radiation protection of the young patient: kenya perspective dr. wambani sidika chief medical...
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RADIATION PROTECTION OF THE YOUNG PATIENT:
Kenya perspective
DR. WAMBANI SIDIKAChief Medical specialist Radiology
Kenyatta National Hospital, Nairobi.17th February 2015 Workshop
8th PACORI-Laico Regency Nairobi
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It is hard to mend babies It is hard to mend babies
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Overview1. Introduction
2. Kenya Health Care Level
3. Nuclear applications in Kenya
4. Level of nuclear applications provision in Kenya
5. Radiation exposure to patients and personnel
6. Conclusion
7. References
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INTRODUCTION
• The human body anatomy and health issues are universal.
• Nuclear Applications are therefore universal.
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INTRODUCTION• Radionuclide and ionizing radiation are
used in a variety of techniques in research, primary and secondary healthcare.
• One out of every five patients attending a hospital in Kenya benefits from some type of nuclear procedure.
• In 2013 over 3.5 million Kenyans benefited from nuclear applications in medicine.
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UNSCEAR 2008: Global use of medical radiology 1991-1996 (per million population)
Level I Level II Level III Level IV World
Doctors 2800 710 21045
(123) 1100
Radiologists 110 80 50.1(3) 70
X-ray Imaging equipment 290 60 40
4(20) 110
CT 17 2 0.40.1
(0.8) 6
*Current values for Kenya in blue
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Distribution of over 300 Radiological facilities
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Distribution of medical nuclear applications in Kenya
Tally Nuclear Technique Frequency (%)
1 General Radiographic X-ray machines 662 Radiographic Fluoroscopic X-ray Machines 12
3 Dental X-ray Machines 124 CT scanners 4
5 Mammography Units 2
6 Interventional Fluoroscopic X-ray Machines 17 Nuclear medicine 18 Cobalt Units <1
9 LINAC Accelerators 1
10 Bone Densitometer <1
11 Open Sources (assays) 1
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ANNUAL NUMBER OF EXAMINATIONS IN KENYA
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Relative Frequency of Radiographic Examinations in Children (< 15 yrs)
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Level of provision of medical radiology staff and facilities per million people
Personnel/ facilities
Kenya
(2011)Ghana (2010)
Uganda (2010)
UNSCEAR HCL IV
Britain (1983)
France (1982)
Netherlands (1983)
UNSCEAR HCL I
Medical doctors 120 140 86 45 1400 2090 1400 2800
Radiologists 3 1 1 0.1 28 91 84 110
Medical physicists 0.6 1
0.2-
- - --
Radiographers 5 87
- 143 340 330 -
X-ray equipment 20 10 4 4 198 244 310 290
CT scanners 0.8 0.5 0.3 0.1 1.7 1 4 17
Mammography 0.5 0.3 0.2 0.1- - -
24
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2012 Workload in Kenya• Each radiologist was responsible for
approximately 325,000 examinations per year.
• When general medical practitioners is included then each doctor is responsible for approximately 8,100 examinations per year.
• The radiographer patient workload is 189,300 examinations per year.
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DNA
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Estimate of annual population dose
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Proportion of Radiological Examinations (2009-2014) at KNH
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DRLs and IAEA Paediatric Patients Pub1609
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Age specific ESAK in the Direct Radiographic Technique
Examination Age (mon.) ESAK (μGy)Suggested LDRLs (μGy)
ESAK of other UK#, Kuwait studies (11), (16) (μGy)
ESAK of other Austria EC*, studies (*17) (μGy)
1CXR AP Neonates 50 60 50#,74 30, 80*
Infants 50 60 50#, 64 36, 100*
13 -60 60 70 70# 4461-120 70 90 120# 54121-180 90 110 - 67
CXR LAT Infants 90 110 132 200*
13 -60 110 130 - - 61-120 130 140 - -
2Abdomen AP Neonates 70 80 146 200*
Infants 80 90 400#, 396 45, 900*
13 -60 130 150 500# 13661-120 170 200 800# 286121-180 200 240 1200# -
Abdomen D.Decubits Neonates 90 110 - -
Infants 90 110 - -13 -60 170 200 - -61-120 310 350 - -
121-180 410 520 - -3PNS LAT Neonates 100 120 - -
Infants 120 150 - -13 -60 130 150 - -61-120 140 150 - -
121-180 150 160 - -
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Age specific ESAK in the Bucky Radiographic Technique
Examination Age (mon.) Mean ESAK (μGy)
Suggested LDRLs (μGy)
ESAK of other UK# , Irish studies(12) (μGy)
1 CXR PA Erect 13 -60 120 180 5061-120 140 190 70
121-180 150 190 902 CXR LAT-Erect 13 -60 260 310 -
61-120 310 410 - 121-180 320 510 -3 Abdomen AP Neonates 220 250
Infants 200 270 33013 -60 280 350 75061-120 370 460 2600#
121-180 490 560 -4 PNS LAT 13 -60 170 180 -
61-120 230 260 - 121-180 260 280 -
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Future Perspectives
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Diagnostic Methods
• Development of quality assurance program in diagnostic and therapeutic radiology.
• Development of clinical specific protocols especially in CT and Interventional radiology procedures.
• Maintain the quality/ control
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Conclusions• Need for catalyzed effort in the transition to the
state-of-the-art nuclear techniques/equipment to Kenya.
• Develop the manpower/human resource
• Develop QA program and imaging guidelines in Radiology.
• Policies that lower expenses and increase availability of nuclear techniques in medicine.
• Policies that support appropriate and practical technology for health care and research.
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THANK YOU
ASANTENI
VIELEN DANKE
SANDIZI
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References1. Korir, G.K., Wambani, J.S., Korir, I.K., Tries, M., Kidali, M.M. Frequency and
Collective Dose of Medical Procedures in Kenya. Health Phys; 2013: in process
2. Wambani, J. S., Korir, G.K., Korir, I. K., Kilaha, S. Establishment of local diagnostic reference levels in paediatric screen-film radiography at a children's hospital. Radiat Prot Dosimetry; 2013; 154(4): 465-476.
3. Korir, G.K, Wambani, J.S., Korir, I.K. Estimation of annual occupational effective doses from external ionizing radiation at medical institutions in Kenya. SAJR; 2011; Vol 15(4): 116-119.
4. Korir, G.K., Ochieng B.O., Wambani, J.S., Jowi C. Radiation exposure in interventional procedures. Radiat Prot Dosimetry; 2012; 152 (4): 339-344.
5. Korir, G.K.,Wambani, J.S., Korir, I.K. Establishing quality management baseline in the use of computed tomography machines in Kenya. J. Appl Clin Med Phys; 2012, Vol. 13(1):187-196.
6. Wambani, J.S., Korir, G.K., Onditi E.G., Korir, I.K. A Survey of computed tomography imaging techniques and patient dose in Kenya. East Afr Med J; 2010; 87(10), 400-407.