ESTIMATION OF ORGAN EQUIVALENT AND EFFECTIVE DOSES

FROM DIAGNOSTIC X-RAY: A CASE STUDY OF AMINU KANO

TEACHING HOSPITAL KANO NIGERIA
BY
ABDULSAMAD ISHAQ
(UG17PHY1027)
UNDER THE SUPERVISION OF
Dr. MUSA GARBA ABDULLAHI
BEING A RESEARCH PROJECT SUBMITTED TO THE
DEPARTMENT OF PHYSICS, NORTHWEST
UNIVERSITY, KANO, IN PARTIAL FULFILMENT OF
THE REQUIREMENTS FOR THE AWARD OF
BACHELOR OF SCIENCE (B.SC) DEGREE IN
PHYSICS.

FEBUARY 2023
 APPROVAL PAGE

This research study has been supervised and approved as meeting the requirement of the
department of Physics, Faculty of Sciences of Yusuf Maitama Sule University Kano, for
the award of B.Sc. Physics.

____________________ _________________

Dr Musa Garba Abdullahi Date

(Proj ect Supervisor)

____________________ _________________

Dr Ridwan Garba Date

(H O D)

____________________ _________________

Dr. Zakiyyu I Takai Date

(Project coordinator)

____________________ _________________

Prof.T.H.Darma Date

(External examiner)

i
 DEDICATION
This report is hereby dedicated to Almighty Allah (SWT) who has been my guide all
through the years of my life also to my respected belovedand most caring fatherAlhaji
IshaqNuhuand my respected, beloved and most caring mother Hajiya Samira who brought
me into this world and gave me enough to survive up to this level. May Almighty Allah
(S.W.T) forgive their sins and reward them immensely with Jannatul Firdausi.

ii
 ACKNOWLEDGEMENT

I am thankful to the Almighty God for His inspiration, guidance and strength throughout
the course of this work. Many thank to my supervisor, Dr Musa Garba Abdullah for taking
time to supervise me during the research. And the entire lecturers in the Department of
Physics for their patience, support and guidance in the course of my study.

My gratitude is further extended to my parents: Alhaji Ishaq Nuhu and

HajiyaSamiraAbdurrashid, no amount of words can fully appreciate your love and support
given to me throughout the program and in the course of writing this project. My prayer is
that,MayAlmighty Allah blesses and supports you in this world and the hereafter (Amin).

I want to appreciate and acknowledge the efforts of my cousins too who prayed and
encouraged me throughout the period of my study: Hajara Sani Abubakar, Ahmad Sani
Abubakar, Mukhtar Nura, SadiyaAuwal and Aisha Auwal.

A tree cannot make a forest, I must acknowledge the effort of my friends whom we
maintained the decorum of brother/sister relationship throughout my study: Muhammad
Imam, Yusuf Auwal, Umar Rufai,Isma’ilSarki Hamza(kwalisa), Abdulkadir Bashir
Sambo, Umar Shisu,Auwal A Adam, Hamza Mustapha, Aminu Abdullahi Zakari
(Daurawa),AbuubaidaBalarabe, Ibrahim Tofa, Muazzam Usman, Ahmad Isa, Ali Huzaifah,
NazifaAbba, I prayed for Allah’s blessing for you all in your endeavors.

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 ABSTRACT

In order to reduce exposure hazards, it is crucial that the patient receives the appropriate
amount of radiation during the radiological examination. In Aminu Kano Teaching
Hospital Konno Nigeria is considered. A data is collected from already examine patients to
determine the average dose that patients got during x-ray examinations. Anterior/posterior
(AP/PA) chest radiography was used to measure the entrance skin doses (ESDs) for this
surgery. A 20 patients data was provided from their routine chest X-ray exams, during
which they were subjected to diagnostic X-ray. The skin dose for the patent was calculated
using Edmond's formula, which is based on the X-ray tube, radiographic exposure
parameters of kVp, mAS, SSD, and total beam filtration. The computed mean skin dosage
varies from 0.013 0.01 mGy to 0.851 0.023 mGy. The ESDs measured for this kind of x-
ray procedures were generally found to be lower than or in agreement with the guideline
level set by the Nigerian Basic Ionizing Radiation Regulation (NBIRR, 2003) standard and
other international bodies, and do not pose any significant health risks to the patient or the
workers.

iv
CONTENTS
CHAPTER ONE....................................................................................................................1

1.0 INTRODUCTION............................................................................................................1

1.1 BACKGROUND..............................................................................................................3

1.2 AIM OF STUDY..............................................................................................................4

1.3 OBJECTIVES..................................................................................................................4

1.4 SCOPEOF STUDY..........................................................................................................4

1.5 LIMITATION OF STUDY..............................................................................................4

1.6 PROBLEMS STATEMENT............................................................................................5

CHAPTER TWO...................................................................................................................6

LITERATURE REVIEW.......................................................................................................6

2.0 DIAGNOSTIC REFERENCE LEVELS (DRLs)............................................................8

2.1 IMAGING MODALITIES...............................................................................................9

2.2 GENERAL RADIOGRAPHY.........................................................................................9

2.3 COMPUTED TOMOGRAPHY.....................................................................................10

2.3.1 MAMMOGRAPHY....................................................................................................12

2.3.2 DENTAL RADIOGRAPHY.......................................................................................13

2.4 ORGAN DOSE DETERMINATION............................................................................13

2.5 DOSE DETECTORS AND DOSIMETERS.................................................................15

v
2.5.1 ANTHROPOMORPHIC PHANTOMS......................................................................16

2.5.2 MONTE CARLO SIMULATIONS............................................................................18

2.6 CHEST RADIOGRAPHY.............................................................................................20

2.7 RADIATION DOSE TO TISSUE OR ORGAN...........................................................21

2.8 ABSORBED DOSE.......................................................................................................22

2.9EQUIVALENT DOSE....................................................................................................22

METHODOLOGY...............................................................................................................23

3.0 AREA OF STUDY........................................................................................................23

3.1 RADIOLOGY DEPARTMENT....................................................................................23

3.1.1. HISTORY OF AMINU KANO TEACHING HOSPITAL RADIOGRAPHY.......24

3.1.2 EQUIPMENT/APPARATUS IN THE DEPARTMENT...........................................24

3.2 DATA COLLECTION AND ANALYSIS....................................................................27

3.2 PATIENT DOSE SURVEY...........................................................................................27

CHAPTER FOUR................................................................................................................30

RESULT AND DISCUSSION............................................................................................30

4.0. INTRODUCTION.........................................................................................................30

4.1 RESULTS......................................................................................................................30

4.1 DISCUSSION................................................................................................................31

CHAPTER FIVE..................................................................................................................33

vi
SUMMARY, RECOMMENDATION AND CONCLUSIONS..........................................33

5.0 INTRODUCTION..........................................................................................................33

5.1 SUMMARY...................................................................................................................33

5.2 RECOMMENDATION.................................................................................................33

5.3 CONCLUSIONS............................................................................................................33

REFERENCES.....................................................................................................................34

vii
LIST OF TABLE
Table 1 : the result of the examination collected in the hospital of 20 patients................................30

viii
LIST OF FIGURES

Figure 1: the relevant dose quantities in patient dosimetry in projection X-ray imaging,

according to TRS 457 (IAEA 2007)......................................................................................9

Figure 2: Acquisition of medical projection radiography, with an X-ray generator and a

detector.................................................................................................................................25

Figure 3: Modern CT scanner (2021), photon-counting CT (Siemens NAEOTOM Alpha)

..............................................................................................................................................26

Figure 4: Bar graph of chest thickness against entrance skin dose for patient’s S/N 1 to 13

..............................................................................................................................................31

Figure 5: Bar graph of chest thickness against entrance skin dose for patient’s S/N 14 to 20

..............................................................................................................................................31

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 CHAPTER ONE

1.0 INTRODUCTION
Ionizing radiation is mostly utilized in medicine for both diagnosis and treatment. As a
result, both individuals and the general population are exposed to considerable levels of
radiation. One of the main sources of population radiation exposure caused by humans is
diagnostic radiology. According to estimates from the National Radiography Protection
Board and nuclear medicine, diagnostic radiology and nuclear medicine accounted up 96%
of the total effective dose from man-made sources in the United Kingdom (NRPB, 1993).
According to a comparable estimate from the National Council on Radiation Protection
and Measurement, this contribution was 88% in the United States (NCRP, 1987). If
ionizing radiation procedures for illness diagnosis and trauma detection were not available,
the population's health would deteriorate. However, there is no justification for
complacency, and radiation protection practice's fundamental tenet is that any exposure
should be justified by comparing the potential harm against the perceived benefit. The
main concern in radiological protection is the reduction of examinations that are either
unlikely to be helpful in patient management or involve those that involve exposure levels
that are not as low as reasonably achievable in order to meet specified clinical objectives.
This is due to the significant benefits from properly conducted medical exposures. X-ray
equipment and logical methods need to be optimized in order to do this (NRPB 1990).
Measurement of the patient dose is a crucial step in this optimization process (Faulkner, et
al 1999). These measurements will identify x-ray facilities with dosages, following which
it will be possible to specify possible dose reduction methods. The establishment of dose
limitations, the assessment of patient risk, and the justification of the examination all
require dose measurement. The International Commission on Radiological Protection
(ICRP) now believes that any use of radiation in medicine should be well justified.
Following justification, it's critical to streamline the process. In radiography, this refers to
applying the lowest dose feasible to produce an ideal image with the highest level of
diagnostic quality.

1
In diagnostic radiography, there are two categories of patient doses that are significant: the
effective dose E, which accounts for dosage equivalent to radiosensitive organs, and the
entrance skin dose. Since effective dose is related to the probability of stochastic effects
like cancer induction, it is of greatest relevance in diagnostic radiology.

