Is the 28-Day Rule Safe for Use in Abdominal Radiography?

Document Type : Original Paper

Authors

Department Of Diagnostic Imaging And Radiotherapy, Kulliyyah Of Allied Health Sciences, International Islamic University Malaysia, Jln Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia

Abstract

Introduction: The 28-day rule is utilized as a precautionary measure for irradiating the fetus at an early stage of conception for abdominal and pelvic radiography. There is a probability of the women being pregnant if the 28-day rule is applied for this examination and thus irradiating the conceptus. It is difficult to convince people that low radiation doses during early pregnancy will not cause any harm to the conceptus. As such this study was to ascertain whether the 28-day rule can be used safely for abdominal radiography in women of reproductive age.
Material and Methods: The experimental study was conducted at the Radiography Laboratory, International Islamic University Malaysia, Kuantan using an anthropomorphic PBU-50 phantom. The entrance surface dose (ESD), organ dose and effective dose (ED) were estimated using CALDose_X 5.0 software, based on the exposure parameters and tube output of the x-ray unit.
Results: The mean ESD for AP abdominal radiographic examination of 3.162 mGy is within that recommended by radiation protection regulatory bodies. Additionally, the mean organ dose of 0.468 mGy is lower than the threshold value of 100 mSv for the “all-or-none” phenomenon to happen. Further, the mean ED of 0.73 mSv is within the recommendation of the International Atomic Energy Agency (IAEA) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR).
Conclusion: This study indicated that the 28-day rule is safe to be used for abdominal radiography for a woman of reproductive age.

