No / Introduction: The purpose was to determine if an age based, local diagnostic reference level for paediatric skeletal surveys could be established using retrospective data. Methods: All children below two years of age referred for a primary skeletal survey as a result of suspected physical abuse during 2017 or 2018 (n ¼ 45) were retrospectively included from a large Danish university hospital. The skeletal survey protocol included a total of 33 images. Dose Area Product (DAP) and acquisition parameters for all images were recorded from the Picture Archival and Communication System (PACS) and effective dose was estimated. The 75th percentile for DAP was considered as the diagnostic reference level (DRL). Results: The 75th percentile for DAP was 314 mGy*cm2 , 520 mGy*cm2 and 779 mGy*cm2 for children <1 month, 1e11 months and 12 < 24 months of age respectively. However, only the age group 1e11 months had a sufficient number of children (n ¼ 27) to establish a local DRL. Thus, for the other groups the DAP result must be interpreted with caution. Effective dose was 0.19, 0.26 and 0.18 mSv for children <1, 1e11 months and 12 < 24 months of age respectively. Conclusion: For children between 1 and 11 months of age, a local diagnostic reference level of 520 mGy*cm2 was determined. This may be used as an initial benchmark for primary skeletal surveys as a result of suspected physical abuse for comparison and future discussion. Implications for practice: While the data presented reflects the results of a single department, the suggested diagnostic reference level may be used as a benchmark for other departments when auditing skeletal survey radiation dose.

Abstract Fluoroscopically guided procedures are currently an area of special concern in relation to radiation protection, as they may produce a high radiation dose to patients and increase the risk of skin injury. ERCP is a gastrointestinal procedure used as a gold standard in the treatment of pancreatobiliary disorders. It is performed under endoscopic and fluoroscopic guidance. Recently, both the number and the complexity with associated increased technical difficulty of therapeutic ERCP procedures have significantly increased. The present study aimed to assess the medical use of radiation in ERCP, with special emphasis on optimisation of radiation protection of patients. For this purpose, the level of patient radiation exposure during ERCP was evaluated by registering the radiation dose indices in Finnish hospitals. The entrance surface dose was measured by thermoluminescent dosimeters and the effective dose was estimated using conversion coefficients. For dose optimisation and for quality assurance, the local diagnostic reference levels (DRL) for ERCP were established and reviewed after five years. A single centre prospective analysis was conducted to identify patient-, procedure- and operator-related factors affecting dose area product (DAP) and fluoroscopy time (FT). The results showed a large variation of dose indices in overall, as among participating hospitals due to differences in patient characteristics, operator, equipment and procedural complexity. The risk of radiation-induced skin injury and the lifetime cancer risk seems to be reasonably low, indicating ERCP to be a low-dose study. Local DRL is an effective tool in the optimisation process, as a certain degree of dose reduction was achieved during the years. Multiple factors were found to affect DAP and FT in ERCP. The awareness of these factors may help to predict possible prolonged procedures that cause a higher radiation dose to the patient and thus facilitate the use of appropriate precautions. / Tiivistelmä Säteilysuojelun näkökulmasta läpivalaisuohjauksessa tehtävät toimenpiteet ovat erityisen huolen aiheena, koska ne voivat aiheuttaa potilaille suuria säteilyannoksia ja siten lisätä ihovaurion riskiä. ERCP on ruoansulatuskanavan endoskopiatoimenpide, jota käytetään haima- ja sappitiesairauksien hoidossa kultaisena standardina. ERCP suoritetaan duodenoskoopilla läpivalaisukontrollissa. Viime vuosina ERCP toimenpiteiden määrät ja toimenpiteiden monimutkaisuus ovat kasvaneet merkittävästi lisääntyneen teknisen haastavuuden vuoksi. Tutkimuksen tarkoituksena oli arvioida säteilyn lääketieteellistä käyttöä ERCP:ssa, kiinnittäen eritystä huomiota potilaan säteilysuojelun optimointiin. Potilaan säteilyaltistuksen tasoa ERCP:ssa arvioitiin keräämällä potilasannoksia suomalaisista sairaaloista, pinta-annokset