Hysterosalpingography dose assessment with direct digital radiography in a medical facility: A potential high risk procedure to patient in South-South Nigeria

Akintayo Daniel Omojola, Azuka Anthonio Agboje, Kanu Bassey Uche, Michael Onoriode Akpochafor, Samuel Olaolu Adeneye, Eunan Okechukwu Oparaocha, Edwin Ehis Amiegbereta

Abstract


Background: Hysterosalpingography (HSG) procedures often come with higher dose due to multiple exposures.

Aims: The study was aimed at carrying out a preliminary audit of doses in HSG exams with thermoluminescent dosimeters (TLDs) in a facility using direct digital radiography (DDR), with the aim of identifying parameters that greatly affect the patient dose and see possible ways to optimize them in the future

Methods: The prospective study involved 53 booked female patients for HSG procedures. The study used a ceiling mounted direct digital radiography unit for exposures. Patient was made to lie in a supine position. Two TLD chips (LiF: Mg, Ti) were positioned at the central axis of the beam covering the pelvis to estimate the entrance surface dose (ESD) and another posteriorly to estimate the exit dose (ED). A PCXMC software was used to estimate the effective dose (Eff) and organ doses.

Results: The mean and 75th percentile ESD was 15.94±2.05 and 18.82±6.41 mGy respectively. The number of exposures, dose area product (DAP) and effective dose (Eff) ranged from 5.7 (4-10), 15.85 (5.02-51.07) Gycm2 and 4.6 (1.46-14.8) mSv. The mean dose to the ovaries, uterus and bladder were 4.63 (4.06-5.03) mGy, 6.17 (5.45-6.65) mGy and 10.8 (9.68-11.92) mGy. Estimated cancer risk was 230 (90-740) per million.

Conclusion: The ESD, Eff and organ doses were comparable to studies that used TLDs with conventional radiography; however this study was multiple times higher compared to fluoroscopy modality. Factors that contributed to patient dose were the number of exposure and patient field sizes. Protocol optimization should be considered to reduce patient risk.


Keywords


Hysterosalpingogram, Organ dose, Thermoluminescent dosimeter, Exposure, Conventional radiography

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References


Schankath AC, Fasching N, Urech-Ruh C, Hohl MK, Kubik-Huch RA. Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings. Insights Imaging. 2012; 3(5):475-83.

Onwuchekwa CR, Oriji VK. Hysterosalpingographic (HSG) Pattern of Infertility in Women of Reproductive Age. J Hum Reprod Sci. 2017; 10(3):178-184.

Ahmed SA, Abo-taleb H. The validity of HSG in infertility work up. Egypt J Radiol Nucl Med. 2019; 50, 63.

Maubon AJ, De Graef M, Boncoeur-Martel MP, Rouanet JP. Interventional radiology in female infertility: technique and role. Eur. Radiol. 2001; 11:771– 778.

Sidi M, Galadanchi KK. Evaluation of the Downtime of Radiological Equipment in Kano Metropolis, Nigeria. DUJOPAS. 2021; 7 (3a): 160-167.

Idowu BM, Okedere TA. Diagnostic radiology in Nigeria: A country report. J Glob Radiol. 2020; 6(1):1072.

Ekpo EU, Egbe NO, Azogor WE, Inyang SO, Upeh ER. Challenges of radiological equipment management policies in some northern Nigerian hospitals. SAR. 2013; 51: 19-22.

Wright DJ, Godding L, Kirkpatrick C. Technical note: digital radiographic pelvimetry – a novel, low dose, accurate technique. Br J Radiol. 1995; 68:528–530.

Fife AJ, Wilson DJ, Lewis CA. Entrance surface and ovarian doses in hysterosalpingography. Br J Radiol. 1994; 67:860-863

ICRP, 2010. Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department. ICRP Publication 117. Ann. ICRP 40(6).

Hart D, Wall BF, Hillier MC, Shirmpton PC. Frequency and collective dose for medical and dental X-ray examinations in the UK, 2008. Didcot: Chilton; 2010. (HPA-CRCE-012).

Ionizing Radiation Exposure of the Population of the United States. Bethesda, MD: National Council on Radiation Protection and Measurements; 2009. NCRP report 160

Papaioannou S, Afnan M, Coomarasamy A, Ola B, Hammadieh N, Sharif K. The use of repeat hysterosalpingography. Fertil Steril. 2001, 76(4):849-50.

