ASSESSMENT OF RADIATION RISK TO PATIENT AND STAFF DURING HYSTEROSALPINGOGRAPHY (HSG) USING CONVENTIONAL X-RAY IN KATSINA STATE, NIGERIA

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.

Keywords: Entrance surface dose, effective dose, hysterosalpingography HSG.

 CHAPTER ONE

GENERAL INTRODUCTION

1.1 Background of the study

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). .

1.2 Introduction

Radiation has several applications; it is used in the industry, agriculture, medicine and

research. The medical use of radiation involves its use in conventional radiography,

fluoroscopy, angiography, nuclear medicine (scintigraphy), computed tomography,

mammography and radiotherapy.

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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).

Measurements through quality control tests provide a means for setting and checking

standards to ensure good practice as an aid to the optimization of patients‟ protection.

Also estimates of the absorbed and effective doses to skin and tissues/organs in the

patient are needed to determine the associated risks. Data generated provide for

improvement in operations hence justifying techniques and procedures put in place in

diagnostic investigations.

Currently, the two fundamental principles (justification of practice and the optimization

of protection) have been placed under serious scrutiny in the achievement of ALARA in

the diagnostic radiology. In the light of the aforementioned, medical exposures are

receiving increasing attention with the realisation that clinical x-rays make the major

contribution from manmade sources to the population collective dose; also, there is

considerable potential for reducing doses without detriment to patient care (IRPA9,

1996).

Hysterosalpingography (HSG) is a special radiographic examination of the uterine

cavity and the fallopian tubes using radio-opaque dye for the evaluation of infertility in

women. „It involves unavoidable irradiation to the ovaries of women in child bearing

age; therefore, optimization is required in all involving procedures to ensure reduction

in the probability of the associated risk‟ (Suleiman et al., 2008). With the growing

concern about radiation doses received by patients and cancer incidence over the years,

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there has been an emergent requirement for information on typical doses and the range

of doses r


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