Obsolete practices are still in use but radiology doses are not higher in Asian countries, study says

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A study, led by Madan M Rehani and published in the European Journal of Radiology, aimed to determine the impact of the International Atomic Agency’s (IAEA) project on imaging technology, radiation dose and interventional procedures in the Asia Pacific region.

The IAEA, in 2002, established an International Action Plan (IAP)—the Radiation Protection of Patients programme (RPoP)—that included actions on reducing patient doses without compromising image safety. The IAEA identified that lack of patient dose assessment information and high radiation doses in paediatrics as issues and sought to find out what the dose levels and technology were in comparison to developed countries and outlined a programme to improve the situation.

The IAEA collected data in phases during 2006–2011 which comprised of structured forms and instruction sheets for the structured forms being send via email to the participating member state through the regulatory authorities and hospitals. The practices covered in the data collection were technology and practices, conventional radiology, mammography (which was considered separately), computed tomography (CT) and interventional procedures.


Rehani et al reported on the large-scale, multi-national studies dealing with the issues outlined by the IAEA in the Asia Pacific region. The authors used the data collected from 20 countries (not all of which participated in every part of the project) to analyse the affect the IAEA’s project had in the participating countries.

In terms of technology and practices, data from China, Israel, Malaysia, Pakistan, Philippines and United Arab Emirates (UAE) was received. According to the results obsolete practices were in use, despite a reported move towards digital units, including obsolete practices in the use of fluoroscopy for positioning of radiography, photofluroscopy, chest fluoroscopy and conventional tomography were reported in four out of seven countries. Maunal film was reported in five countries and use of adult CT protocols for CT examination of children was observed in three countries: Philippines (in 40% of hospitals); Syria (25%) and Malaysia (10%).

The authors reported that data from conventional radiography surveys in Bangladesh, Iran, Mongolia, Philippines, Saudi Arabia, Sri Lanka, Syria, Thailand, UAE and Veitnam, three countries results showed initial image quality assessment were poor quality image (7–30%). Thailand and Syria, according to the results, had dose reductions at 85% for chest PA in Thailand and 34% for skull AP and reductions in Syria were 20% for chest PA and 10% for lumbar spine AP/LAT, 28% for skull AP and 35% for skull LAT.  However, the authors said: “It is evident that patient doses in these countries are not higher than international DLRs and, in some cases, are much lower.”

In the study, 13 countries participated in the investigation into CT dose reduction in adult and paediatric CT patients. Japan was reported to have a “relatively low” paediatric CT frequency and Syria was the highest (23%)

In regards to interventional procedures in 11 countries, Rehani et al said that “there were variations in workload and dose level among the different centres. All participating centres had some cases of KAP values higher than 200 Gycm2, and this represented 16% of all cases.” The results also showed that interventional cardiology patients received doses that were associated with negative radiation effects (16-15%).

The authors summarised their findings saying that the results from the study suggest that obsolete practices are still in use, conventional radiology doses are not higher in Asian countries than in developed, that IAEA protocols resulted in improved protocols for paediatric CT, that a high percentage of patients in interventional cardiology receive radiation doses with risk of skin injury and that high frequency interventional procedures for children need evaluation

“This multi-national study is the first of its kind in the Asian region and provided a good insight into the situation and opportunities for improvement,” concluded Rehani et al. “It is hoped that results will provide motivation to many countries and lead to national actions for disseminations of results within the professional community and training activities to promote patient safety,”

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