mitattiin termoloistedosimetreilla ja efektiivinen annos laskettiin muuntokertoimilla. Säteilyaltistuksen optimointi- ja laadunvalvonnan työkaluksi ERCP:lle asetettiin paikalliset vertailutasot ja ne tarkistettiin 5 vuoden kuluttua. Potilaaseen, toimenpiteeseen ja toimenpiteen suorittajaan liittyvät tekijät, jotka vaikuttavat annoksen ja pinta-alan tuloon (DAP) sekä läpivalaisuaikaan, selvitettiin retrospektiivisesti yhdessä sairaalassa. Tutkimuksen tulokset osoittivat, että potilaan säteilyannoksissa oli suurta vaihtelua niin yleisesti, kuin osallistuvien sairaaloiden välillä. Vaihtelu johtui potilaan ominaisuuksista, erilaisista läpivalaisulaitteista, toimenpiteen suorittajista ja ERCP toimenpiteiden vaikeusasteesta. Säteilyn aiheuttaman ihovaurion riski ja elinikäinen syöpäriski näyttäisi tulosten perusteella olevan kohtuullisen alhainen, mikä osoittaa, että ERCP on matala-annostutkimus. Paikallinen vertailutaso osoittautui tehokkaaksi optimointityökaluksi, sillä annostason lasku ERCP:ssa saavutettiin vuosien kuluessa. Useiden tekijöiden todettiin vaikuttavan DAP:n ja läpivalaisuaikaan ERCP:ssa. Näiden tekijöiden tiedostaminen voi auttaa tunnistamaan etukäteen ne haastavat ERCP toimenpiteet, jotka voivat aiheuttaa suuria säteilyannoksia potilaille, ja siten mahdollistaa niihin varautumisen.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Diagnostic Radiography, Department of Nursing and Radiography in the Faculty of Health Wellness Sciences at Cape Peninsula University of Technology 2014 / Aim: The aim of this study was to record the values of CTDIw and DLP displayed on the Computed Tomography (CT) scanner monitors of patients undergoing CT examinations of the head as Diagnostic Reference Levels (DRL) for dose optimisation in Northern Nigeria. Background: A brain CT scan is the most common CT examination performed, and this modality is recognized as delivering a high dose. CT, therefore, contributes significantly to the total collective effective dose to the population. Elimination of unnecessary or unproductive radiation exposure is necessary. To achieve this, practitioners must adhere to the principles of the justification of practices, and optimisation of radiation protection. Furthermore, the development of DRLs for the local context is advised. These reference doses are a guide to the expected exposure dose from a procedure and are useful as an investigation tool to identify incidences where patient doses are unusually high. Methodology: The study was conducted in three radiology departments with CT centres in Northern Nigeria. Data was collected, using a purposive sampling technique, from 60 consenting adult participants (weighing 70 ±3 kg) that had brain CT scans on seventh generations 4&16-slice GE and 16-slice Philips CT scanners. Prior to commencement of the study the CT scanners were certified by the medical physicists. For each brain scan, patient information, exposure factors, weighted computed tomography dose index (CTDIw), volume computed tomography dose index (CTDIvol) and dose length product (DLP) values were recorded. The data were analysed using SPSS version (16) statistical software. The mean, standard deviation and third quartile values of the CTDIw and DLP were calculated. An inter-comparison of the measured doses from the three research sites was conducted. A combined dose for the three centres was calculated, and compared with the reported data from the international communities where there are established DRLs. Results: The mean CTDIw and DLP values were: centre A (88 mGy and 713 mGy.cm), centre B (68 mGy and 1098 mGy.cm), and centre C (70 mGy and 59 mGy.cm). Comparison of CTDIw and DLP for the scanners of the same manufacturers showed statistically significant differences (p=0.003) and (p=0.03) respectively. In the case of the scanners of a different model but the same number of slices, the comparison of DLP was statistically significant (p=0.005) while no significant difference was noted in the measured CTDIw. Third quartile values of the cumulative doses of CTDIw and DLP, for Northern Nigeria were determined as 77 mGy and 985 mGy.cm respectively. Conclusion: The study has established Local DRLs (LDRLs) which are significantly higher than most of the reported data in the literature. Also dose variation between centres was noted. Optimization is thus recommended. Keywords: Head Imaging, Radiation Dose, Dose optimization, Computed Tomography, Local Diagnostic Reference Levels, Radiation Protection