To swiftly and effectively estimate and categorize the exposure is one of the key
components of integrated risk assessment, according to Drek (2010), who suggested this
for public health management of radiation emergencies.

Since ionizing radiation is known to cause cancer at large doses and that low-dose
exposure can result in clinical symptoms, radiation safety, monitoring, and assessment
have grown to be major concerns. Direct chromosomal alteration, indirect free-radical
production, radiation catractogenesis, cancer induction, and other clinical signs are among
the damages and illnesses brought on by ionizing radiation exposure (Serro, 1992).

During physical exams, diagnostic X-rays are utilized to spot illnesses and other issues.
Any diagnostic X-ray examination's goal is to provide images of the patient with the
necessary details and image quality to aid practitioners in the accurate and effective
diagnosis and treatment of a variety of illness conditions. Due to the hazards involved in
exposing patients to X-rays during diagnostic X-ray examinations, it is advised that the
entrance skin dose be recorded and monitored and that only the absolute minimal quantity
of X-radiation be utilized. Edmonds has demonstrated it, that X-ray exposure to patients is
influenced by the filtration, kVp, mAs, and SSD exposure factors.

Ananterior -posterior (AP), posterior-anterior (PA), and lateral chest X-ray make up the
typical chest exam. The films are viewed collectively at the radiology department using a
chest radiograph, sometimes known as a chest X-ray (CXR).

The first of this research's two main goals is to assess the patient entrance skin dose in
order to have a way of establishing and evaluating acceptable practice guidelines that will
help to maximize patient protection. In order to appropriately justify diagnostic procedures
and thoroughly analyze cases of unintentional overexposure, it is also important to quantify
the absorbed dose to the patient's tissues and organs.

2
1.1 BACKGROUND
Human organ imaging is now carried out using a variety of devices and techniques.
Traditional radiography, fluoroscopy, and computed tomography (CT) procedures are just
a few of the new diagnostic techniques that will undoubtedly continue to benefit modern
medicine greatly. However, radiography is also anticipated to advance because it is still a
potent tool that benefits patients significantly. As a result, this radiography has increased
radiation exposure to patients globally (The 2007 Recommendations of the International
Commission on Radiological Protection, ICRP publication 103, 2007; European
Commission, European Guidance on Estimating Population Doses from Medical X-Ray
Procedures. Radiation Protection N.154, 2008; Fazel et al., 2009; Hart et al, 2010; United
Nations Scientific Committee Effects Atomic Radiation, 2010). The numerous ionizing
radiation-based diagnostic imaging methods deliver patients with a wide spectrum of
radiation absorbed doses. The risk of radiation-induced harm to the patient exists even
though it is expected that these procedures will result in a net benefit (The AAPM/RSNA
Physics Tutorial for Residents Typical Patient Radiation Doses in Diagnostic Radiology 1,
1999). The fundamental radiation protection idea or philosophy ALARA asserts that all
exposures must always be maintained "As Low as Reasonably Achievable" due to the fact
that employing ionizing x-rays is connected with some risk of acquiring cancer (National
Council on Radiation Protection and Measurements, 1990).

Therefore, in order to reduce the danger of exposures involving a large number of people,
it is crucial to be aware of the radiation dose that the patient received during the
radiological examination. To calculate the harm from cancer and the genetic impacts of
radiation, various markers are used. According to ICRP 60, the effective dose, which is a
valuable and essential number for dose limitation in the field of radiological patient
protection, is the fundamental quantity related with the risk of adverse effects on health
(International Commission on Radiological Protection, 1991). This dose descriptor is being
used more frequently to estimate the amount of radiation dose that patients having
diagnostic x-ray scans would receive (Brenner and Huda, 2008; Kharita et al., 2010;
Mettler et al, 2008; Osei and Darko, 2013; Shahbazi-Gahrouei and Baradaran-

3
Ghahfarokhi, 2013; Teles et al., 2013).The estimate of effective dosage (ED), which is
determined by patient structure and radiographic technique, is extremely important.
Effective dose must be assessed indirectly during clinical procedures because it is nearly
difficult to measure it directly.

In general, incident air kerma (Ka,i) measurement is used as the input parameters for an
indirect estimation of the effective dosage, which then employs special conversion
coefficients (European Commission, European Guidance on Estimating Population Doses
from Medical X-ray Procedures, Radiation Protection N.154, 2008; International Atomic
Energy Agency, 2007; International Commission Radiation Units, 2005). Entrance skin
dose (ESD) is another crucial factor in determining the dosage a patient receives during a
single radiography exposure. The European Union has identified this physical quantity as
one to be monitored as a diagnostic reference level in the hopes of optimizing patient dose
(Bushong, 2001 and ICRP, 1991).

1.2AIM OF STUDY

The aim of this work is to study the estimation of organ equivalent and effective doses
from diagnostic x-ray.

1.3OBJECTIVES
To assess the patient entrance skin dose in order to have a way of establishing and
evaluating acceptable practice guidelines that will help to maximize patient protection.
And to measure the equivalent dose.

1.4SCOPEOF STUDY

This research work is carried out to establish the trend of dose received by patient during
x-ray examination in Aminu kano teaching hospital Kano state, Nigeria.

1.5LIMITATION OF STUDY
The key issues with this work were the financial limitations that were faced during project
execution, the limited sources of resources, and the challenges in obtaining data for
analysis.

4
1.6PROBLEMS STATEMENT
I was been motivated to go for this project because people are exposing to cancer in my
location. I carried this research out to bring the solution to this problem.

5
 CHAPTER TWO

LITERATURE REVIEW

One of the industries that uses the advantages of X-rays the most frequently is diagnostic
radiology. Radiation protection is motivated by minimizing the negative effects of ionizing
radiation. The ALARA concept, which stands for as low as reasonably possible, is a
fundamental tenet of radiation protection (ICRP 2007). It provides a summary of the
present understanding of the use of ionizing radiation; in the region of low doses, the
likelihood of radiation harm rises as a function of rising radiation dosage (ICRP 2007). The
most recent statistics states that, excluding X-ray tests for dental surgery, Finland did about
3.7 million X-ray exams in 2011. (Helasvuo 2013). Approximately 9% of them were
computed tomography (CT) scans, and the remaining 89% were traditional and contrast
medium X-ray scans. The most frequent conventional X-ray exams were thorax and
mammography, whereas the most frequent CT exams were head, whole-body, abdomen,
and thorax scans. A further estimate puts the total number of dental radiographs performed
in Finland each year at around 2.7 million. In Finland, there were 2.4 million intraoral,
panoramic, 35,000 cephalometric, and 7,500 cone beam computed tomography (CBCT)
exams performed in 2014. (T Helasvuo, June 11, 2015, personal communication).
Although there have been fewer X-ray exams—from 4.6 million in 1984 to 3.7 million in
2011—there have been more CT exams, and the total radiation dosage from CT exams has
grown as a result (Helasvuo 2013; Brenner 2010).

The patient in X-ray imaging absorbs some radiation energy during the imaging process.
According to the characteristics of the organs and tissues, the radiation that enters the
patient is attenuated. Different organs and tissues react differently to radiation. The organ
dose is equal to the radiation energy absorbed in a tissue or organ divided by the tissue or
organ mass. The most important step in determining a person's radiation risk is
determining their organ dosage. Organ doses cannot be directly measured, and the method
chosen to estimate an organ dose has a significant impact on the uncertainty surrounding
the organ doses.

6
The detrimental effects of radiation might be random or deterministic. High dose levels of
radiation have deterministic effects that harm and kill populations of cells. There is a
threshold dose below which deterministic effects are not seen clinically. As the dose
increases, the impact gets stronger. Cancer risk and hereditary effects are examples of
stochastic effects, and the likelihood of an impact grows as a function of dose without
reaching a threshold (ICRP 2007). The definition of harm and threshold, dose limitation
principles, and radiation effect classification has all changed significantly during the past
few decades (Hamada &Fujimichi 2014).

The term "effective dose" has been defined by the International Commission on
Radiological Protection (ICRP) for the purposes of risk management, along with the tissue
weighting factors used in the calculation of the effective dosage. Based on epidemiological
cancer incidence research and hereditary disease risk estimation, the tissue weighting
factors (ICRP 2007). The tissue weighting factors are initially based on whole-body
exposure data from atomic bomb survivors, however in X-ray imaging, organs and tissues
are exposed in partial or diverse ways. The tissue weighting variables are not meant to be
used for a specific person, but rather for a population of people of all ages and genders.
Since we have learned more about the effects of radiation, the tissue weighting variables
have changed roughly every ten years. Additionally, various ICRP committees may choose
to emphasize different parameters, such as cancer incidence rather than cancer mortality. In
ICRP publications 60 and 103, the tissue weighting factor for breast increased from 0.05 to
0.12, illustrating the latter (ICRP 1991; ICRP 2007).

However, the idea of an effective dose has faced criticism and debate (Brenner 2008;
Dietze et al. 2009; Brenner 2012). In the realm of radiography, the terms equivalent dose
and effective dose are frequently misused and confused. Although a replacement quantity
has been suggested (Brenner 2008; Brenner 2012), radiation protection still uses the idea of
the effective dose. Because the effective dose is meant to estimate the radiation exposure
of entire populations rather than individuals, it has been claimed that the individual organ
dose is a better indicator of patient risk (Brenner & Hall 2007; Martin 2007; Zhang et al.
2012; Hall & Brenner 2008; Brenner et al. 2003). The effective dosage is still often used in

7
the literature despite the fact that some recent papers (Blaszak&Juszkat 2014; Saltybaeva
et al. 2016) use organ doses rather than the effective dose to estimate patient risk.
Additionally, the United Nations Scientific Committee on the Impacts of Atomic Radiation
(UNSCEAR) has underlined that because the effective dose was designed for radiation
protection purposes, it cannot be used to interpret data on health effects (UNSCEAR
2008a; UNSCEAR 2008b). However, from a risk perspective, it can be utilized to compare
various examination types, equipment, and procedure aspects, but there is no need to
quantify any risk coefficients as the detriment or risk per effective dose (IAEA 2007).

