– Assessment of Radiation Risk to Patient and Staff During Hysterosalpingography (HSG) Using Conventional X-ray in Katsina State, Nigeria –
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ABSTRACT
Scientific evidence has revealed radiation as one of the causes of cancer and the use of radiation in medicine is on a continuous increase; studies have revealed that the medical use of x-ray is the major contributor of man-made source of radiation to the world‟s population.
The drive for this study was the increase in the number of patients available for hysterosalpingography, HSG investigation. The aim of the study was to determine the radiation risks to the patients and staff during HSG procedure.
A cross sectional study was conducted on 38 female patients in two diagnostic facilities in Katsina state of Nigeria.”
It is important to know that the staff performing the procedure stays in the radiographic room together with the patient while the x-ray exposures take place, this should not be confused with the operator of the x-ray machine”.
Quality control tests were conducted on the x-ray machines involved in the study as preliminary tests to ascertain the credibility of the generated data.
The entrance surface doses ESDs to the patients‟ pelvis and anterior neck surface of the staff were measured by placing TLDs on the patients‟ pelvic surface and the shirt collar of the staff respectively. The mean measured patient ESD and staff ESD were 10.88mGy and 0.12mGy.
The patients‟ mean measured effective doses to the ovaries, uterus, bladder, rectum, pelvic bone surface and the pelvic skin surface were 0.87mSv, 1.31mSv, 0.44mSv, 1.31mSv, 0.11mSv and 0.11mSv.
While, the staff mean measured effective doses to thyroid, eyes and facial skin were 4.8µSv, 14.4µSv and 1.2µSv.
The total exposed films used were between 4 to 6 films, this implies that the patients‟ ESD per film is 1.8 to 2.8mGy which is below the IAEA diagnostic reference level of 10mGy for Antero-posterior (AP) projection pelvis.
And the mean radiation dose received by the staff is below the recommended occupational dose of a radiation worker by international commission on radiological protection ICRP 103.
Though the mean measured effective dose values obtained were low, it does not indicate zero health effect since in radiation protection there is no safe dose for now. It should be understood in principle that dose acquisition has cumulative effect.
Therefore, there is need for further optimization of procedure by reducing the number of patient radiation exposures (x-ray films taken), proper choice of exposure factors, tighter x-ray beam collimation and regular QC checks.
TABLE OF CONTENTS
Declaration Page- – – – – – – – – – II
Certification Page- – – – – – – – – – III
Acknowledgements- – – – – – – – – – IV
Dedication- – – – – – – – – – – V
Abstract- – – – – – – – – – – VI
Table of Contents – – – – – – – – – VII
List of Tables- – – – – – – – – – X
List of Figures- – – – – – – – – – XII
CHAPTER ONE: GENERAL INTRODUCTION
1.1 Background- – – – – – – – – – 1
1.2 Introduction- – – – – – – – – – 1
1.3 Statement of the Problem- – – – – – – – 3
1.4 Justification- – – – – – – – – – 4
1.5 Aim and Objectives- – – – – – – – – 5
1.6 Scope of the Study- – – – – – – – – 6
CHAPTER TWO: LITERATURE REVIEW
2.1 Radiation Effects – – – – – – – – – 7
2.1.1 Somatic effects- – – – – – – – – 7
2.1.2 Genetic effects- – – – – – – – – – 9
2.2 Radiation Dosimetry- – – – – – – – – 10
2.2.1 Radiation quantities and units- – – – – – – 10
2.3 Radiation Detection and Measurement- – – – – – – 17
2.3.1 Survey instrument – – – – – – – – 18
2.3.2 Personnel monitoring instrument- – – – – – – 18
2.4 Radiation Protection- – – – – – – – – 23
2.4.1 Building design and layout- – – – – – – – 24
2.4.2 Quality assurance and control- – – – – – – 30