Ching W, Robinson J, McEntee M. Patient-based radiographic exposure factor selection: A systematic review. J Med Radiat Sci. 2014; 61:176–190.

Martin C. Optimisation in general radiography. Biomed Imaging Interv J. 2007; 3(2):e18.

Duncan JR, Street M, Strother M, Picus D. Optimizing radiation use during fluoroscopic procedures: a quality and safety improvement project. J Am Coll Radiol. 2013; 10(11):847-53.

International Atomic Energy Agency. Patient dose optimization in fluoroscopically guided interventional procedures. Vienna: IAEA; 2010. IAEA-TECDOC-164.

Matsubara K, Yoshida S, Hirosawa A, Chusin T, Furukawa Y. Characterization of Small Dosimeters Used for Measurement of Eye Lens Dose for Medical Staff during Fluoroscopic Examination. Diagnostics (Basel). 202; 11(2):150.

Mangiarotti M, D'Ercole L, Quaretti P, Moramarco L, Lafe E, Zappoli Thyrion F. Evaluation of an active personal dosimetry system in interventional radiology and neuroradiology: Preliminary results. Radiat Prot Dosimetry. 2016, 172(4):483-487.

International Atomic Energy Agency, Dosimetry in diagnostic radiology: an international code of practice. Vienna: IAEA; 2007. Technical Reports Series No.: 457.

RaySafe. Application note: How to calculate KAP and DAP from dose measurements. RaySafe Publications. 2020; 1-2

Nazififard M, Suh KY, Mahmoudieh A. Experimental analysis of a novel and low-cost pin photodiode dosimetry system for diagnostic radiology. Rev Sci Instrum. 2016; 87:073502.

Picano E, Piccaluga E, Padovani R, Antonio Traino C, Grazia Andreassi M, Guagliumi G. Risks Related To Fluoroscopy Radiation Associated With Electrophysiology Procedures. J Atr Fibrillation. 2014; 31; 7(2):1044.

Omojola AD Akpochafor MO, Adeneye SO. Validation of entrance surface air kerma of MTS-N (LiF: Mg, Ti) chips with reference ionization chamber using kilovoltage X-ray machine for patient dosimetry. SAR.2020; 58 (2): 16-21

Omojola AD, Akpochafor MO, Adeneye SO, Aweda MA. Calibration of MTS-N (LiF: Mg, Ti) chips using cesium-137 source at low doses for personnel dosimetry in diagnostic radiology. Radiat Prot Environ 2020;43:108-14

Omojola AD, Akpochafor MO, Adeneye SO, Aweda MA. Determination of Calibration Factors and Uncertainties Associated with the Irradiation of MTS-N (LiF: Mg, Ti) Chips with Cesium-137 and X-ray Sources Under Low Doses for Personal Dosimetry in Diagnostic Radiology. J Global Radiol 2021;7(1):1103.

Yakoumakis E, Tsalafoutas IA, Nikolaou D, Nazos I, Koulentianos E, Proukakis C. Differences in effective dose estimation from dose-area product and entrance surface dose measurements in intravenous urography. Br J Radiol. 2001; 74(884):727-34.

Meiboom MF, Hoffmann W, Weitmann K, von Boetticher H. Tables for effective dose assessment from diagnostic radiology (period 1946–1995) in epidemiologic studies. PLoS ONE. 2021; 16(4): e0248987.

Hart D, Wall BF. Radiation exposure of the UK population from medical and dental X-ray examinations. NRPB-W4. Didcot: Chilton; 2002.

ICRP, 1991. Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann. ICRP. 1990; 21 (1-3).

Hart D, Hillier MC, Shirmpton PC. Doses to patients from radiographic and fluoroscopic X-ray imaging procedure in the UK-2010 report. Didcot: Chilton; 2012. (HPA-CRCE-034).

Günalp M, Gülünay B, Polat O, Demirkan A, Gürler S, Akkaş M, Aksu NM. Ionising radiation awareness among resident doctors, interns, and radiographers in a university hospital emergency department. Radiol Med. 2014; 119(6):440-7.

Zhou GZ, Wong DD, Nguyen LK, Mendelson RM. Student and intern awareness of ionising radiation exposure from common diagnostic imaging procedures. J Med Imaging Radiat Oncol. 2010; 54(1):17-23.

