Prospective study of clinical application of justification and optimization principles of alara in pediatric ct imaging, Tikur Anbessa specialized hospital, Addis Ababa University, Addis Ababa, Ethiopia
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Date
2018-10
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Addis Ababa University
Abstract
Background : Despite the improvements in the diagnosis and treatment of numerous medical conditions in pediatric patients by medical imaging, radiation exposure, particularly with CT imaging, continues to be worrisome for children who are more vulnerable than adults from radiation associated cancer development. Recent studies indicate that a cumulative dose of 50mGy triples the risk of leukemia and a dose of 60mGytriples the risk of brain tumors in children.
Objective: To assess the clinical application of Justification and Optimization principles of ALARA in pediatric CT imaging in Tikur Anbesa Specialized Hospital.
Method: An institution based prospective cross sectional study was conducted from December 2017 to July 2018 G.C in TASH Addis Ababa. Data was collected by using a standardized CT request form with preset form fields which will have to be completed manually by the physician requesting the CT. All pediatric patients who came for CT imaging in the study period was included in the study. The collected data was entered and analyzed using SPSS version 25.
Result: Among the total of 429 CT requests received during the study period (8 months), 246 (57.3%) were male and 183(42.7%) were female. When we see the age distribution 52(12.1%) were less than 1 year, 153(35.7%) were 1 year to less than 5 years, 113(26.3%) were 5 year to less than 10 years and 111(2.9%) were 10 years to 14 years old. Out of the total 429 requests 28(6.5%) were rejected during the study period based on ALARA justification principle. From the rejected requests, for 11(39.2%) MRI was suggested instead of CT, for 6(21.42%) US were suggested instead of CT, additionally review of previous CT scan helped to reject 4(14.28%). Review of prior chest radiography helped in rejecting 2(7.14%) CT requests. For 5 (17.8%), other imaging modalities like Endoscopy, Echo, IVP and barium study were suggested. Nineteen (4.4%) Ct requests from 429 CT requests were optimized by applying principles optimization and thus received reduced radiation from CT imaging.
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Conclusion: In general in this study 47(11%) patients were protected from unnecessary radiation exposure by applying optimization and justification principle of ALARA which indicates that applying ALARA principle has significant advantage in decreasing radiation exposure to children. The use of other alternating imaging modalities like US or MRI with no radiation exposure ha major role in replacing CT especially in pediatric patients who are more radiosensitive and have longer time to manifest radiation induced injury.
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radiation induced injury