1. RADIATION PROTECTION OF THE YOUNG PATIENT: Kenya perspective
DR. WAMBANI SIDIKA
Chief Medical specialist Radiology
Kenyatta National Hospital, Nairobi.
17th February 2015 Workshop
8th PACORI-Laico Regency Nairobi

2. It is hard to mend babies

3. Overview Introduction Kenya Health Care Level
Nuclear applications in Kenya
Level of nuclear applications provision in Kenya
Radiation exposure to patients and personnel
Conclusion
References

4. INTRODUCTION The human body anatomy and health issues are universal.
Nuclear Applications are therefore universal.

5. 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.

6. UNSCEAR 2008: Global use of medical radiology 1991-1996 (per million population)
Level I
Level II
Level III
Level IV
World
Doctors
2800
710
210 45
(123)
1100
Radiologists
110 80 5
0.1
(3) 70
X-ray Imaging equipment
290 60 40 4
(20) CT 17 2
0.4
(0.8) 6
*Current values for Kenya in blue

7. Distribution of over 300 Radiological facilities

8. Distribution of medical nuclear applications in Kenya
Tally
Nuclear Technique
Frequency (%) 1
General Radiographic X-ray machines 66 2
Radiographic Fluoroscopic X-ray Machines 12 3
Dental X-ray Machines 4
CT scanners 5
Mammography Units 6
Interventional Fluoroscopic X-ray Machines 7
Nuclear medicine 8
Cobalt Units
<1 9
LINAC Accelerators 10
Bone Densitometer 11
Open Sources (assays)

9. ANNUAL NUMBER OF EXAMINATIONS IN KENYA

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

11. 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
2800
Radiologists 3 1
0.1 28 91 84
110
Medical physicists
0.6
0.2 -
Radiographers 5 8 7
143
340
330
X-ray equipment 20 10 4
198
244
310
290
CT scanners
0.8
0.5
0.3
1.7 17
Mammography 24

12. 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.

13. DNA

14. Estimate of annual population dose
Although the benefit from a radiological procedure to the patient outweighs the potential radiation risk, the total number of patients was large and increasing. Therefore, small individual radiation risk, multiplied by the large number of patient, adds up resulting in a major public health problem that may not become clearly evident for many years under inadequate quality assurance program.

15. Proportion of Radiological Examinations (2009-2014) at KNH

16. DRLs and IAEA Paediatric Patients Pub1609

17. 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) 1
CXR AP
Neonates 50 60
50#,74
30, 80*
Infants
50#, 64
36, 100*
13 -60 70
70# 44
61-120 90
120# 54
110 - 67
CXR LAT
132
200*
130
140 2
Abdomen AP 80
146
400#, 396
45, 900*
150
500#
136
170
200
800#
286
240
1200#
Abdomen D.Decubits
310
350
410
520 3
PNS LAT
100
120
160

18. 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 50
61-120
140
190 70
150 90 2
CXR LAT-Erect
260
310 -
410
320
510 3
Abdomen AP
Neonates
220
250
Infants
200
270
330
280
350
750
370
460
2600#
490
560 4
PNS LAT
170
230

19. Future Perspectives

20. 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

21. 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.

22. THANK YOU ASANTENI VIELEN DANKE SANDIZI

23. References
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
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):
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):
Korir, G.K., Ochieng B.O., Wambani, J.S., Jowi C. Radiation exposure in interventional procedures. Radiat Prot Dosimetry; 2012; 152 (4):
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):
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),