Keywords

Main Subjects

References

  1. Checking the Pregnancy Status of Females of Childbearing Age. University Hospitals of Leicester, National Health Services, UK (http://www.library.leicestershospitals.nhs.uk/pubscheme/Documents/ Services%20we%20offer/Patient%20information/Imaging/ADULTS/Radiology%20%20Checking%20Pregnancy%20Status%20Edition%204-7125284%20-%20UHL%20Patient%20Information%20-%20Imaging.pdf).
  2. ICRP, 2000. Pregnancy and Medical Radiation. ICRP Publication 84. Ann. ICRP 30 (1).
  3. Royal College of Radiologists. Radiation and the early fetus. Royal College of Radiologists. London; 2013. Available from: http://www.rcr.ac.uk.
  4. Scharwächter C, Röser A, Schwartz CA, Haage P. Prenatal radiation exposure: Dose calculation. Röfo. 2015 May; 187(5): 338–46.
  5. Nguyen CP, Goodman LH. Fetal risk in diagnostic radiology. Semin Ultrasound CT MR. 2012 Feb; 33(1): 4–10.
  6. James B, Kelly B. The abdominal radiograph. Ulster Med J. 2013 Sep; 82(3): 179–87.
  7. McCollough CH, Schueler BA, Atwell TD, Braun NN, Regner DM, Brown DL, et al. Radiation exposure and pregnancy: When should we be concerned? RadioGraphics. 2007; 27(4): 909–17.
  8. Chaparian A, Aghabagheri M. Fetal radiation doses and subsequent risks from X-ray examinations: Should we be concerned? Iran J Reprod Med. 2013; 11(11): 899-904.
  9. International Atomic Energy Agency (IAEA). Radiation protection of pregnant women in radiology, 1–10. 2018. Available from: https://www.iaea.org/resources/rpop/health-professionals/radiology/pregnant-women.
  10. Akintomide AO, Ikpeme AA. Radiation safety of women of the reproductive age: Evaluation of the role of referring physicians. J Family Med Prim Care. 2014; 3(3): 243–6.
  11. Lowe SA. Diagnostic radiography in pregnancy: Risks and reality. Aust N Z J Obstet Gynaecol. 2004 Jun; 44(3): 191-6.
  12. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Fifty-seventh session, includes Scientific Report: summary of low-dose radiation effects on health. New York: United Nations. 2010.
  13. Kramer R, Khoury HJ, Vieira JW. CALDose_X: A software tool for the assessment of organ and tissue absorbed doses, effective dose, and cancer risks in diagnostic radiology. Phys Med Biol. 2008; 53:6437-59.
  14. European Commission. (2008). European guidance on estimating population doses from medical x-ray procedures. Radiation Protection No. 154. Luxembuorg: Office for Official Publications of the European Communities.
  15. ICRP, 2017. Diagnostic reference levels in medical imaging. ICRP Publication 135. Ann. ICRP 46(1).
  16. Khoshdel-Navi D, Shabestani-Monfared A, Deevband MR, Abdi R, Nabahati M. Local-reference patient dose evaluation in conventional radiography examinations in Mazandaran, Iran. J Biomed Phys Eng. 2016; 6(2): 61–70.
  17. Yacoob HY, Mohammed HA. Assessment of patients X-ray doses at three government hospitals in Duhok city lacking requirements of effective quality control. J Radiat Res Appl Sc. 2017; 10: 183-7.
  18. National Radiological Protection Board. (1994). Estimation of effective dose in diagnostic radiology from entrance surface dose and dose-area product measurements, NRPB report, 262.
  19. Toosi MTB, Nazery M, Zare H. Application of dose-area product compared with three other dosimetric quantities used to estimate patient effective dose in diagnostic radiology. Iran J Radiat Res. 2006; 4(1): 21-7.
  20. Ministry of Health Malaysia (MOH). Malaysian Diagnostic Reference Levels in Medical Imaging (Radiology). Putrajaya: Radiation Health and Safety Section. 2013.
  21. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources and Effects of Ionizing Radiation, UNSCEAR 2008 Report: Volume I: Sources – Report to the General Assembly Scientific Annexes A and B. New York: United Nations. 2008.
  22. Hart D, Hillier MC, Shrimpton PC. Doses to patients from radiographic and fluoroscopic X-ray imaging procedures in the UK-2010 Review (HPA-CRCE-034). Chilton: Health Protection Agency (HPA). 2012.
  23. Osei EK, Darko J. A survey of organ equivalent and effective doses from diagnostic radiology procedures. ISRN Radiol. 2012 Sep; 2013: 204346.
  24. Aliasgharzadeh A, Mihandoost E, Masoumbeigi M, Salimian M, Mohseni M. Measurement of entrance skin dose and calculation of effective dose for common diagnostic X-Ray examinations in Kashan, Iran. Glob J Health Sci. 2015; 7(5): 202–7.
  25. Nikzad S, Pourkaveh M, Jabbari Vesal N, Gharekhanloo F. Cumulative radiation dose and cancer risk estimation in common diagnostic radiology procedures. Iran J Radiol. 2018; 15(3): e60955.
  26. Helmrot E, Pettersson H, Sandborg M, Altén JN. Estimation of dose to the unborn child at diagnostic X-ray examinations based on data registered in RIS/PACS. Eur Radiol. 2006; 17: 205-9.
  27. Nahangi H, Chaparian A. Assessment of radiation risk to pediatric patients undergoing conventional X-ray examinations. Radioprotection. 2015; 50(1): 19-25.
  28. Ko J, Kim Y. Evaluation of effective dose during X-ray training in a radiological technology program in Korea. J Radiat Res Appl Sc. 2018; 11: 383-92.
  29. ICRP, 1991. 1990 Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann. ICRP 21 (1-3).
  30. Parry RA, Glaze SA, Archer BR. The AAPM/RSNA physics tutorial for residents: typical patient radiation doses in diagnostic radiology. RadioGraphics. 1999; 19: 1289–1302.
  31. Ofori EK, Ofori-Manteaw BB, Gawugah JNK, Nathan JA. Relationship between patient anatomical thickness and radiographic exposure factors for selected radiologic examinations. Journal of Health, Medicine and Nursing. 2016; 23: 150-62.
  32. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources and effects of ionising radiation. Vol. I, Sources, Annex D, Medical radiation exposures. New York: United Nations. 2000.
  33. Aborisade CA, Famurewa OC, Ibitoye FI, Balogun FA. Variation in entrance skin dose and scattered radiation in paediatric patients undergoing X-ray examination in some Nigerian teaching hospitals. Am J Radiol Imaging. 2018; 1(1); 1001.
  34. Gaillard F, Goel A. Radiopaedia.org. Filters. 2005-2020. [cited 2020 Jan 11]. Available from https://radiopaedia.org/articles/filters.
  35. Moey SF, Shazli ZA. A phantom study for the optimization of image quality and radiation dose for common radiographic examinations in digital radiography. Iran J Med Phys. 2018; 15: 271-6.
  36. Willis CE. Computed radiography: a higher dose? Ped Radiol. 2002; 32: 745–50.
  37. ICRP, 2007. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP 37 (2-4).
  38. Garzón WJ, Kramer R, Khoury HJ, Barros VSM, Andrade G. Estimation of organ doses to patients undergoing hepatic chemoembolization procedures. J Radiol Prot. 2015; 35: 629–47.

 

 

 

Iranian Journal of Medical Physics
Volume 18, Issue 3
May and June 2021
Pages 187-193

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History

  • Receive Date: 03 February 2020
  • Revise Date: 07 May 2020
  • Accept Date: 18 May 2020

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