Diagnostic reference levels for hysterosalpingography studies at three centres in Kampala, Uganda

Abstract

Introduction: Studies show an increase in infertility across the world and increasing use of Hysterosalpingography studies to investigate this problem. However this study like many other fluoroscopic studies is associated with radiation dose exposure to the ovaries of women in the reproductive age group. Ovaries of young women are known to be more sensitive to radiation compared to other body parts. Diagnostic Reference Levels (DRLs) are useful tools used to identify unusually high radiation doses for radiological examinations so that corrective action can be taken. International bodies recommend the use of DRLs to help regulate radiation doses to patients without compromising image quality. Every Health Unit should ideally have its own DRLs for commonly performed imaging procedures and the established DRLs should be reviewed every five years. Studies have reported a reduction of about 30% in the mean doses of radiation doses received by patients in countries that have established and used DRLs. Uganda like many countries in Africa has not established DRLs for common radiological examinations. Objective: To determine Local Diagnostic Reference Levels for hysterosalpingography studies at three Health Units in Kampala Uganda. Methodology: This was a cross sectional, descriptive and analytical study for female patients in the age group of 18-49 years undergoing HSG studies at three Study Centers. A total of 90 patients were recruited from the three Health Units. Thirty patients were recruited from each facility. Systemic random sampling was used to select thirty (30) patients from each of the three Health Units. Entrance Skin Dose and Dose Area Product which represented patient radiation doses were derived from calculations using accepted formulas. Results: The overall median Kerma Area Product (DAP) for HSG was 1.77 Gycm2 and its 75th percentile of 2.05 Gycm2 is the local DRL for the three Study Centers. Conclusion: The Local DRL for the three Study Centers of 2.05 Gycm2 was comparable to the national DRL for UK of 1.9 Gycm2. Recommendation: Different Imaging Centres should develop their own local procedure protocols which are Uganda patient dose tailored.