Radioprotection 60-3 | Página 59

S. Semghouli et al.: Radioprotection 2025, 60( 3), 256 – 261 259

Table 5. Correlation between BMI, age, tension, charge, ESD and the DAP.

a significant relationship between the acquisition parameters( kV and mAs), effective dose, and DAP. In addition, the high mAs observed for certain examinations could be due to an imprecision in the manufacturer’ s programed reference exposure technique or to imprecise manual adjustment by the radiology technologist in response to variations in patient size that exceeded the exposure technique recommended by the manufacturers( Alshamrani et al., 2021).

According to Table 5, DRLs in terms of DAP for the four X-ray examinations included in this study are lower than those reported in France( IRSN, 2020). However, DRL in terms of DAP calculated for the thorax( PA) was higher than those reported in Germany( Wright and Ramsdale, 1998), Austria( Wachabauer et al., 2019), and Saudi Arabia( Alshamrani et al., 2021). The DRLs for the lumbar spine( AP) and abdomen( AP) calculated in this study are higher than those reported in Germany and Austria. For the pelvis( AP), the DRL of this study was higher than that reported in Germany, Austria, and Saudi Arabia.

The marked increase in the 75th percentile and the mean DAP observed in certain X-ray examinations could be attributed to the selection of a high mAs technique and a wide field size. In addition, technologists’ sub-optimal practices regarding the choice of radiographic technique( i. e., mAs) or oversized collimation may also affect this increase in DAP( Alshamrani et al., 2021).

The optimisation of radiation applications in radiology depends on the size of the patient. It is there for recommended to report parameters that characterise the patient’ s stature( e. g. BMI, body weight, body diameter, and size-specific dose estimate)( AAPM, 2011). However, the operators at the study site do not consider the patient’ s BMI when choosing the acquisition parameters, which has an impact on the dose delivered to the patient. Therefore, three of the examinations included in this study showed no significant relationship between BMI and DAP. These are the thorax( p = 0.876), lumbar Spine( p = 0.159) and pelvis( p = 0.853). Whereas the abdomen shows a significant relationship between patient BMI and DAP( p = 0.001).

The development and implementation of a radiation protection strategy in collaboration with healthcare professionals, radiologists, medical physicists, radiology technologists, and radiation safety officers is essential for the systematic optimisation of ionising radiation applications, including the use of DRLs and local reference values( El Fahssi et al., 2023). Furthermore, the effectiveness of using local diagnostic reference levels and comparing doses between local hospitals to reduce radiation doses has been demonstrated. Overall, the adoption of local reference levels has been successful and highly relevant( Wright et al., 1998). All radiologists need to know the typical local doses in their department in relation to national and international diagnostic reference levels( Vassileva and Rehani, 2015).

Over the last years, a culture of patient radiation protection has developed in Morocco following a several studies carried out in this field( Semghouli et al., 2016; Talbi et al., 2021; Aabid et al., 2023; El Fahssi et al., 2024b; Semghouli et al., 2024b). With this in mind, the decree on the protection of workers, the public and the environment against ionizing radiation has just been adopted by the public authorities, and mentions for the first time the importance of establishing DRLs as the main tool for optimizing doses delivered to patients during radiological examinations. It also stresses the need to assign medical physicists to radiology departments, which has had a positive impact on dose optimization in these departments. In addition, the comparison between the dosimetric values of the four most frequently performed radiographic procedures that we established in this department in 2020, and those carried out as part of this study, showed a remarkable reduction( up to 50 %) in ESD for certain conventional examinations such as chest X-rays( El Fahssi et al., 2023). This marked improvement could be attributed to several factors, including the strengthening of the training program for radiology technicians, and the introduction of a radiation protection and radiobiology module in their training program( ICRP, 2017). In addition, the results of previous studies we have carried out on the estimation of doses delivered to patients have been communicated to department managers so that they can be made aware of them and make the necessary decisions. These optimization efforts have had a positive impact on protecting patients from unnecessary exposure during medical imaging examinations. However, to ensure the sustainability of optimized radiological procedures, we recommend the following measures:( 1) assign a medical physicist to each department;( 2) set up a quality assurance program;( 3) develop a continuing education program for medical and paramedical staff;( 4) plan public awareness campaigns on the harmful effects of ionizing radiation

5 Conclusion

The variation in doses delivered for the radiological examinations included in this study is significant. Consequently, it is possible to reduce the dose delivered to patients in the regional hospital of Agadir. This could be achieved through the continuous training of radiology workers, implementation of a quality assurance program for equipment, and institutionaliza-