Patients in developing countries undergo repeated X-rays

Washington, May 28 : An Indian origin scientist at the International Atomic Energy Agency (IAEA) has shown that patients in developing countries have to undergo repeated X-ray examinations so that doctors have the image quality they need for useful medical diagnosis.

A survey carried out under technical cooperation (TC) projects of the IAEA, aimed at strengthening radiological protection of patients, was conducted on thousands of patients in 45 hospitals and 12 countries of Africa, Asia and Eastern Europe.

"Poor image quality constitutes a major source of unnecessary radiation to patients in developing countries. Fortunately, we´re moving forward to help countries improve the situation and have shown definite improvements," said Dr. Madan Rehani of the IAEA Division of Radiation, Waste and Transport Safety.

The survey was done in phases from August 2005 to December 2006 at hospitals in the Democratic Republic of the Congo, Ghana, Madagascar, Sudan, Tanzania, Zimbabwe, Iran, Saudi Arabia, Thailand, United Arab Emirates, Bosnia and Herzegovina, and Serbia.

Project counterparts in these countries worked through IAEA-supported regional technical cooperation projects that aim to help countries implement quality assurance programmes for radiographic examinations, in line with international radiation safety standards.

"The use of X-rays in medical care is growing in developing countries," said Rehani.

However, he added that vital information about both the quality of X-ray images and patient doses is "grossly lacking" at many hospitals where the IAEA has helped launch quality assurance programmes.

According to Rehani, they found that more than half (53 percent) of all X-ray images evaluated through the project were of poor quality affecting diagnostic information. One consequence is that patients then are given repeat examinations, i.e. exposing them to X-rays again, as well as entailing extra costs. The survey included patients receiving chest, pelvic, abdomen, skull, and spine X-ray examinations.

And it appears that efforts to improve quality through quality assurance (QA) are paying off. Researchers have reported in a paper that considerable benefits were seen regionally after introduction of QA programmes.

The quality of X-ray images improved up to 16 percent in Africa, 13 percent in Asia and 22 percent in Eastern Europe. At the same time, patient dose reductions ranging from 1.4 percent to 85 percent were achieved overall.

Rehani pointed out that the IAEA-supported projects could help change the picture at more hospitals in developing countries by changing the approach to quality assurance in radiography. In the past, the QA approach has been dominated by primarily testing the radiographic equipment.

"Our work shows that focusing on the machine is not enough. We´re documenting that the evaluation of image quality and patient dose goes hand in hand with safe and effective medical radiography," he said.

The paper is published in the June edition of the American Journal of Roentgenology.

ANI