1. CURRENT TRENDS AND LIMITATIONS IN ESTABLISHING DIAGNOSTIC REFERENCE LEVELS FOR RADIOLOGICAL EXAMINATIONS IN NIGERIA The 48th Annual Conference and Scientific workshop of the Association of Radiographers of Nigeria. “Kano 2016” BY
JOSEPH ,DLAMA ZIRA
DEPARTMENT OF RADIOLOGY, ABUBAKAR TAFAWA BALEWA UNIVERSITY TEACHING HOSPITAL BAUCHI , BAUCHI STATE.

2. TABLE OF CONTENTS INTRODUCTION AIM AND OBJECTIVES OF THE STUDY
SIGNIFICANCE OF THE STUDY
CONCLUSION
RECCOMMENDATION
REFERENCES
KEY WORDS - [ Diagnostic Reference levels, x-ray, Radiation, Radiology, Dose]

3. The use of diagnostic reference levels has been supported by national and international advisory bodies (Donald et al., 2012 ,ICRP, 2011).
Diagnostic reference level is defined as an investigation level used to identify unusually high radiation doses for Radiological examinations. (Jeska et al., 2014).
They are suggested action levels above which a facility should review its methods and determine if acceptable image quality can be achieved at lower doses (Wallace, 2010).
Diagnostic reference levels should be used by regional, national and local authorized bodies (Jenia and Madan 2015).
INTRODUCTION
5/30/2018

4. STATEMENT OF THE research PROBLEM
There are no established Diagnostic reference levels for radiological examinations in Nigeria as indicated by the Regulatory body. (Nworgu and Bamidele, 2010 ,Olowookere et al., 2012). Absence of DRLs could result to unsafe practice which poses detrimental effects on patients and personnel.
The burden of knowing whether the protection of patients has been adequately optimized is a major problem that necessitated this study.
5/30/2018

5. Objective
To create awareness on the need to establish diagnostic reference levels for Radiological examinations in Nigeria.
To discuss current trends and limitations in establishing DRLs

6. Significance
DRLs is intended to serve as a simple test for identifying situations where the level of patient dose is unusually high and to know whether the protection of patients has been adequately optimized.
Gives a guide on the imperativeness of establishing DRLs which will be used as a guidance level for optimization and will also help to reduce unnecessary doses and the consequent radiation risks.

7. LITERATURE REVIEW Conceptual Review
Diagnostic reference levels were first mentioned by the International Commission on Radiological Protection (ICRP) in 1990 and subsequently recommended in greater detail in 1996 from the 1996 report. (ICRP 73, 1996)
ARPANSA, 2008
IAEA,2002
EU,1996
UK/ Hart et al., 2002
Theoretical review
Empirical Review

8. Research methodology
A systematic search through the internet, Medline, web of science, Scopus ,google scholar and manual search was conducted using search terms extracted from three terms;
DRLs
Doses in radiological examination
DRLs in different countries.
The search resulted in 90 articles in which 30 were included after a screening process.

9. Results The Combined search strategy identified 90 articles
6 identified from Medline
4 from scopus
5 from web of science and 15 from google scholar and manual search.
Diagnostic reference levels will be taken from the third quartile (75th percentile) readings of the distribution of mean doses from different radiological examination.
The Result showed that no comprehensive DRLs for radiological examination have been set for Nigeria.

10. May consider image quality either subjective or objective
ANNALS OF ICRP STILL AT CONSULTATION STAGE, 11TH JANUARY 2016 (Not a reference document)
DRLs 75percentile of the mean doses but now suggests 75 percentile of the median doses
May consider image quality either subjective or objective
Different categories of patients body built eg 40-50kg, 51-60kg, 61-70ky… instead of representative patients.
Anthropo-technical parameters should be considered. AQD a new suggested concept

11. Conclusion
DRLs is still an ongoing project in Radiography and Radiation science hitherto, the need to establish it.
AQD Is aimed at optimization within the DRLs. it is facility initiated and takes into account some important parameters. IQ, Dose and Patients body build.
While it is crucial to establish DRLs in every country the new research area and current trends should be given due attention by Radiographers

12. RECCOMMENDATION
Regulatory bodies/ agencies and professional bodies should collaborate with researchers to develop DRLs in Nigeria.

13. REFERENCES .
ARPANSA, RPS 14. (2014) .Code of Practice for Radiation Protection in Medical Applications of Ionizing Radiation. National Diagnostic Reference levels Fact sheet. A publication of Australian Radiation Protection and Nuclear Safety Agency, Yallambie.2014
ARPANSA RPS 14.1 (2008) .Code of Practice for Radiation Protection in Medical Applications of Ionizing Radiation. National Diagnostic Reference levels Fact sheet. A publication of Australian Radiation Protection and Nuclear Safety Agency, Yallambie.2008
Donald L, Stephen B, Robert G, Boris N, Gabriel B, John F, Lawrence T, Micheal S. (2012). Quality Improvement Guidelines for Recording Patient Radiation Dose in the Medical Record for Fluoroscopically Guided Procedures. Journal of Vascular Interventional Radiology. 23(10):

14. REFERENCES CON’T
EUR96 European Guidelines on Quality Criteria for Diagnostic Radiographic Images, European Commission, EUR EN, June 1996
EUR96 European Guidelines on Quality Criteria for Diagnostic Radiographic Images in Pediatrics, European Commission, EUR EN, June 1996
Jeska S, Geoffrey K, Mark A, Ian K, Jedidah M. (2014). Patients Radiation exposure during general fluoroscopy examinations. Journal of Applied Clinical Medical Physics; 15(2):1-10.
ICR73 ICRP Publication 73 (Annals of the ICRP Vol. 26 No.2 (1996) Radiological Protection and Safety in Medicine; Pergamum Press, Oxford
ICRP 2000 “Recommendation of International Commission on Radiological Protection” ICRP Publication64 Ann ICRP (1-3) Pergamum Press, Oxford UK.

15. REFERENCES CON’T
ICRP,(2011). Diagnostic reference levels in medical imaging: Review and additional advice. Ann ICRP, 31(4):33-35
IAEA (2002) Radiological Protection for Medical Exposure to Ionizing Radiation. IAEA: Vienna,2002
Ionizing Radiation Medical Exposure Regulations.(2012).(IRMER) Guidance on the use of Diagnostic Reference Levels as the Term applies to Ionizing Radiation. Regulation 2000.
Johan and Idrastuti.(2012). An Attempt to Establish National Dose Reference Levels for Head CT- Scan Examinations in Indonesia: Preliminary Results from Melang Hospitals. International Journal Of Engineering Technology. 12(6):
Jenia V and Madan R. (2015). Diagnostic Reference Levels. American Journal of Roentgenology. 2015; 204:W1-W3
Johnson and Brenan (2012). Reference Dose Levels is for Patients Undergoing Common Diagnostic X-rays Examination in Irish Hospitals. British Journal of Radiology – 402.

16. THANK YOU

17. QUESTIONS ?