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

It is hard to mend babies It is hard to mend babies

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

INTRODUCTION

• The human body anatomy and health issues are universal.

• Nuclear Applications are therefore universal.

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.

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

Distribution of over 300 Radiological facilities

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

ANNUAL NUMBER OF EXAMINATIONS IN KENYA

Relative Frequency of Radiographic Examinations in Children (< 15 yrs)

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

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.

DNA

Estimate of annual population dose

Proportion of Radiological Examinations (2009-2014) at KNH

DRLs and IAEA Paediatric Patients Pub1609

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 - -

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 -

Future Perspectives

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

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.

THANK YOU

ASANTENI

VIELEN DANKE

SANDIZI

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.