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Radiation exposure and protection in conventional pediatric radiology of thorax

Radiation protection depends on many factors that can be divided on the ground of technical and human factors that are both equally relevant for the radiation protection. To provide the best care for the young patients the effects of radiation should be minimized in accordance with ALARA (As Low As Reasonably Achievable) principle. Chest radiograms represent the basic radiological examination of thorax as they provide diagnostic information on the lung and heart status, and the skeletal system. To provide the best care for the young patients the effects of ionizing radiation should be minimized. Dosimetry is an indispensable part of every investigation related to the optimization and improvement of radiation protection. This study is dealing with the significance of different dosimetry systems that are applied in X-rays diagnostics, determination of doses received by patients and with the role of human factor during the radiological examination. Also the impact of ionizing radiation on cytogenetic status of children exposed to X-rays, since understanding the risks of low doses of radiation is an important aspect in the risk benefit analysis in pediatric populations. The study comprised child population that had a clinical indication for chest X-ray examination. Absorbed dose measurements were conducted on the forehead, thyroid gland, gonads, chest and back of the patients as well as on the phantom for radiological examinations of thorax. In this work doses were measured using various thermoluminescence (TL) and recently radiophotoluminescence (RPL) dosimetry systems. RPL and TL dosimeters were placed on the patients at the entrance of the beam in the centre of the X-ray field to measure the entrance dose. For comparison, during chest radiography, the dose in anthropomorphic child phantom was measured with TL dosimeters. The results on patients with both dosimetry systems showed a good correlation of measured dose. Also dose values on phantom were comparable with the results obtained on patients. If all technical malfunctions are excluded equal responsibility is on radiology technicians that are responsible for the patient’s dose. Depending on their education and experience, technicians perform X-ray examination with various end results. In this study doses measured by two technicians were in a good agreement, for the third one doses were significantly higher. Following the analysis of the dosimetry results and the education of the personal the doses measured on children for all of them were in very good agreement and lower than before education. For the cytogenetic monitoring comet assay and micronucleus test were applied as a sensitive biomarkers for the detection of DNA damage and chromosomal instability after irradiation. Results demonstrated that there is significant potential of inducing genetic instability with even the low level diagnostic X-ray procedures. Radiological examination of children is extremely significant since it stands for the sole and most accurate investigation method. Radiation protection depends on many factors and a suitable cooperation of all medical doctors especially radiologists would be recommended. In conclusion, this work shows the importance of continues education and good teamwork for dose reduction to minimize the potential damage and maintain the optimal benefit for the young patients.

radiation exposure, radiation protection, pediatric radiology, dosimetry systems, TLD, RPL, genomic instability, comet assay, micronucleus assay, ALARA

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