In four diagnostic X-ray imaging modalities—general radiography, CT, mammography,

and dental radiography—this thesis focuses on determining organ dose using dose
measurements or Monte Carlo simulations. Mammography and general radiography
compare the variations in patient dosages and simplified patient models. In general
radiography, CT, and mammography, the influence of patient size on the dose conversion
coefficients or absolute doses is determined, and the effect of radiation quality on the dose
conversion coefficients or absolute doses is determined. For the estimate of fetal dosage in
CT and dental X-ray exams, results on measurement-based conversion coefficients are
presented, and the impact of lead shielding in dental X-ray exams is assessed.

2.0 DIAGNOSTIC REFERENCE LEVELS (DRLs)

The national radiation authorities produce diagnostic reference levels (DRLs) in
accordance with the requirements of the Basic Safety Standards (BSS), and they are
codified in law (European Parliament 2014). The BSS mandate the use of DRLs in order to
maximize patient protection in diagnostic radiology (IAEA 2014). The DRL identifies the
radiation dosage level that, in an examination carried out in accordance with good
procedures, is not anticipated to be surpassed for a patient of average size. In diagnostic
radiology, DRLs are employed in the management of patient doses to make sure that the
dosage levels of a chosen patient cohort, which is chosen based on weight or compressed
breast thickness (CBT) data, are sufficient but not excessive for the essential diagnostic
data. Ka,i, Ka,e, DG, PKA, and PKL are the dosimetric quantities advised for the establishment

8
of DRLs (ICRU 2005). Expanded uncertainty using coverage factors is a common way to
express the uncertainty of measurement data.

Figure 1:the relevant dose quantities in patient dosimetry in projection X-ray imaging, according to TRS 457
(IAEA 2007).

2.1IMAGING MODALITIES
The quantities related to direct measurements, specifically the intrinsic error, the difference
in radiation quality between the Secondary Standards Dosimetry Laboratory (SSDL) or
calibration laboratory and the user, the direction of the radiation incidence, the kerma rate,
the operating tube voltage, and the environmental parameters, are generally the largest
sources of measurement uncertainty in diagnostic dosimetry (air pressure, temperature,
humidity and electromagnetic compability), the size, homogeneity, and long-term
instrument stability of the field (IAEA 2007).

2.2 GENERAL RADIOGRAPHY

One of the most fundamental types of medical X-ray imaging is general radiography,
which uses single projections to create two-dimensional images based on the various
attenuation characteristics of tissues and organs. General radiography does not employ
contrast media. Mammography is included in the definition of conventional radiography,
which also refers to non-contrast medium X-ray exams. The dose to an organ during single
projection imaging is higher on the X-ray beam's entrance side and lower on its exit side.

9
Thoracic radiological examination is one of the most frequent diagnostic procedures.
Exams using X-rays (Helasvuo 2013; Speets et al. 2006; Veldkamp et al. 2009). There are
three different projections for looking at the thorax: posterior-anterior (PA), anterior-
posterior (AP), and lateral (LAT). When opposed to an AP projection, where the
radiosensitive breast tissue is exposed to the highest absorbed dosage at the patient
entrance, the thorax PA projection offers the advantage of exposing radiosensitive breast
tissue to a lower absorbed dose (Huda &Gkanatsios 1997). The low energy photons that
might otherwise increase the radiation dose absorbed by the patient are removed from the
X-ray beam through filtering. Filtration would reduce the dose to the breasts in AP
projection as it is visible at the patient entrance. However, the PA projection is the
conventional standing chest radiograph along with the LAT projection; If a patient is
unable to stand during a normal examination, AP projection may be utilized instead of PA
projection (Radiology Masterclass 2016).

This thesis uses Monte Carlo simulations without dosimetric measurements to analyze
general radiography. Most of the uncertainty in Monte Carlo simulations are caused by
statistical mistakes. Organs inside the X-ray beam receive dosages with lower statistical
uncertainty than organs outside the beam. The relative uncertainty in the latter situation
grows as one gets further away from the scan range. The level of statistical uncertainty is
determined by the number of primary photons employed in the simulation. Uncertainties in
the attenuation coefficients and inadequate model descriptions of the X-ray source and the
patient are additional sources of uncertainty in Monte Carlo simulations. (ICRU 2005)

2.3 COMPUTED TOMOGRAPHY

In order to provide cross-sectional tomographic images of certain patient locations,
computed tomography combines a number of X-ray projections. Standard-sized cylindrical
polymethyl methacrylate (PMMA) phantoms are utilized to specify the dosage values used
in CT, including Ca,100, CW, CVOL, and PKL. The diameters of the common cylindrical
head and body phantoms are 16 cm and 32 cm, respectively. In contrast to projection
imaging, the internal phantom and patient dose distributions in CT are more consistent.
The CT dosage amounts, however, do not match the patient doses since they are unable to

10
take into account the various patient sizes, genders, and anatomical structures. The CT
dose numbers are helpful for comparing protocols between various CT devices and for
assessing the effects of parameter changes to the dose.

Contrarily, CT exposes fetus to a sizable amount of radiation. Again, the amount of

prenatal radiation exposure varies depending on the type of investigation, with the CT
pelvis exposing the fetus to the most radiation at 50 mGy. This dose is exactly at the
threshold over which a proven adverse effect on the fetus occurs.

When thinking about using CT on pregnant women, it is important to constantly take other
options into consideration because CT adds to substantially higher fetal radiation. Before
using CT, it is best to first explore other imaging modalities such MRI, plain radiographs,
ultrasound, and nuclear medicine tests. Instead of using CT initially, common clinical
presentations like appendicitis need to be assessed using MRI first. If there is a clinical
suspicion of cholecystitis, right upper quadrant ultrasonography should be used. When
treating nephrolithiasis and collecting system blockage, renal ultrasonography should be
given priority over CT. It is critical to improve CT settings to reduce radiation if CT is the
first indication study of choice in patients with traumatic pregnancies to evaluate for intra-
abdominal injuries. The radiation dose can be decreased by using narrow collimation and
wide pitch. Additionally, CT protocols should be improved to reduce unneeded radiation
exposure. Only when there is a clinical indication should a clinician do extra delayed
imaging. Multiphasic procedures that are not required should be consolidated into a single-
phase protocol.

The fetus is not exposed to much disperse radiation when body areas other than the
abdomen and pelvis are imaged with a CT scanner. As a result, a shield has little effect on
the fetus's exposure to radiation during the CT scan. A lead shield could be a precaution
that is not essential. It may provide patients a sense of security and safety while only
slightly reducing the exposure from scatter radiation. The institution and provider may
decide whether to utilize a lead shield.

11
2.3.1MAMMOGRAPHY
Low energy X-rays are used in mammography, a specialized type of breast X-ray imaging,
to identify cancer generally before women exhibit symptoms. Early detection enables
treatment when breast cancer is still most amenable to cure. The craniocaudal (CC)
projection and the mediolateral oblique (MLO) projection are the standard projections
(views) in mammography, and they are often done on routine screening mammograms for
all patients. In the CC and MLO perspectives, the projection angles are 0° and 45°,
respectively. Breast compression is utilized in mammography because it improves image
quality while reducing radiation exposure and breast thickness. The dosage to the breast's
glandular tissue, or MGD, is the pertinent dose quantity in mammography. Depending on
the patient's breast surface's quantifiable incidence air kerma, thickness, and glandularity,
as well as the radiation's quality. CBT is also the mammography-relevant patient thickness.

A PMMA phantom of 45 mm thickness is typically used in mammography and is advised

to replicate the usual breast of 50 mm in thickness and 50% glandularity (ICRU 2005;
European Commission 2006; IAEA 2007; Fitzgerald 1989). Dance et al. (Dance 1990;
Dance et al. 2000) computed PMMA equivalent breast thicknesses for CBTs ranging from
20 to 110 mm. Furthermore, Dance et al. (Dance 1990; Dance et al. 2000; Dance et al.
2011) have produced the most recent conversion and correction factors for mammography
by Monte Carlo simulations, and they are both domestically (Toroi et al. 2011) and
globally (European Commission 2006, IAEA 2007) advised for use in calculating MGD.
The differences in the MGD calculated for patients and phantoms of various thicknesses
are the main topic of this thesis.

The accuracy of reading and tube loading indication, the uncertainty in measurement
position, the uncertainties associated with half value layer (HVL) measurements, and the
uncertainty in patient or phantom thickness are the specific sources of measurement
uncertainties in mammography. (IAEA 2007).

12
2.3.2 DENTAL RADIOGRAPHY
Different sub-modalities of dental radiography are employed for various objectives. To
create an X-ray image of a single tooth or a group of teeth, employ intraoral radiography.
Cephalometric dental examinations are utilized in orthodontics, and panoramic dental
examinations give a picture of the entire maxilla and mandible. When standard dental or
facial x-rays are insufficient, CBCT dental examinations are a specialized form of x-ray
technology employed. In a single scan, CBCT creates three-dimensional (3D) pictures of
the teeth and bones. In dental radiography, the head and neck receive the highest dosages;
the main cause of exposures in other areas is dispersed radiation. The radiation exposures
to the fetus and breasts during dental radiography with and without lead shielding are the
main subject of this research.

The accuracy of reading and the uncertainty in measurement position are the specific
sources of measurement uncertainties in dental radiography (IAEA 2007).

