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Radiation doses for barium meals and barium enemas in the Western Cape South Africa
Since their discovery in 1895, the use of x-rays is continuously evolving in medicine making the diagnosis of injuries and diseases more practicable. It is therefore not surprising that x-rays contribute 90% of the radiation dose to the population from manmade sources (DWP, 1992). Moreover, these radiation doses are associated with both fatal and non-fatal cancer risk that is detrimental to adults between 20 to 60 years (Wall, 1996). Radiation dose to individuals therefore needs to be actively monitored in order to minimise such risk. Barium contrast examinations were characterised as one of the radiological examinations that contributed enormously to the collective dose to the patients in the radiology department (DWP, 1992). Determining the diagnostic reference levels of such examinations would reduce the over-exposure of individuals to ionising radiation. Currently in South Africa (SA), there are no diagnostic dose reference levels for barium meal (BaM) and barium enema (BaE) examinations. This study therefore investigated the radiation doses delivered to patients referred for BaM and BaE, obtained potential regional reference doses for these examinations, compared the radiation doses obtained with those from similar dosimetry studies and investigated sources of dose variation among the study sites. A total of 25 BaM and 30 BaE patients in the age range 18 to 85 years, weighing 50 kg to 90 kg, at 3 hospitals in the Western Cape, SA were investigated. The radiation dose to the patients was measured using Dose Area Product (DAP) meters that were permanently fitted onto fixed fluoroscopy units at these 3 hospitals. The third quartile DAP values were 20.1 Gycm2 and 36.5 Gycm2 for BaM and BaE respectively. The median DAP values were 13.6 Gycm2 and 27.8 Gycm2 for BaM and BaE respectively. The median values were recommended as the potential Diagnostic Reference Levels for BaM and BaE as they are less affected by outlying values of under or over- weight (Yakoumakis, Tsalafoutas, Sandilos, Koulentianos et al, 1999). The weights of the patients, fluoroscopy time, the number of images obtained, the use of digital or conventional fluoroscopy equipment and the level of training of the radiologists were the factors considered for dose variation among the 3 hospitals.