ͑PCI͒ are scarce. [8][9][10][11] Is diagnostic coronary angiography sufficiently well standardized to apply guidance level methodology?…”

Patient radiation exposure during general fluoroscopy examinations

“…The ${\mathrm{normalK}}_{\mathrm{a},\mathrm{r}}$ in children were smaller than those for adults due to the automatic selection of fluoroscopy technique triggered by the smaller patient size. The fluoroscopy examinations were performed with longer time and higher KAP, resulting in large effective doses (Table 3) that were also broad with respect to the measured values as compared to the available values in the literature 2 , 9 , 10 , 11 , 12 , 13 , 14 , 15 . The IDRLs for the ${\mathrm{normalK}}_{\mathrm{a},\mathrm{r}}$, KAP, and fluoroscopy time, especially in children, were not available in the cited literature for comparison.…”

“…These quality assurance challenges are exacerbated by emerging health needs and lack of adequate resources coupled with the ballooning population. This study aimed to determine the radiation dose to patients, establish the necessary optimization strategies for fluoroscopy procedures, and compare the findings with the international DRLs 2 , 9 , 11 , 12 , 13 , 14 , 15 …”