2.4 ORGAN DOSE DETERMINATION

The patient's anatomy and the radiation field must be modelled in detail for the organ doses
to be estimated accurately (Samei et al. 2014). The size and composition of the patient
have an impact on the organ locations and sizes within the body, which in turn affects the
patient's anatomy. The patient's weight, height, body mass index, or thickness, for instance,
can be used to describe the patient's size. A patient's breast thickness or size-related metrics
computed based on the AP and LAT thicknesses can also be utilized to describe the
patient's size. In CT, the tube current modulation (TCM) technique, radiation quality,
projection, field size, and other factors are taken into account while describing the
irradiation field. The X-ray spectrum represents radiation intensity as a function of photon
energy; the anode material defines the characteristic peaks in the spectrum, and the tube
voltage determines the maximum energy. By removing low energy photons, for example,
filtering the spectrum changes the form of the spectrum. The anode characteristics, the
HVL, the X-ray tube voltage, and the total filtration are the variables and factors that are
utilized to describe a radiation quality (ICRU 2005).

13
The fact that organ dose cannot be accessed directly in patients presents the first challenge
because doing so would necessitate installing internal dosimeters in the patient's organs,
which is unethical. For the estimation and determination of patient organ dose, many
approaches are available. Using the average or usual tabulated dose value of the
examination is the crudest and least accurate level of dose estimation. The use of
conversion coefficients enables taking into account the measurably incident dose, and they
are often estimated based on measurements made in physical phantoms or Monte Carlo
simulations. Because they are thoroughly tested and have the crucial advantage of
flexibility over phantom measurements, Monte Carlo simulations are the most well-
established method for determining organ dose conversion coefficients (IAEA 2007). The
conversion coefficients are most accurate when the real and simulated scenarios are as
similar as possible and when they are chosen based on the information of the patient
anatomy and the exposure situation. The circumstance where organ dosage estimation is
required, however, may not always be covered by the conversion coefficients that are now
accessible. A more exact way for determining organ dose is provided by anthropomorphic
phantom measurements and Monte Carlo simulations that are directly applicable to the
particular case. These techniques are particularly helpful for patients who are pregnant or
in other unusual circumstances.

Utilizing patient-specific organ dose estimation based on dose simulations on the patient's
actual CT data is the most precise and time-consuming method. This method is frequently
employed in calculating radiation therapy doses, although it is not regularly utilized in
patient dosimetry in diagnostic radiology. There is not the same requirement for
individually tailored patient dose estimation as in radiation treatment because the organ
dose assessment in diagnostic radiology is typically made for certain procedures and
techniques that are applied to a large number of patients (ICRU 2005). Due to this,
diagnostic radiology has traditionally used standard patient models; however, more
recently, the American Association of Physicists in Medicine (AAPM) has produced
patient size-specific dose estimates (SSDEs) for CT (AAPM 2011). Similar patient size-
specific dosage estimates are not yet widely used in projection radiography.

14
2.5DOSE DETECTORS AND DOSIMETERS

To detect and quantify the radiation dose within or outside of a human exposed to ionizing
radiation, or to measure the tube output or air kerma of X-ray equipment, are a few
examples of how dose detectors and dosimeters are used in medical dosimetry. Whether
measurements are taken in the main radiation beam or merely scattered radiation is
dependent on the situation and the choice of an appropriate dose measurement device.

Gas-filled chambers with an anode and a cathode serve as ionization chambers. The
amount of electron-ion pairs produced by incoming radiation within the gas volume is used
to calculate the charge (Knoll 2000). Ionization chambers come in a wide variety of shapes
and sizes for various uses. For CTDI and air kerma measurements in CT, pencil ionization
chambers are employed. Low energy ionization chambers can also be used to measure the
air kerma in mammography.

Solid state detectors are based on semiconductors and operate similarly to ionization
chambers, except that radiation produces electron-hole pairs in the semiconducting
material, which is often silicon or germanium, instead of electron-ion pairs. The same
numbers of holes are produced in the valence band as are transported from the valence
band to the conduction band. However, in a totally pure semiconductor, this is the case; in
actual materials, very low quantities of residual impurities dominate the electrical
properties (Knoll 2000). For instance, tube output and scattered radiation dose
measurements can be performed using solid state dosimeters.

Thermoluminescent dosimeters (TLDs), radiophotoluminescent dosimeters (RPLDs),

optically stimulated dosimeters (OSLDs), and metal-oxide-semiconductor field-effect
transistors (MOSFETs) are further dosimeter types utilized in medical dosimetry (Ristic
2013; Manninen 2014; Yoshizumi et al. 2007; Kaasalainen 2015). The organ dose
measurements inside anthropomorphic phantoms can be carried out using any of these
dosimeter types. When compared to TLDs, MOSFET dosimeters provide for quick reading
upon radiation exposure (Yoshizumi et al. 2007). The operation of MOSFET dosimeters is
based on the change in the threshold voltage needed to turn on the transistor as a result of

15
the electron-hole pairs produced by ionizing radiation. MOSFET dosimeters are composed
of an insulating layer of silicon dioxide (SiO2), a silicon semiconductor substrate, and a
polycrystalline silicon or metal gate. (Knoll 2000; Brady & Kaufman 2012). MOSFET
dosimeters' angular dependence needs to be taken into account while using different
irradiation angles. MOSFET dosimeters' angular sensitivity has been found to vary,
therefore they must always be calibrated for the beam geometry in actual clinical scenarios
(Koivisto et al. 2013).

By definition, traceability is a continuous calibration chain with estimated uncertainties at

every stage. The International Measurement System (IMS) for radiation metrology
provides the traceability of the measured doses to the primary standards. The Primary
Standards Dosimetry Laboratories (PSDLs), Secondary Standards Dosimetry Laboratories
(SSDLs), and radiation users who conduct measurements make up the International
Measurement System (IMS) (IAEA 2007). Additionally, the International Atomic Energy
Agency (IAEA) operates an SSDL laboratory. Although calibration services are also
offered by the instrument manufacturers, SSDLs are often where radiation instruments
used in medical dosimetry are calibrated. The SSDL in Finland includes the Radiation and
Nuclear Safety Authority (STUK). Detectors used in medicine should have routine
calibrations done at the SSDL. The calibration of dosimeters used in various imaging
modalities is advised using standard radiation quality (IEC 2005; ICRU 2005; IAEA
2007). However, the radiation quality in a therapeutic setting may not be the same as the
radiation quality utilized for calibration.

2.5.1 ANTHROPOMORPHIC PHANTOMS

Finding a model for dosimetry that effectively mimics human anatomy is one of the
challenges in determining patient organ dose. Computational phantoms and physical
phantoms are two categories of anthropomorphic phantoms used in medical dosimetry.
Mathematical or voxel phantoms are two types of computational ghosts. About 27 physical
phantoms and 121 computational phantoms had been described in the literature by the end
of 2009 for investigations involving both ionizing and non-ionizing radiation (Xu
&Eckerman 2009). The majority of the computational phantoms, 84, were created from

16
cross-sectional scans of post-mortem participants or CT or MRI images of live subjects
(Xu &Eckerman 2009).

At Oak Ridge National Laboratory (ORNL), Fisher and Snyder created the first humanoid
mathematical phantom in the 1960s (Fisher & Snyder 1966; Fisher & Snyder 1967). The
study at ORNL proceeded, and in 1969 the "MIRD-5 Phantom"—the first heterogeneous
phantom—was reported (Snyder, Fisher, et al. 1969; Snyder, Ford, et al. 1969). The organ
masses were chosen to match the ICRP Reference Man's statistics as closely as feasible
(ICRP 1975). Numerous derivations of the MIRD (Medical Internal Radiation Dose)
phantom have been created, including the gender-specific adult phantoms ADAM and
EVA, infants and children of various ages (Cristy 1980), and family phantom series (Cristy
&Eckerman 1987). then later in the 1990s, an adult female phantom who was pregnant
(Stabin et al. 1995). The MIRD phantom's body and organs have simple, geometrical
shapes, which is a built-in restriction of mathematical phantoms. Numerous concessions
with regard to anatomical details in mathematical phantoms can occasionally provide
conclusions that are incorrect (Xu 2014). However, new works continue to highlight the
significance of mathematical phantoms (Seidenbusch& Schneider 2014; Damilakis,
Tzedakis, et al. 2010).

With the development of powerful computer and tomographic imaging technology in the
late 1980s, more lifelike voxel phantoms were made available. To distinguish them from
the first generation mathematical phantoms, voxel phantoms are referred to as second
generation phantoms. Organ segmentation is done using CT or MRI data, which is the
foundation for voxel phantoms. Two adult male voxel models were created in the 1990s:
NORMAN and Voxelman (Zubal 1999). (Dimbylow 1997). With approximately 3.7
billion voxels, The VIP-Man (Xu et al. 2000) was the most intricate phantom to date. The
most extensive series of voxel phantoms is the GSF family, which includes both pediatric
(Veit et al. 1989) and adult phantoms of both sexes, varying ages, and body sizes
(Petoussi-Henss et al. 2002). Additionally, adult female voxel phantoms of various
nationalities have been created (Dimbylow 2005; Sheng et al. 2013; Sato et al. 2009).
Following the development of the adult and pediatric phantoms, phantoms depicting

17
various phases of pregnancy (Xu et al. 2007; Dimbylow 2006) and phantoms of newborn
babies (Lee et al. 2007) have also been created. Additionally, in 2009, ICRP Reference
Male and Female voxel phantoms that closely match the ICRP 89 reference values for their
body mass, weight, and height were created (Zankl& Wittmann 2001; ICRP 2002; ICRP
2009). Reference for the ICRP To enable estimations of the effective dosage and the organ
and tissue equivalent doses, male and female phantoms are defined. Dental radiography
and mammography both use voxel phantoms that simulate the entire human body
(Tzamicha et al. 2015). (Morant et al. 2013). Additionally, dynamic phantoms that
replicate the movements of the heart and lungs or different postures have been created
(Segars et al. 2010; Nagaoka & Watanabe 2009). In contrast to early voxel phantoms,
which used a constructive solid geometry method, many of the most current phantoms are
based on sophisticated boundary representation methods (Xu 2014).