2.5 Anatomy and Physiology of the Female Pelvis- – – – – – 31
2.5.1 The bony pelvis (pelvic girdle) – – – – – – – 31
2.5.2 The female reproductive system- – – – – – – 33
2.6 Hysterosalpingography HSG- – – – – – – – 37
2.7 Related Studies- – – – – – – – – 39
CHAPTER THREE: MATERIALS AND METHODS
3.1 Materials – – – – – – – – – – 47
3.2 Methods – – – – – – – – – – 48
3.2.1 X-ray room design and layout – – – – – – – 48
3.2.2 Quality control tests- – – – – – – – – 52
3.2.3 HSG procedure- – – – – – – – – – 59
CHAPTER FOUR: RESULTS AND DISCUSSION
4.1 X-ray Machine Specification- – – – – – – – 61
4.2 Quality Control Test Report- – – – – – – – 62
4.2.1 kVp accuracy and reproducibility- – – – – – – 63
4.2.2 Filtration and half value layer (HVL)- – – – – – – 68
4.2.3 mAs/timer linearity and reciprocity- – – – – – – 70
4.2.4 Radiation output reproducibility- – – – – – – 72
4.2.5 Light beam misalignment test- – – – – – – – 73
4.2.6 Radiation leakage- – – – – – – – – 75
4.2.7 Lead apron test- – – – – – – – – – 75
4.3 HSG Procedure- – – – – – – – – – 76
CHAPTER FIVE: CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion- – – – – – – – – – 78
5.2 Recommendations- – – – – – – – – 79
REFERENCES- – – – – – – – – – 80
INTRODUCTION
X-ray is a form of electromagnetic radiation which was discovered on November 8, 1895 by Wilhelm Conrad Roentgen. This ground breaking discovery gave birth to radiography on December 27, 1895; when Roentgen took the first x-ray image of his wife‟s hand (Explorable.com, 2010).
This made scientists at that time use this amazing ray to create images of the inside of the human body. But it was not for long when people started complaining of skin burns and cancer.
In the late 1896, Elihu Thomson, an American physicist, deliberately exposed the little finger of his left hand to an x-ray tube for several days, half an hour per day which resulted in pain, swelling, stiffness, erythema and blistering.
In 1942, the leaders of the Manhattan District of U.S. asked Ernest O. Wollan, a cosmic ray physicist at the University of Chicago, to form a group to study and control radiation hazards and this was when the word „health physics‟ was born.
However, because of the various complaints that arose as a result of the uses of x-rays, various bodies (both governmental and non-governmental) were created to provide solutions and recommendations on how to reduce the adverse effects of radiation (Kathren & Ziemer, 1980; Turner, 2007).
The use of ionizing radiation in clinical practice is on the increase both locally (in Nigeria) and globally.
Certain checks have to be periodically done in order to ensure the optimization and protection of patients from these dangerous rays; in addition to investigate compliance level,
Survey data showed that physicians underestimate the magnitude of radiation doses and their associated detrimental effects and thus underestimating the level of risk to patients (Mercuri et al., 2011).
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AERB Safety Code no. AERB/SC/MED-2 (Rev. 1): Safety code for medical diagnostic x- ray equipment and installation (2001). Atomic Energy Regulatory Board Mumbai 400 094
Al-Kinani, A.T. and Mohsen, Y. (2013). Study of Quality Assurance of Conventional X- ray M Research Journal of Medicine and Medical Sciences. (ISSN: 2354- 3238) Vol. 1(5) pp. 194-200, www.meritresearchjournals.org/mms/index.htm
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Ellis H. and Mahadeva V. (2010). Clinical anatomy: applied anatomy for students and junior doctors, 12th edition. Pp. 146 – 159. ISBN 978-1- 4051-8617-9 Encyclopædia Britannica Online (last updated 5-1-2015). Pelvic girdle. Retrieved October 29. 2016, from https://www.britannica.com/science/pelvic-girdle.
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