Management of diagnostic x-ray radiation in developing countries

The purpose of this study is to provide a simple, inexpensive, and effective method to prevent the scattering of x-ray radiation by using a lead apron in the x-ray rooms of developing countries. In developed countries, the scattering of x-ray radiation among patients and radiographers in diagnostic x-ray rooms has been minimized by various methods. However, in some developing countries, scattered x-ray radiation has not yet been adequately contained. The policy of As Law As Reasonably Achievable (ALARA) requires that patients who are waiting for their examinations must be protected from scattered x-ray radiation. However, from the author’s experience, protection from scattered x-ray radiation in x-ray rooms is often insufficient in developing countries. In addition, major public hospitals in big cities are overwhelmed with patients because radiology resources in developing countries are concentrated in the big cities. Moreover, the situation is made worse by short working hours in public hospitals. Hours from 10 a.m. to 3 p.m. are typical. Because of the circumstances, radiographers, who are in a rush to finish all of the examinations within their normal working hours, sometimes allow patients to enter the x-ray rooms while they are waiting for their examinations. Chest and abdominal x-rays are the most common kinds of diagnostic x-ray examination in developing countries. Thus, in this study, anthropomorphic chest and abdominal phantoms were x-rayed for measuring the scattered x-ray radiation with and without protection using a 0.25mmPb lead apron at specific points from the anthropomorphic phantoms in the x-ray room. The lead apron was hung on a mobile apronhanger and placed next to the anthropomorphic phantom. The scattered radiation dosimetry for chest x-rays proves that this simple method reduces scattered x-ray radiation to 15% at one-meter point and to almost 0% at the two-meter point from the anthropomorphic phantom in the x-ray room. Lead aprons are generally available in most developing countries, and the method described is simple and effective to reduce scattered x-ray radiation in the x-ray rooms. INTRODUCTION In modern hospitals of industrialized countries, the demand for diagnostic radiology has recently increased dramatically, and techniques have become more sophisticated along with the development of electronics and computer technology. In contrast, there is a great discrepancy in the availability of radiological services and equipment in developed and developing countries. The World Health Organization (WHO) reports that about two-third of the population in developing countries has no access to essential radiological services. On the other hand, regarding the increasing number of people who are dying of circulatory diseases, the demand for diagnostic radiology is expected to increase in developed countries as well as in developing countries (1). Consequently, medical exposure to the population is expected to increase gradually (2). As far as the safe use of x-rays in developing countries is concerned, Ghana could be used as an example. In Ghana, there were no institutional performance checks following major repairs of faulty equipment, nor were there routine checks at regular intervals to ensure the consistent performance of the equipment. Moreover, quality assurance for providing the radio diagnostic information at the lowest possible cost with the least possible exposure is not always available (3). This situation may oppose the policy of ALARA. One reason for this problem may be simply lack of money. The data shows that a comparison of the expenditure on medical equipment per capita is just 0.5 U.S. dollars in Sub-Saharan Africa. In contrast, the UK and USA spent 21 U.S. dollars and 66 U.S. dollars, respectively (4). However, in the author’s experience in developing countries as an expert with the Japan International Cooperation Agency (JICA), radiation protection management has not always had a high priority in hospitals. Some other reasons for this problem in developing countries are as follows: 1) Enthusiastic managers for radiation protection are not always available. 2) Measuring devices for radiation exposure are not always available. 3) Radio diagnostic equipment is much more complicated than general medical equipment. As a consequence, protecting patients in developing countries from unnecessary x-ray radiation must be organized and accomplished with achievable techniques. Based on this concept, the goal of this study is to provide an easy method for preventing the scattering of diagnostic x-rays among patients in developing countries.