Physical anthropomorphic phantoms can also be utilized in Monte Carlo simulations and
dosage measurements, in addition to the usual usage of mathematical and voxel phantoms
in simulation programs. Small cavities in physical phantoms are used to house dosimeters
like MOSFET dosimeters and TLD dosimeters. For instance, CIRS ATOM phantoms
come in a variety of sizes and include adult male and female phantoms as well as pediatric
infant, one-year-old, five-year-old, and ten-year-old phantoms. As a standard of reference
for diagnostic radiology of the head, there is also the CIRS ATOM Max dental and
diagnostic head phantom. The RANDO phantom (The Phantom Laboratory, Salem, NY,
USA) and Alderson ART phantoms are two more physically present anthropomorphic
phantoms that are available for purchase (Radiology Support Devices, Long Beach, CA,
USA). For assessing the glandular dose in a typical breast during mammography, Dance's
non-anthropomorphic PMMA breast phantom is advised, but various additional models
have also been created (Cassola & Hoff 2010).

2.5.2 MONTE CARLO SIMULATIONS

Medical dosimetry frequently makes use of Monte Carlo models. The simulation of the
radiation field incident on the patient, the photon transport through the body, and the
patient anatomy are the fundamental needs of a Monte Carlo model (IAEA 2007; ICRU

18
2005). Because the incident photon energies are below 150 keV, the simulated photon
interactions in medical X-ray imaging are the photoelectric effect and coherent and
incoherent scattering (ICRU 2005). The X-ray apparatus and patient anatomy must be
characterized and modeled for voxel-based Monte Carlo simulations. (Gu et al. 2009; Ding
et al. 2012; Lee et al. 2011; Bostani et al. 2015; Tian et al. 2014; Sinclair et al. 2015; Li et
al. 2011a). Data for the X-ray spectrum and the bowtie filter in CT are needed for the
modeling of the X-ray device. Additionally, measurement data for air kerma values (such
Ka or PKA) may be needed as the input value for Monte Carlo simulations. Therefore, the
simulation outcomes can be displayed as conversion coefficients in relation to the input
value. All conversion coefficients are influenced by the radiation quality, and they are most
accurate when the simulated scenario is as similar to the actual circumstance in which the
organ doses are needed as possible (IAEA 2007).

The Center for Devices and Radiological Health, the National Institutes of Health, and the
National Cancer Institute have released the most thorough summaries of organ dosage
conversion coefficients (CDRH), the National Radiological Protection Board (NRPB),
formerly known as the Health Protection Agency (HPA), and the German Center for
Health and the Environment (GSF) (ICRU 2005). Because they are more applicable than
measurements in physical phantoms when a wide range of clinical scenarios or exposure
settings need to be taken into account, Monte Carlo simulations were used to establish
these extensive tabulations of organ dose conversion coefficients (ICRU 2005). But when
comparing these simulations to measured organ doses, it was found that there was
generally agreement within 30% for adult phantoms and 40% for pediatric phantoms
(ICRU 2005). Additionally, a number of writers have released organ dose conversion
equations for various exposure scenarios based on Monte Carlo simulation. (e.g.Zankl et
al. 2002; Schlattl et al. 2007; Turner et al. 2011; Seidenbusch& Schneider 2014; Johnson et
al. 2009; Schultz et al. 1994; Lee et al. 2012; Petoussi-Henss et al. 2002). It can be
challenging to compare the dosage conversion coefficient with those normalized to other
standards, such as CVOL, when doses have only been normalized to the P It in some
instances.

19
Programs to calculate patient dose have utilized the data provided by the GSF and the
NRPB. For instance, CT-Expo (Stamm& Nagel 2002) and ImPACT CT patient dosimetry
calculator (IMPACT 2011) both use NRPB and GSF data, respectively. Mathematical or
voxel phantom patient models can be employed in Monte Carlo calculations and
simulation programs. Some of the computation programs employ a standard-sized
phantom and make assumptions about the beam location. For instance, the organ doses
produced by the Monte Carlo approach given in NRPB-R262 and NRPB-SR262 are the
basis for XDOSE (Le Heron 1994). In contrast to the typical MIRD-type geometrical
patient model used in NRPB-R262 and NRPB-SR262, CALDose X (Kramer et al. 2008)
provides an upgraded patient model by using male and female voxel phantoms (Hart et al.
1994a; Hart et al. 1994b). Hermaphrodite mathematical phantoms are included in the
PCXMC program (Tapiovaara&Siiskonen 2008) and range in age from 0 to adult. These
phantoms’ primary weights and heights are based on the criteria developed for PCXMC by
Cristy &Eckerman (1987). With user-defined acquisition parameters, the ImpactMC
application from CT Imaging, Erlangen, Germany (Deak et al. 2008; Schmidt &Kalender
2002) enables the user to construct 3D dose distributions in CT data of phantoms or
people. Several public domain Monte Carlo code systems that can be applied to medical
dosimetry include for example MCNP (X-5 Monte Carlo Team 2003), MCNPX (Pelowitz
2008), EGSnrc (NRC 2016), Geant4 (Agostinelli et al. 2003; Allison et al. 2006),
PENELOPE (Baró et al. 1995) and Fluka (Battistoni et al. 2007). The large variety of
mathematical, voxel and physical phantoms available can be used in different Monte Carlo
simulation programs, which expands the possibilities of organ dose determination in
medical dosimetry.

2.6 CHEST RADIOGRAPHY

A projection radiograph of the chest, often known as a chest X-ray or CXR, is used to
diagnose conditions affecting the chest, its contents, and adjacent structures. The most
frequent test used as a treatment for numerous clinical disorders is a chest radiograph. It is
used to identify a variety of diseases that affect the thorax, thoracic bones, and internal

20
organs such the heart, lungs, and major vessels. By chest radiograph, pneumonia and
congestive heart failure are frequently diagnosed conditions. In industries like mining
where workers are exposed to dust, chest radiographs are also used to screen for lung
diseases connected to the job. Like all techniques, chest radiographs use ionizing radiation
in the form of X-rays to produce images of the chest.

A chest radiograph typically exposes an adult to 0.02mSv for a front (PA) view and
0.04mSv for a side (lateral) view of the body. As a result, different views of the chest can
be obtained by altering the body's relative orientation and the X-ray beams' direction. A
survey of 171 patients receiving chest, abdominal, and lumbar spine x-ray examinations at
three public hospitals in Nigeria was conducted. The radiation dose, which was discovered
to vary greatly, was measured using the technical parameters of tube potential and
exposure FFD utilizing TLD chips. Patient was exposed to whipping 120m red per x-ray
in one unit (Ogundare, 2004). In Jos University Teaching Hospital, research on the impact
of exposure variables on the quality of the skull radiograph revealed that the exposure
factors needed to produce a good skull x-ray radiograph at the lowest dose are 60-70kV,
300-50mA, and 0.6-1.6s (Nwankwo et al., 2004).

To operate or work with x-ray machines in Nigeria, radiographers, radiologists, and

medical physicists must complete a two-week radiation protection training course. To
protect both patients and employees, the Nigeria Basic Ionizing Radiation Legislation
(NBIRR) under the Nigeria Nuclear Regulatory Authority (NNRA) introduced this
regulation.

2.7RADIATION DOSE TO TISSUE OR ORGAN

The most practical way to express the size of a radiation dosage is to give the radiation's
energy deposition rate. Absorbance dose is the fundamental radiation dose measurement
(Sato et al., 1995).

21
2.8 ABSORBED DOSE

When radiation interacts with matter, energy is transferred from the radiation to the matter.
The energy that is eventually delivered to tissue or a radiation shield is converted to heat.
The radiation dosage is influenced by the radiation's power and intensity, as well as its
duration, exposure area, and depth of energy deposition. Giving the Absorbed Dose is:

dE
D= (2.0)
dm

The unit is J/kg or Gray (Gy) formally rad.

1Gy = 100 rad.

It is possible to calculate the absorbed dose in a material if the exposure is known.

D(Gy)=f ∙ x ( Ck g )(2.1)
−1

Where f is the conversion coefficient depending on the medium (Sato et al., 1995)

2.9EQUIVALENT DOSE
The damage that radiation can do cannot be accurately predicted by the absorbed dose. For
instance, an absorbed dose of 0.1Gy of alpha radiation is more dangerous than 0.1Gy of
beta or gamma radiation. The equivalent dose is used to represent the harm caused by
various radiation types to biological systems.

H=W R ∙ D ( Gy ) (2.2)

Where

H is the equivalent dose in tissue,

WR is the radiation weighting factor (Sato et al., 1995).

The unit is sievert (Sv) formally rem. And 1Sv = 100rem.

