X-rays Often Repeated For Patients In Developing Countries

"Poor image quality constitutes a major source of unnecessary radiation to patients in developing countries," emphasizes Dr. Madan Rehani of the IAEA Division of Radiation, Waste and Transport Safety, which carried out the survey under technical cooperation (TC) projects of the IAEA. "Fortunately, we´re moving forward to help countries improve the situation and have shown definite improvements."

The survey was done in phases from August 2005 to December 2006 at hospitals in the Democratic Republic of the Congo, Ghana, Madagascar, Sudan, Tanzania, Zimbabwe, Iran, Saudi Arabia, Thailand, United Arab Emirates, Bosnia and Herzegovina, and Serbia. Project counterparts in these countries worked through IAEA-supported regional technical cooperation projects that aim to help countries implement quality assurance programmes for radiographic examinations, in line with international radiation safety standards.

"The use of X-rays in medical care is growing in developing countries," Dr. Rehani says. However, he adds, vital information about both the quality of X-ray images and patient doses is "grossly lacking" at many hospitals where the IAEA has helped launch quality assurance programmes.

The survey found that more than half (53%) of all X-ray images evaluated through the project were of poor quality affecting diagnostic information, Dr. Rehani said. One consequence is that patients then are given repeat examinations, which means exposing them to X-rays again, as well as entailing extra costs. The survey included patients receiving chest, pelvic, abdomen, skull, and spine X-ray examinations.

The good news is that efforts to improve quality through quality assurance (QA) appear to be paying off. In a paper just published in the June edition of the American Journal of Roentgenology, Dr. Rehani and colleagues report that considerable benefits were seen regionally after introduction of QA programmes. The quality of X-ray images improved up to 16% in Africa, 13% in Asia and 22% in Eastern Europe. At the same time, patient dose reductions ranging from 1.4% to 85% were achieved overall.

The IAEA-supported projects could help change the picture at more hospitals in developing countries by changing the approach to quality assurance in radiography. In the past, the QA approach has been dominated by testing the radiographic equipment primarily, Dr. Rehani points out.

"Our work shows that focusing on the machine is not enough," he says. "We´re documenting that the evaluation of image quality and patient dose goes hand in hand with safe and effective medical radiography."

Background

The project on strengthening radiological protection of patients is designed to help countries apply the International Basic Safety Standards for the Protection Against Ionizing Radiation and for the Safety of Radiation Sources (BSS), developed by the IAEA, World Health Organization and other partners. The standards require attention to image quality by considering corrective actions if such exposures do not provide useful diagnostic information and do not yield medical benefits to patients.

Despite the finding that repeat X-ray examinations were often needed, patient doses in the 12 countries surveyed were in line with international diagnostic reference levels and similar to doses recorded in developed countries. Thousands of X-ray images were evaluated as part of the survey. (Worldwide each year, the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) estimates that nearly two billion (2000 million) medical X-rays are done, in its report of 2000 and the indications are that it is getting almost doubled now in 2008).

Altogether 34 countries agreed to participate in the IAEA survey, though data presently are available for only 12 countries and more countries are likely to provide data in coming months.