Estimation of the Entrance Surface Air Kerma, Patients Body Organ Doses and Effective Dose from Diagnostic X-Ray Examinations in Some Centres in Ibadan

Estimation of the Entrance Surface Air Kerma, Patients Body Organ Doses and Effective Dose from Diagnostic X-Ray Examinations in Some Centres in Ibadan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Estimation of the Entrance Surface Air Kerma, Patients Body Organ Doses and Effective Dose from Diagnostic X-Ray Examinations in Some Centres in Ibadan Eze King Onwukwe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6432698/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Entrance surface air kerma (ESAK), body organ dose (BOD), and effective dose (ED) from two hospitals/diagnostic centres in Ibadan, Oyo State, Nigeria for adult patients undergoing routine thorax posterior-anterior (PA) x-ray examination were assessed in this study. Materials and Methods A totally of 207 patients were carefully selected and considered for the study. CALDose_X 5.0 software program was used. The software makes use of the patients’ anthropometrical data, technical exposure parameters and the tube output of the X-ray machine. Results The estimated values of the ESAK in both centres were 0.258 mGy and 0.704 mGy, respectively. The skin recorded the highest BOD in both centres with 0.275 mGy in Hospital A and 0.717 mGy in Hospital B. Similarly, the whole body effective dose (ED) were also higher in Hospital B than Hospital A by a factor of 1.9. The effective dose recorded in Hospital A were below the value (0.04 mSv) reported in literatures for chest PA x-ray examination. Conclusion It was observed that the median values obtained for ESD in both centres are comparable with the established dose reference levels and the dose to male patients were higher than their female counterparts. Nevertheless, these results call for a quality assurance program (QAP) in diagnostic X-ray units in Nigerian hospitals. Entrance Surface Air Kerma Body Organ Dose Entrance Skin Dose Effective Dose PA Diagnostic X-ray Examination Figures Figure 1 Figure 2 Figure 3 Introduction Radiation has been known to impart a causal relationship to malignant growth for over 50 years (NCRPM, 2009). It has been perceived that ionizing radiation makes the most noteworthy commitment to man-made radiation dose and an estimation of over 90% of the all-out exposure of the populace to ionizing radiation originates from X-ray machine. One of the most often required diagnostic procedures utilized in clinical practice is chest X-ray assessment and it may likewise be actualized in screening programs for huge populaces with noteworthy impact on the aggregate dose (Salat and Nikodemova, 2008 ). Patient dose determination and optimization have gotten progressively topical lately in medical applications. Patient dosimetry is generally founded on the determination of the quantifiable dose quantities associated with the primary X-ray beam attributes, for example incident air kerma (INAK), entrance surface air kerma (ESAK) and kerma-area product (KAP). These quantities are utilized for the establishment of good clinical practice guidelines with the fundamental aim of optimizing the radiation protection of the patients. However, estimation of the absorbed dose in the organs and tissues of the patients are required for the radiation risk evaluation, subsequently, permitting to justify the radiological practice and to perform a comparative risk assessment (ICRU, 2005). Organ or tissue doses cannot be straightforwardly estimated in patients. There are two distinct ways to deal with the organ dose estimation: direct estimations in physical phantoms and computational methods. The calculation is considered to be a more practical approach because the measurements using physical phantoms are complicated and time-consuming (Golikov et al., 2018 ). The objective of radiation protection is to prevent or limit exposures that have no benefit; therefore, patient dose estimation is fundamental in radiation protection and quality assurance programs (Morgan, 1999 ). Radiologists always face the issue of attempting to limit patient exposure whenever possible, while still utilizing exposures that are sufficiently high to create images of good quality as to be able to provide a proper diagnosis. Regular control and dosimetry can support the doctor and physicist to guarantee that the dose received by patients who undergo diagnostic/interventional procedures following the ALARA (As Low As Reasonably Achievable) principle does not surpass the amount required to get great radiographic scan. In Nigeria, a few investigations on patient dosimetry have been done on the estimation of entrance skin doses to patients in four common diagnostic assessments by thermoluminescence dosimetry (TLD) (Obed et al., 2007 ). Notwithstanding, with few works on indirect method of patient dose measurement with respect to the machine parameters such as tube potential (KVp), tube current-time product (mAS), focus-film distance (FFD), focus-skin distance (FSD) and tube filtration and patient’s anthropometrical information (patient’s height, weight, age, gender, BMI and chest thickness for chest x-rays) calls for review. In addition, it is basic that, because of evolving equipment, imaging staff and the expansion in the number of cancer incidence in the country, a broad dose overview is important to find out the degree of patient dose and compliance with acceptable dose limit in Nigeria. Moreover, Nsikan and Obed ( 2012 ), assessed the doses received by patients during thorax posterior-anterior (PA) and right lateral (RLAT) X-ray examinations at the University Teaching Hospital Port Harcourt (UPTH), Rivers State, Nigeria using CALDose_X5 software