22
 CHAPTER THREE

METHODOLOGY
3.0 AREA OF STUDY
Aminu kano teaching hospital Kano State.Aminu Kano Teaching Hospital was established
in August, 1988 when the Kano State Government formally handed over the then Aminu
Kano Cottege Hospital to the Federal Government to be used as a Teaching Hospital.The
hospital which temporarily started operation at Murtala Mohd. Specialist Hospital moved
to its permanent site in 1996. This is located at tarauni local government area. And have
geographical presentation as 11.9626°North 8.5519°East. Today the hospital has grown to
be a full 500 bedded Teaching hospital with some modern equipment and facilities.
(Iliyasu, Z; Abubakar, IS; Abubakar, S; Lawan, UM; Gajida, AU December 2010) . The
hospital has a staff strength of two thousand four hundred out of which over one hundred
are consultants in various specialties. One major area that the hospital has impacted on the
lives of the people is in the area of kidney transplant.Aminu Kano Teaching Hospital
serves three main functions: training of medical students and Resident doctors, provision
of specialist medical services to the sick and important research for the advancement of
medical knowledge.(AKTH)

It is used for the training of Bayero University medical students and postgraduate medical
doctors (Residency training). It recorded success over the years, including being the first
government hospital to perform a successful kidney transplant in the year 2002; the former
Chief Medical Director Professor Abdulhamid Isa Dutse was instrumental in the
transplant.(Yakasai, Ia; Ugwa, Ea; Otubu, J 2013)

3.1 RADIOLOGY DEPARTMENT

The radiology department may also be called the X-ray or imaging department. It is the
facility in the hospital where radiological examinations of patients are carried out, using
the range of equipment listed below.A radiologist is a specially trained doctor who
interprets diagnostic imaging to guide the management of disease. If you have an
interventional procedure (such as an angiogram or biopsy) a specially trained radiologist

23
called an interventional radiologist will perform the procedure. Radiologists provide a scan
report which is then sent to your doctor.

A diagnostic radiographer is a person who has been trained to take your X-ray or perform
your MRI or CT scan. If trained to perform an ultrasound a radiographer is known as a
sonographer. Radiographers also support a radiologist in performing interventional
procedures.Diagnostic radiographers employ a range of techniques to produce high quality
images to diagnose disease. Some radiographers are also trained to provide reports on X-
ray imaging. The identification and monitoring of diseases, skeletal and soft tissue
abnormalities and trauma are the major focus of diagnostic radiography.

3.1.1. HISTORY OF AMINU KANO TEACHING HOSPITAL RADIOGRAPHY

The department of radiology is offering a wide variety of diagnostic and image-guided
therapeutic services. In addition, is active in teaching, research and dissemination of
knowledge. These activities are taking place from its major service delivery points
(Muhammadu Sanusi Diagnostic Center, Accident and emergency unit, Old Radiology
Block, special care baby unit, main theatre, Abdullahi Bayero Diagnostic Centre, VAMED
and ultrasound blocks) and occasionally, by the bedside of the patients. Additional satellite
services are being offered in the department at Kumbotso Comprehensive Health Center
and at the Federal Medical Centers Gusau and Rasheed Shekoni Specialist Hospital.

3.1.2 EQUIPMENT/APPARATUS IN THE DEPARTMENT

X-RAY MACHINE

An X-ray machine is any machine that involves X-rays. It may consist of an X-ray
generator and an X-ray detector.

24
 Figure 2: Acquisition of medical projection radiography, with an X-ray generator and a detector

Examples include

a) Machines for medical projectional radiography

b) Machines for computed tomography
c) Backscatter X-ray machines, used as "body scanners" in airport security
d) Detectors in X-ray astronomy

MRI MACHINE

Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to

form pictures of the anatomy and the physiological processes of the body. MRI scanners
use strong magnetic fields, magnetic field gradients, and radio waves to generate images of
the organs in the body. MRI does not involve X-rays or the use of ionizing radiation,
which distinguishes it from CT and PET scans. MRI is a medical application of nuclear
magnetic resonance (NMR) which can also be used for imaging in other NMR
applications, such as NMR spectroscopy. MRI is widely used in hospitals and clinics for
medical diagnosis, staging and follow-up of disease. Compared to CT, MRI provides better
contrast in images of soft-tissues, e.g. in the brain or abdomen. However, it may be
perceived as less comfortable by patients, due to the usually longer and louder
measurements with the subject in a long, confining tube, though "Open" MRI designs
mostly relieve this. Additionally, implants and other non-removable metal in the body can

25
pose a risk and may exclude some patients from undergoing an MRI examination safely.
(McRobbie DW, Moore EA, Graves MJ, Prince MR 2007).

COMPUTED TOMOGRAGHY MACHINE

A computed tomography scan (usually abbreviated to CT scan; formerly called computed

axial tomography scan or CAT scan) is a medical imaging technique used to obtain
detailed internal images of the body. The personnel that perform CT scans are called
radiographers or radiology technologists. CT scanners use a rotating X-ray tube and a row
of detectors placed in a gantry to measure X-ray attenuations by different tissues inside the
body. The multiple X-ray measurements taken from different angles are then processed on
a computer using tomographic reconstruction algorithms to produce tomographic (cross-
sectional) images (virtual "slices") of a body. CT scan can be used in patients with metallic
implants or pacemakers, for whom magnetic resonance imaging (MRI) is contraindicated.

Figure 3: Modern CT scanner (2021), photon-counting CT (Siemens NAEOTOM Alpha)

26
ULTRASOUND MACHINE

Ultrasound-based diagnostic medical imaging is used to visualize muscles, tendons, and

many internal organs, to capture their size, structure and any pathological lesions with real
time tomographic images.

Ultrasound imaging uses sound waves to produce pictures of the inside of the body. It
helps diagnose the causes of pain, swelling and infection in the body's internal organs and
to examine an unborn child (fetus) in pregnant women. In infants, doctors commonly use
ultrasound to evaluate the brain, hips, and spine. . It also helps guide biopsies, diagnose
heart conditions, and assess damage after a heart attack. Ultrasound is safe, noninvasive,
and does not use radiation. (Worton, R. G.; Holloway, A. F. 1966)

DOSIMETER

A radiation dosimeter is a device that measures dose uptake of external ionizing radiation.
It is worn by the person being monitored when used as a personal dosimeter, and is a
record of the radiation dose received. Modern electronic personal dosimeters can give a
continuous readout of cumulative dose and current dose rate, and can warn the wearer with
an audible alarm when a specified dose rate or a cumulative dose is exceeded. Other
dosimeters, such as thermoluminescent or film types, require processing after use to reveal
the cumulative dose received, and cannot give a current indication of dose while being
worn.(Senthil Srinivasan, V.S.; Pandya, Arun 2011)

3.2 DATA COLLECTION AND ANALYSIS

The data was collected from Aminu Kano teaching hospital kano.The goal of this research
is to estimate the organ equivalent and effective doses from diagnostic x-ray.the age of the
patient determine the effective dose and organ equivalent dose that patient will absorb
during the x-ray. This research uses correlational study.

3.2 PATIENT DOSE SURVEY

This study's survey methodology was developed in accordance with the standards outlined
by the NBIRR protocols. The Aminu Kano Teaching Hospital in Kano served as the

27
study's source. Specific information about the employed x-ray machine, including type,
model, waveform, filtration, film-screen combination, and output, was documented. Only
the posterior anterior (PA) perspective was taken into account in this work. Sex, age,
weight, height, body mass index, focus-to-film distance (FFD), film size, chest thickness,
kVp, and mAs were all noted for each patient and x-ray unit.

This project uses a tungsten target-anode rotating diagnostic x-ray machine. Some patients'
chest radiograph tests were taken into consideration. The posterior-anterior radiographic
view with grade was used to take the patients' x-rays. Patients were exposed to x-rays from
a control room where the kVp and mAs exposure parameters for each patient were chosen.
For each patient, the focal - film distance (FFD) and the thickness of the patient's chest
were used to calculate the source to skin distance (SSD).

SS D = FFD – thickness of the patient ’ s chest (3.0)

The radiograph of the chest involves two major viewings of positioning of patients during
medical examinations; the posterior anterior (PA) view and the lateral view but in this
investigation, we only considered the posterior anterior (PA) view.

A loaded x-ray films cassette (35cm x 42cm) is fixed on an erect, Bucky or chest stand.
The shoulders are rolled forward and the arms are put on each side of the hips with the
chest in contact with the Bucky (this is to displace the scapulae from a lungs field). The
lower boundary of the scapulae lies in the center of a horizontal x-ray beam that is 90 cm
from the films. The interest region is collimated by the beam. Carefully chosen exposure
factors are used, with an FFD of 150cm.

The information gathered is only based on the exposure settings and total beam
filtration of the equipment. The greatest amount of x-rays that can be absorbed by live
tissues during a medical examination is known as the entrance skin dose. The skin
dose to patients was determined by calculation from the x-ray tube parameters and
exposure radiographic parameters using Edmonds (1984) skin dose formula which is
given as:

28
 1
( +0.114)
Skin dose (µGy) = 418(KVp) 1.74
mAs T (3.1)
2
(SSD)

Where kVp is the peak voltage responsible for the quality of penetration, mAs is the
tube current, responsible for quantity of electrons from the filament, T is the total
filtration of the beams always a constant (2.5mm AL) or (0.25 cm AL), and SSD =
FFD – thickness.

29
 CHAPTER FOUR

RESULT AND DISCUSSION

4.0. INTRODUCTION
This chapter will include the result that was collected from Aminu kano teaching hospital
Kano, Chart showing Chest thickness against entrance skindose.

