诊断参考水平(DRL)和可实现剂量(AD)为进行医学成像程序的患者提供了优化辐射剂量的指导。这项多中心研究旨在比较不同医院的机构DRL(IDRL),为斯里兰卡的四种常见X射线检查提出AD和多中心DRL(MCDRL),并评估剂量减少的可能性。一项前瞻性横断面研究,对894名成人患者进行腹部前后(AP),肾-输尿管-膀胱(KUB)AP,腰椎AP,并进行腰椎外侧(LAT)X线检查。患者人口统计信息(年龄,性别,体重,BMI)和暴露参数(管电压,收集管电流-暴露时间乘积)。使用PKA计以角质面积乘积(PKA)测量患者剂量。IDRL,广告,和MCDRL是按照国际放射防护委员会准则计算的,AD和MCDRL定义为PKA分布中位数的第50和第75百分位数,分别。不同医院的IDRL范围差异很大:腹部AP为1.42-2.42Gycm2,KUBAP为1.51-2.86Gycm2,0.83-1.65Gycm2用于腰椎AP,和1.76-4.10Gycm2用于腰椎LAT。建议的AD为1.82Gycm2(腹部AP),2.03Gycm2(KUBAP),1.27Gycm2(腰椎AP),和2.21Gycm2(腰椎LAT)。MCDRL为2.24Gycm2(腹部AP),2.40Gycm2(KUBAP),1.43Gycm2(腰椎AP),和2.38Gycm2(腰椎LAT)。在所有四次检查中,都观察到PKA的医院内和医院间存在很大差异。尽管斯里兰卡的广告和MCDRL与现有文献中的广告和MCDRL相当,确定的医院内和医院间的差异强调了在不损害诊断信息的情况下减少剂量的必要性.建议IDRL高的医院审查和优化他们的做法。这些MCDRL作为初步的国家DRL,指导医疗专业人员和政策制定者的剂量优化工作。
Diagnostic reference levels (DRLs) and achievable doses (ADs) provide guidance to optimise radiation doses for patients undergoing medical imaging procedures. This multi-centre
study aimed to compare institutional DRLs (IDRLs) across hospitals, propose ADs and multi-centric DRLs (MCDRLs) for four common x-ray examinations in Sri Lanka, and assess the potential for dose reduction. A prospective cross-sectional
study of 894 adult patients referred for abdomen anteroposterior (AP), kidney-
ureter-bladder (KUB) AP, lumbar spine AP, and lumbar spine lateral (LAT) x-ray examinations was conducted. Patient demographic information (age, sex, weight, BMI) and exposure parameters (tube voltage, tube current-exposure time product) were collected. Patient dose indicators were measured in terms of kerma-area product (PKA) using a PKAmeter. IDRLs, ADs, and MCDRLs were calculated following the International Commission on Radiological Protection guidelines, with ADs and MCDRLs defined as the 50th and 75th percentiles of the median PKAdistributions, respectively. IDRL ranges varied considerably across hospitals: 1.42-2.42 Gy cm2for abdomen AP, 1.51-2.86 Gy cm2for KUB AP, 0.83-1.65 Gy cm2for lumbar spine AP, and 1.76-4.10 Gy cm2for lumbar spine LAT. The proposed ADs were 1.82 Gy cm2(abdomen AP), 2.03 Gy cm2(KUB AP), 1.27 Gy cm2(lumbar spine AP), and 2.21 Gy cm2(lumbar spine LAT). MCDRLs were 2.24 Gy cm2(abdomen AP), 2.40 Gy cm2(KUB AP), 1.43 Gy cm2(lumbar spine AP), and 2.38 Gy cm2(lumbar spine LAT). Substantial intra- and inter-hospital variations in PKAwere observed for all four examinations. Although ADs and MCDRLs in Sri Lanka were comparable to those in the existing literature, the identified intra- and inter-hospital variations underscore the need for dose reduction without compromising diagnostic information. Hospitals with high IDRLs are recommended to review and optimise their practices. These MCDRLs serve as preliminary national DRLs, guiding dose optimisation efforts by medical professionals and policymakers.