Wong CS, Huang B, Sin HK, Wong WL, Yiu KL, Chu Yiu Ching T. A questionnaire study assessing local physicians, radiologists and interns' knowledge and practice pertaining to radiation exposure related to radiological imaging. Eur J Radiol. 2012; 81(3):e264-8.

Achuka JA, Aweda MA, Usikalu MR, Aborisade CA. Assessment of Patient Absorbed Radiation Dose during Hysterosalpingography: A Pilot Study in Southwest Nigeria. J Biomed Phys Eng 2020; 10(2)

Alzimami K, Sulieman A, Babikir E, Alsafi K, Alkhorayef M, Omer H. Estimation of effective dose during hystrosalpingography procedures in certain hospitals in Sudan. Appl Radiat Isot. 2015, 100:2-6.

Khoury HJ, Maia A, Oliveira M, Kramer R. Patient dosimetry in hysterosalpingography. IAEA Publications. 2001: IAEA-CN-85-94

Iacob O, Diaconescu C. Doses to patients from diagnostic radiology in Romania. IAEA Publications. 2001; IAEA-CN-85-105: 53-57

Yousef M, Tambul JY, Sulieman A. Radiation dose measurements during hysterosalpingography. Sudan Med Monit. 2014; 9:15-18.

Gregan AC, Peach D, McHugo JM., 1998. Patient dosimetry hysterosalpingography: a comparative study. Br J Radiol. 1998; 71:1058–1061.

Sulieman A, Theodorou K, Vlychou M, Topaltzikis T, Roundas C, Fezoulidis I, Kappas C. Radiation dose optimisation and risk estimation to patients and staff during hysterosalpingography. Radiat Prot Dosimetry. 2008;128(2):217-26.

Perisinakis K, Damilakis J, Grammatikakis J, Theocharopoulos N, Gourtsoyiannis N. Radiogenic risks from hysterosalpingography. Eur Radiol. 2003; 13(7):1522-8.

Wambani JS, Korir GK, Tries MA, Korir IK, Sakwa JM. Patient radiation exposure during general fluoroscopy examinations. J Appl clin med phys. 2014; 15(2), 262-270.

Buls N, Osteaux M. Patient and staff dose during hysterosalpinography. IAEA Publications. 2001: IAEA-CN-85-73

Otoo J. Patient radiation dose assessment during fluoroscopic procedures: a survey to propose local diagnostic reference levels for selected facilities. Published Thesis. Department of Medical Physics, University of Ghana, Legon. 2018

Ngaile JE, Msaki PK, Kazema RR. Monte Carlo based estimation of organ and effective doses to patients undergoing hysterosalpingography and retrograde urethrography fluoroscopy procedures. Radiation Physics and Chemistry. 2018;145: 148-159.

Fernandez JM, Vano E, Guibelalde E. Patient doses in hysterosalpingography. Br J Radiol. 1996; 69, 751–754.

Maataoui A, Reusch E, Khan MF, Gurung J, Thalhammer A, Ackermann H, Mulert-Ernst R, Vogl TJ, Jacobi V. Vergleich analoger und digitaler Durchleuchtungsgeräte hinsichtlich der Strahlenexposition der Patienten bei Enteroklysmen [Comparison of analog and digital fluoroscopy devices regarding patient radiation exposure in enteroclysis]. Rofo. 2008; 180(3):246-51

Nakamura K, Ishiguchi T, Maekoshi H, Ando Y, Tsuzaka M, Tamiya T, Suganuma N, Ishigaki T. Selective fallopian tube catheterisation in female infertility: clinical results and absorbed radiation dose. Eur Radiol. 1996; 6(4):465-9.

Hedgpeth PL, Thurmond AS, Fry R, Schmidgall JR, Rosch J. Radiographic fallopian tube recanalization: absorbed ovarian radiation dose. Radiology. 1991; 180:121–122

Kramer R, Khoury HJ, Lopes C, Vieira JW. Equivalent dose to organs and tissues in hysterosalpingography calculated with the FAX (Female Adult voXel) phantom. Br J Radiol 2006; 79 (947):893-899.

National Research Council. Health effects exposure to low levels of ionizing radiation. BEIR V, National Academy Press, Washington DC. 1990

National Radiological Protection Board (NRPB). Estimates of radiation detriment in a UK population. NRPB R260. HMSO Publications center, Chilton, UK. 1994




DOI: http://dx.doi.org/10.36162/hjr.v8i1.520

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