Establishment of local diagnostic reference levels in terms of dose area product (DAP) in conventional radiology at the Regional Hospital Center of Souss Massa, Morocco

Introduction: The effectiveness of diagnostic reference levels (DRLs) in reducing the doses delivered to patients has been demonstrated. Establishing DRLs in terms of the dose surface product (DSP) is an essential step in the management of radiation doses in conventional radiology. Objective: This retrospective study aimed to assess local diagnostic reference levels (LDRLs) for four types of X-ray examinations in terms of DAP at the Regional Hospital Center of Souss Massa. Materials and methods: Data from 120 adult patients, 30 per location (thorax (PA), pelvis (AP), lumbar spine (AP) and abdomen (AP)) were collected. Patient parameters such as gender, age, BMI, clinical indications, and examination acquisition parameters such as kV, mAs, patient source distance (PSD), and exposure field dimensions were recorded for each patient. The calculation of DRLs is based on a statistical method known as the 75th percentile of the distribution of DAP. The data were statistically analysed by SPSS software V 21.0. Pearson’s parametric test was used to explore the relationship between the different quantitative variables. Results: The mean ESDs for the thorax (PA), lumbar spine (AP), abdomen (AP), and pelvis (AP) were 0.17, 2.55, 2.16, and 2.63 mGy, respectively. The mean DAP values for the thorax (PA), lumbar spine (AP), abdomen (AP), and pelvis (AP) were 16.53, 213.11, 230.55, and 265.19 cGy.cm2, respectively. The DRLs in terms of ESD for the thorax (PA), lumbar spine (AP), abdomen (AP), and pelvis (AP) were 0.17, 2.77, 2.64, 2.87 mGy, respectively. In terms of DAP, they were 16.58, 245, 291.83, and 300.45 cGy.cm2, respectively. The results show a significant relationship between DAP and tension, charge, and ESD for all examinations. In addition, there was a significant relationship between DAP and BMI for abdomen X-ray, and no significant relationship for the three other X-ray examinations. Conclusion: It is possible to reduce the dose delivered to patients in the Regional Hospital Center of Souss Massa through the continuous training of radiology workers, implementation of a quality assurance program for equipment, and institutionalization of DRL as an approach to reducing patient doses and health service costs.