4.1 RESULTS
Table 1 : the result of the examination collected in the hospital of 20 patients

Patien Chest Mean Mean Focal Film Total Source to Entrance

t S/N Thickness kVp mAs Distance Filtration T Skin Skin Dose
(cm) (kV) (mAs) (FFD) (cm) (cm) Distance (mGy)
(SSD) (cm)

1. 72 65 20 150 0.25 78 0.008068

2. 75 65 20 150 0.25 75 0.008726
3. 75 65 20 150 0.25 75 0.008726
4. 78 55 25 150 0.25 72 0.005664
5. 78 60 16 150 0.25 72 0.008237
6. 78 74 30 150 0.25 72 0.017798
7. 79 74 30 150 0.25 71 0.018302
8. 79 60 20 150 0.25 71 0.008471
9. 82 60 20 150 0.25 68 0.009235
10. 84 65 25 150 0.25 66 0.014085
11. 84 65 20 150 0.25 66 0.011268
12. 87 65 25 150 0.25 63 0.015459
13. 90 70 20 150 0.25 60 0.019389
14. 92 70 25 150 0.25 58 0.020749
15. 92 65 32 150 0.25 58 0.014591
16. 94 76 40 150 0.25 56 0.030818
17. 95 74 20 150 0.25 55 0.040667
18. 98 70 25 150 0.25 52 0.025813
19. 103 70 30 150 0.25 47 0.037917
20. 109 70 32 150 0.25 41 0.053149

30
 100

90

80

70

60

50

40

30

20

10

0
0 1 2 3 4 5 6 7 8 9 10 11 12 13

Figure 4:Bar graph of chest thickness against entrance skin dose for patient’s S/N 1 to 13

115

110

105

100

95

90

85

80
14 15 16 17 18 19 20

Figure5: Bar graph ofchest thickness against entrance skin dose for patient’s S/N 14 to 20

4.1 DISCUSSION
Biographical information, including machine characteristics, was captured in this survey.
In Table 1, this is displayed.The chest thickness ranges from 72 cm to 109 cm and the

31
entrance skin dose ranges from 0.005664 mGy to 0.053149 mGy. The maximum entrance
skin dose measured is 0.53149mGy; this may be due to the patients' large chests or their
advanced ages. The International Atomic Energy Agency (IAEA) and other international
organizations' advisory levels were compared to hospital data.The bar graphs in Figure 4.1
and Figure 4.2 shows that the entrance skin dose received by the patients’ increases with
increase in the chest thickness. WherekVp is the peak voltage responsible for the quality of
penetration, mA is the tube current, responsible for quantity of electrons from the filament,
T is the total filtration of the beams always a constant (2.5mm AL) or (0.25 cm AL), and
SSD = FFD – thickness.

Where

SSD is the skin source distance and

FFD is the focal of the film distance

32
 CHAPTER FIVE

SUMMARY, RECOMMENDATION AND CONCLUSIONS

5.0 INTRODUCTION
This chapter will provide A Summary of the finding of Study, a conclusion a set of
recommendations.

5.1 SUMMARY
These studies estimate the organ equivalent and effective doses from diagnostic x-ray. The
result show that the as the thickness of the patient chest is increasing also the entrance skin
dose is increasing. The entrance skin dose is calculated using Edmonds skin dose formula.

5.2 RECOMMENDATION
Patients who are younger than the recommended age for radiological tests should get extra
attention, with doses being reduced utilizing a high kilovolt method and lower mAs. When
doing x-ray activities, the ALARA (as low as reasonably possible) concept should be
followed. A consistent Quality Assurance procedure and staff training will significantly
lower the radiation doses that patients receive.

5.3 CONCLUSIONS
Another factor that contributes to the high ESD found in this analysis is likely the findings
of this study show that the ESDs that patients receiving x-ray examinations at Aminu Kano
Teaching Hospital experienced were within the 0.4mGy guiding range established by
radiation safety agencies. A reference skin dosage of 1mGy can still be used to compare
the skin doses examined in this study, despite the state of the machine utilized for the
assessment. Although all x-ray machines must pass through quality control evaluations
after every three months before they are authorized to run, it is nevertheless conceivable
that the x-ray machine is adequately maintained. We must thus offer the following advice
because the maximum absorbed dose seen in this study was 0.53149mGy, which is slightly
more than the recommended amount.

33
REFERENCES
1. AAPM, 2011. AAPM Report 204 / TG-204: Size-Specific Dose Estimate (SSDE)
in Pediatric and Adult Body CT Examinations, College Park.
2. Aminu Kano Teaching Hospital (AKTH) | VECD Global Health Fellowship
3. Yakasai, Ia; Ugwa, Ea; Otubu, J (2013). "Gynecological malignancies in Aminu
Kano Teaching Hospital Kano: A 3 year review". Nigerian Journal of Clinical
Practice. 16 (1): 63–66. doi:10.4103/1119-3077.106768. PMID 23377473.
4. Iliyasu, Z; Abubakar, IS; Abubakar, S; Lawan, UM; Gajida, AU (December 2010).
"Patients' satisfaction with services obtained from Aminu Kano Teaching Hospital,
Northern Nigeria". Nigerian Journal of Clinical Practice. 13 (4): 371–8. PMID
21220848
5. https://www.researchgate.net/institution/Aminu_Kano_Teaching_Hospital/
departments
6. Abramoff, M., Magalhaes, P. & Ram, S., 2004. Image Processing with ImageJ.
Biophotonics International, 11, pp.36–42.
7. Senthil Srinivasan, V.S.; Pandya, Arun (2011). "Dosimetry aspects of hafnium
oxide metal–oxide–semiconductor (MOS) capacitor". Thin Solid Films. 520 (1):
574–577. Bibcode:2011TSF...520..574S. doi:10.1016/j.tsf.2011.07.010.
8. Worton, R. G.; Holloway, A. F. (1966). "Lithium Fluoride Thermoluminescence
Dosimetry". Radiology. 87 (5): 938–943. doi:10.1148/87.5.938. PMID 5924913.
9. ACR, 2008. ACR-SPR Practice Guideline for Imaging Pregnant or Potentially
Pregnant Adolescents and Women With Ionizing Radiation. Resolution 39,
(Amended 2014).
10. Agostinelli, S., Allison, J., Amako, K., Apostolakis, J., Araujo, H., Arce, P., Asai,
M., Axen, D., Banerjee, S., Barrand, G., et al., 2003. Geant4—a simulation toolkit.
11. Nuclear Instruments and Methods in Physics Research Section A: Accelerators,
Spectrometers, Detectors and Associated Equipment, 506(3), pp.250–303.
12. Allison, J., Amako, K., Apostolakis, J., Araujo, H., Dubois, P.A., Asai, M.,
Barrand, G., Capra, R., Chauvie, S., Chytracek, R., et al., 2006. Geant4

34
 developments and applications. IEEE Transactions on Nuclear Science, 53(1),
pp.270–278.
13. Avramova-cholakova, S., Vassileva, J., Borisova, R. &Atanasova, I., 2008. An
estimate of the influence of the measurement procedure on patient and phantom
doses in breast imaging. Radiation Protection Dosimetry, 129(1-3), pp.150–154.
14. Baró, J., Sempau, J., Fernández-Varea, J.M. &Salvat, F., 1995. PENELOPE: An
algorithm for Monte Carlo simulation of the penetration and energy loss of
electrons and positrons in matter. Nuclear Instruments and Methods in Physics
Research Section B: Beam Interactions with Materials and Atoms, 100(1), pp.31–
46.
15. Scan – Mayo Clinic". Mayoclinic.org. Archived from the original on 15 October
2016. Retrieved 20 October 2016.
16. "Patient Page". ARRT – The American Registry of Radiologic Technologists.
Archived from the original on 9 November 2014.
17. "Individual State Licensure Information". American Society of Radiologic
Technologists. Archived from the original on 18 July 2013. Retrieved 19 July 2013.
18. Battistoni, G., Cerutti, F., Fassò, a., Ferrari, a., Muraro, S., Ranft, J., Roesler, S. &
Sala, P.R., 2007. The FLUKA code: Description and benchmarking. AIP
Conference Proceedings, 896(May), pp.31–49.
19. BEIR, 2006. Committee to assess health risks from exposure to low levels of
ionizing radiation. Health risks from exposure to low levels of ionizing radiation.
BEIR VII., Washington, DC.
20. Birch, R. & Marshall, M., 1979. Computation of bremsstrahlung x-ray spectra and
comparison with spectra measured with a Ge(Li) detector. Phys. Med. Biol., 24,
pp.505–17.
21. Blaszak, M. a. &Juszkat, R., 2014. Monte Carlo simulations for assessment of
organ radiation doses and cancer risk in patients undergoing abdominal stent-graft
implantation. European Journal of Vascular and Endovascular Surgery, 48(1),
pp.23–28.

35
22. Boone, J.M., Cooper, V.N., Nemzek, W.R., McGahan, J.P. & Seibert, J.A., 2000.
Monte Carlo assessment of computed tomography dose to tissue adjacent to the
scanned volume. Medical Physics, 27(10), pp.2393–407.
23. Bostani, M., Mueller, J.W., McMillan, K., Cody, D.D., Cagnon, C.H., DeMarco,
J.J. & McNitt-Gray, M.F., 2015. Accuracy of Monte Carlo simulations compared
to in-vivo MDCT dosimetry. Medical Physics, 42(2), pp.1080–1086.
24. Brady, S.L. & Kaufman, R.A., 2012. Establishing a standard calibration
methodology for MOSFET detectors in computed tomography dosimetry. Medical
physics, 39(6), pp.3031–40.
25. Brenner, D.J., 2008. Effective dose: a flawed concept that could and should be
replaced. The British Journal of Radiology, 81(967), pp.521–523.
26. Brenner, D.J., 2010. Should we be concerned about the rapid increase in CT usage?
Reviews on environmental health, 25(1), pp.63–8.
27. Brenner, D.J., 2012. We can do better than effective dose for estimating or
comparing low-dose radiation risks. Annals of the ICRP, 41(3-4), pp.124–128.
28. Brenner, D.J., Doll, R., Goodhead, D.T., Hall, E.J., Land, C.E., Little, J.B., Lubin,
J.H., Preston, D.L., Preston, R.J., Puskin, J.S., et al., 2003. Cancer risks attributable
to low doses of ionizing radiation: assessing what we really know. Proceedings of
the
29. National Academy of Sciences of the United States of America, 100(24),
pp.13761–6.
30. Brenner, D.J. & Hall, E.J., 2007. Computed Tomography — An Increasing Source
of Radiation Exposure. New England Journal of Medicine, 357(22), pp.2277–2284.
31. Brink, J. a & Morin, R.L., 2012. Size-specific dose estimation for CT: how should
it be used and what does it mean? Radiology, 265(3), pp.666–8.
32. Buch, B., Fensham, R. & Maritz, M.P., 2009. An assessment of the relative safety
of dental x-ray equipment. SADJ : journal of the South African Dental Association
= tydskrif van die Suid-AfrikaanseTandheelkundigeVereniging, 64(8), pp.348–350.
33. Cassola, V.F. & Hoff, G., 2010. Comparative study of computational dosimetry
involving homogeneous phantoms and a voxel phantom in mammography : a

