Getting started with medical physics in Morocco via the introduction of local dose reference levels and international bench marking

Abstract

Author(s): Sanae Douama, Youssef Bouzekraoui*, Imane Ou-Saada, Hilde Bosmans, Lesley Cockmartin, Rachid Errifai, Zaama Lahoucine, M Ouahman and Farida Bentayeb

Introduction and purpose: The present work is part of the ‘Radiology As A Steward For Quality In Moroccan Healthcare’ (RASQUAM) of the VLIRUOS (Flanders, Belgium). Patient dose measurement campaigns were considered the best first initiative to promote medical physics Quality Assurance activities and to prepare the roll-out of a patient dose management system. The study in 5 Moroccan hospitals focused on common diagnostic radiology examinations. Patient doses were expressed as Entrance Skin Dose (ESD) and the Effective Dose (ED). The aim of the study was to calculate the local Dose Reference Levels (DRL), to compare dose data results with international literature and to plan subsequent actions.

Material and methods: The work was carried out in six conventional radiology rooms of five hospitals, designated by A, B, C, D, E and F. The examinations included Chest, Cervical spine, Skull and Lumbar spine, for lateral and Postero Anterior (PA) or Antero Posterior (AP) projections. Technical parameters (kV, mAs, FFD) and patient data (age, sex, weight) were collected at the time of the examination. Patient dose estimates were obtained with the DoseCal software that provides ESD and E for adults.

Results and discussion: The radiological parameters vary depending on the examination, projection types and rooms. The Local Diagnostic Reference Levels (lDRL) in terms of ESD are 0.35mGy for Chest PA, 0.8 mGy for Chest AP, 2.79mGy for Skull AP, 2.07 mGy for cervical spine AP, 2.36 mGy for cervical spine LAT and 2.72 mGy for lumbar AP spine. The local DRLs comply with international recommendations and their comparison with previous studies was satisfactory.

The average effective doses were: 0,03 mSv for the Chest PA, 0,07 mSv for the cervical spine AP, 0.03 mSv for the cervical spine LAT, 0.45 mSv for Lumbar AP, 0.66 mSv for the lumbar LAT, 0.03 mSv for the Skull AP and 0.01 mSv for the scull LAT.

Conclusion: The local DRLs are promising preliminary results that should be worked out up to the level of national DRLs. Medical physicists can now start with quality optimization strategies.

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