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

It is hard to mend babies

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

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 710 210 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

Distribution of over 300 Radiological facilities

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)

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 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

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.

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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.

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) 1 CXR AP Neonates 50 60 50#,74 30, 80* Infants 50#, 64 36, 100* 13 -60 70 70# 44 61-120 90 120# 54 121-180 110 - 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

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 70 121-180 150 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

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

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): 465-476. 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. Korir, G.K., Ochieng B.O., Wambani, J.S., Jowi C. Radiation exposure in interventional procedures. Radiat Prot Dosimetry; 2012; 152 (4): 339-344. 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. 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.