36
 discussion on applications in constancy tests and calculation of glandular dose in
patients. , 43(6), pp.395–400.
34. Christner, J. a., Braun, N.N., Jacobsen, M.C., Carter, R.E., Kofler, J.M. &
McCollough, C.H., 2012. Size-specific Dose Estimates for Adult Patients at CT of
the Torso. Radiology, 265(3), pp.841–7.
35. Ciraj-Bjelac, O., Beciric, S., Arandjic, D., Kosutic, D. & Kovacevic, M., 2010.
Mammography radiation dose: Initial results from Serbia based on mean glandular
dose assessmentfor phantoms and patients. Radiation Protection Dosimetry,
140(1), pp.75–80.
36. Cristy, M., 1980. Mathematical phantoms representing children of various ages for
use in estimates of internal dose. Nureg/Cr-1159, ORNL/Nureg/TM-367, pp.1–
110.
37. Cristy, M. &Eckerman, K., 1987. Specific absorbed fractions of energy at various
ages from internal photon sources. Report ORNL/TM-8381/V1., pp.1–100.
38. Dabin, J., Mencarelli, A., McMillan, D., Romanyukha, A., Struelens, L. & Lee, C.,
2016. Validation of calculation algorithms for organ doses in CT by measurements
on a 5 yearoldpaediatric phantom. Physics in Medicine and Biology, 61(11),
pp.4168– 4182.
39. Damilakis, J., Perisinakis, K., Tzedakis, A., Papadakis, A.E. &Karantanas, A.,
2010.
40. Radiation Dose to the Conceptus from Multidetector CT during Early Gestation: A
Method That Allows for Variations in Maternal Body Size and Conceptus Position.
Radiology, 257(2), pp.483–489.
41. Damilakis, J., Perisinakis, K., Voloudaki, a&Gourtsoyiannis, N., 2000. Estimation
of fetal radiation dose from computed tomography scanning in late pregnancy:
depthdose data from routine examinations. Investigative radiology, 35(9), pp.527–
533.
42. Damilakis, J., Tzedakis, A., Perisinakis, K. & Papadakis, A.E., 2010. A method of
estimating conceptus doses resulting from multidetector CT examinations during
all stages of gestation. Medical physics, 37(12), pp.6411–6420.

37
43. Dance, D.R., 1990. Monte Carlo calculation of conversion factors for the
estimation of mean glandular breast dose. Physics in medicine and biology, 35(9),
pp.1211–1219.
44. Dance, D.R., Skinner, C.L., Young, K.C., Beckett, J.R. &Kotre, C.J., 2000.
Additional factors for the estimation of mean glandular breast dose using the UK
mammography dosimetry protocol. Physics in medicine and biology, 45(11),
pp.3225–3240.
45. Dance, D.R., Young, K.C. & van Engen, R.E., 2011. Estimation of mean glandular
dose for breast tomosynthesis: factors for use with the UK, European and IAEA
breast dosimetry protocols. Physics in medicine and biology, 56(2), pp.453–471.
46. Deak, P., van Straten, M., Shrimpton, P.C., Zankl, M. &Kalender, W.A., 2008.
Validation of a Monte Carlo tool for patient-specific dose simulations in multi-slice
computed tomography. European Radiology, 18(4), pp.759–772.
47. Dietrich, M.F., Miller, K.L. & King, S.H., 2005. Determination of Potential
Uterine (Conceptus) Doses From Axial and Helical CT Scans. Health Physics,
88(suppl 1), pp.S10–S13.
48. Dietze, G., Harrison, J.D. &Menzeli, H.G., 2009. Effective dose: A flawed concept
that could and should be replaced. Comments on a paper by D J Brenner (Br J
Radiol2008;81:521-3). British Journal of Radiology, 82(976), pp.348–350.
49. Dimbylow, P., 2006. Development of pregnant female, hybrid voxel-mathematical
models and their application to the dosimetry of applied magnetic and electric
fields at 50 Hz. Physics in Medicine and Biology, 51(10), pp.2383–2394.
50. Dimbylow, P., 2005. Development of the female voxel phantom, NAOMI, and its
application to calculations of induced current densities and electric fields from
applied low frequency magnetic and electric fields. Physics in Medicine and
Biology, 50(6), pp.1047–1070.
51. Dimbylow, P.J., 1997. FDTD calculations of the whole-body averaged SAR in an
anatomically realistic voxel model of the human body from 1 MHz to 1 GHz.
Physics in Medicine and Biology, 42(3), pp.479–490.

38
52. Ding, A., Mille, M.M., Liu, T., Caracappa, P.F. & Xu, X.G., 2012. Extension of
RPI-adult male and female computational phantoms to obese patients and a Monte
Carlo study of the effect on CT imaging dose. Physics in Medicine and Biology,
57(9), pp.2441– 2459.
53. Doll, R. & Wakeford, R., 1997. Risk of childhood cancer from fetal irradiation.
The British Journal of Radiology, 70(830), pp.130–139.
54. Doshi, S.K., Negus, I.S. &Oduko, J.M., 2008. Fetal radiation dose from CT
pulmonary angiography in late pregnancy: A phantom study. British Journal of
Radiology, 81(968), pp.653–658.
55. Drexler, G., Panzer, W., Petoussi, N. &Zankl, M., 1993. Effective dose - how
effective for patients? Radiation and environmental biophysics, 32(3), pp.209–19.
56. European Commission, 2006. European guidelines for quality assurance in breast
cancer screening and diagnosis. In N. Perry, M. Broeders, C. De Wolf, S.
Törnberg, & L. Von Karsa, eds. Annals of oncology official journal of the
European Society for Medical Oncology ESMO. pp. 614–22.
57. European Commission, 1996. European Protocol on Dosimetry in Mammography.
EUR 16263, Luxembourg.
58. European Parliament, 2014. Council Directive 2013/59/Euratom of 5 December
2013 laying down basic safety standards for protection against the dangers arising
from exposure to ionising radiation, and repealing Directives 89/618/Euratom,
90/641/Euratom, 96/29/Euratom, 97/43/Euratom a. Off J EurCommun L13,
(December 2003), pp.1–73.
59. Felmlee, J.P., Gray, J.E., Leetzow, M.L. & Price, J.C., 1990. Estimated fetal
radiation dose from multislice CT studies. American Journal of Roentgenology,
154(1), pp.185–190.
60. Fisher, H.L.J. & Snyder, W.S., 1967. Distribution of dose in the body from a
source of gamma rays distributed uniformly in an organ. ORNL-4168.
61. Fisher, H.L.J. & Snyder, W.S., 1966. Variation of dose delivered by 137Cs as a
function of body size from infancy to adulthood. ORNL-4007.

39
62. Fitzgerald, M., 1989. The commissioning and routine testing of mammographic x-
ray systems topic group report 59. Institute of Physical Sciences in Medicine.
63. Goldberg-Stein, S., Liu, B., Hahn, P.F. & Lee, S.I., 2011. Body CT during
pregnancy:
64. Utilization trends, examination indications, and fetal radiation doses. American
Journal of Roentgenology, 196(1), pp.146–151.
65. Griglock, T.M., Sinclair, L., Mench, A., Cormack, B., Bidari, S., Rill, L. &
Arreola, M., 2015. Determining Organ Doses from CT with Direct Measurements
in Postmortem Subjects: Part 1—Methodology and Validation. Radiology, 277(2),
pp.463–470.
66. Gu, J., Bednarz, B., Caracappa, P.F. & Xu, X.G., 2009. The development,
validation and application of a multi-detector CT (MDCT) scanner model for
assessing organ doses to the pregnant patient and the fetus using Monte Carlo
simulations. Physics in Medicine and Biology, 54(9), pp.2699–2717.
67. Gu, J., George Xu, X., Caracappa, P.F. & Liu, B., 2013. Fetal doses to pregnant
patients from ct with tube current modulation calculated using monte carlo
simulations and realistic phantoms. Radiation Protection Dosimetry, 155(1), pp.64–
72.
68. Hall, E.J. & Brenner, D.J., 2008. Cancer risks from diagnostic radiology. British
Journal of Radiology, 81(965), pp.362–378.
69. Hamada, N. &Fujimichi, Y., 2014. Classification of radiation effects for dose
limitation purposes: History, current situation and future prospects. Journal of
Radiation Research, 55(4), pp.629–640.
70. Han, S., Lee, B., Shin, G., Choi, J., Kim, J., Park, C., Park, H., Lee, K. & Kim, Y.,
2012. Dose area product measurement for diagnostic reference levels and analysis
of patient dose in dental radiography. Radiation Protection Dosimetry, 150(4),
pp.523– 531.
71. Hart, D., Jones, D. & Wall, B., 1994a. Estimation of effective dose in diagnostic
radiology from entrance surface dose and dose-area product measurements. Report
NRPBR262, London: HMSO.

40