program. The estimated ESD median values were 0.96 and 1.85 mGy for thorax posterior-anterior (PA) and right lateral (RLAT), respectively. The obtained results were comparable to the international reference dose levels, except for the PA projection of the thorax. Therefore, this research work is aimed at Estimating the Entrance Surface Air Kerma (ESAK), Patients Body Organ Doses (BOD) And Effective Dose (ED) from Diagnostic X-Ray Examinations in Some Centres in Ibadan. Achievement of this goal will go a long way in reducing patient dose in Nigeria through an appropriate feedback mechanism. Materials and Methods A total sample of 207 patients of the adults’ population within the age range of 20–80 years undergoing chest x-ray examinations were carefully considered for the study. One hundred and forty-seven (147) patients from Hospital A (53 males and 94 females) and 60 patients from Hospital B (33 males and 27 females). For each patient selected in each of the diagnostic centre considered in this study, the following patient’s anthropometrical data and machine parameters were recorded during exposure, namely; sex, age, weight, height, body mass index, chest thickness, focus-to-film distance, focus-to-skin distance, kVp and mAs. The patient’s chest thickness was estimated from FFD and FSD (FFD minus FSD) while the body mass index (BMI), were derived from weight/(height) 2 , which is a useful classification scheme for the size and shape of a person (Gibson, 1990 ). The data collection took place from the 19th of August to the 2nd of September, 2019. The model of x-ray machine used for the study in Hospital A, is Philips and was installed on February 2019, this implies that the machine was five months old at the time of this study. The tube head was manufactured on May 2018, with E7252X and 18E1501 as the model and serial numbers respectively, the transformer was manufactured on July 2018, with 180090 as the serial number, while the receptor with serial and model number J8-644515-1204 and PoxScan 4336WV4 respectively was manufactured on July 2018. The total filtration in the x-ray tube was 2mm Al. In Hospital B, the x-ray machine used was General Electric DX-300 with serial number SI-10-52-34786A and total tube filtration of 2mm Al. A window-based software CALDose X5.0 was utilized in the investigation. Kramer et al. ( 2008 ), created CALDose X, a software tool that provides the possibility of calculating incident air kerma (INAK) and entrance surface air kerma (ESAK), two significant quantities utilized in x-ray diagnosis, in view of the output of the x-ray machine. Also, the software uses conversion coefficients (CCs) to assess the committed dose to organs and tissues of the human body, the effective dose as well as the patient’s cancer risk for radiographic examinations. The CCs, ratios between organ or tissue absorbed doses and measurable quantities, have been calculated with the FAX06 and the MAX06 phantoms for 34 projections of 10 commonly performed x-ray examinations, for 40 combinations of tube potential and filtration ranging from 50 to 120 kVcp (60 to 150 KVcp for the current version used in this work) and from 2.0 to 5.0 mm Al, respectively, for various field positions, for 29 selected organs and tissues and simultaneously for the measurable quantities, INAK, ESAK and kerma area product (KAP). Based on the x-ray irradiation parameters defined by the user, CALDose X shows images of the phantom together with the position of the x-ray beam. By using true to nature voxel phantoms, CALDose X improves earlier software tools, which were mostly based on mathematical MIRD5-type phantoms, by using a less representative human anatomy (Hart et al., 1994 ). The patients’ anthropometrical data and exposure parameters were inputted into the software. Based on the x-ray output, the software estimates the INAK, ESAK and BSF, hence assessed the BODs using CCs and any of the first two quantities (the ESAK was used in this study) as show in table 1. The last dose quantity shown on the table is the ‘Weighted Male Whole Body Dose’. A similar quantity appears at the end of the corresponding list for the FAX06 phantom/patient. According to ICRP103 (ICRP 2007 ), the arithmetic mean (Eq. 1) of these two sex-specific weighted absorbed doses is the effective dose. $$\:\mathbf{E}=\left[\varvec{H}\right(\varvec{m}\varvec{a}\varvec{l}\varvec{e})+\varvec{H}(\varvec{f}\varvec{e}\varvec{m}\varvec{a}\varvec{l}\varvec{e}\left)\right]/2$$ E = - [∑ H (male + H (female)] ( 1) Results The mean (range) of patient’s anthropometric data and exposure parameters selected for the chest x-ray examinations are presented in Table 2. Table 3 is the descriptive dose statistics of the ESAK, Breasts, Lungs, ESD at 7.2cm×7.2cm, thyroid and Effective dose at the two centres. Table 4 and figure 1, is a comparison of the obtained ESD in this work with established reference doses in the UK (NRPB), IAEA, and UNSCEAR recommendation and with the results obtained by some researchers in Nigeria. Lastly, Table 5, figure 2 and 3, shows the comparison of the mean doses, anthropometrical data and exposure parameters for male and female patients in both centres. Table 3: Descriptive statistics of ESAK (mGy), dose to the Breasts (mGy), Lungs (mGy), ESD (mGy), dose to the Thyroid (mGy) and the Effective dose (mSv) at the centres Centres Min Max Median 1 st Quartile 3 rd Quartile Mean Std. D ESAK Hospital A 0.040 1.000 0.230 0.190 0.300 0.258 0.121 Hospital B 0.270 2.520 0.530 0.350 0.720 0.704 0.562 Breasts Hospital A 0.004 0.095 0.018 0.014 0.024 0.020 0.012 Hospital B 0.007 0.115 0.018 0.010 0.031 0.026 0.024 Lungs Hospital A 0.017 0.420 0.085 0.067 0.109 0.096 0.046 Hospital B 0.055 0.601 0.107 0.076 0.175 0.154 0.126 ESD Hospital A 0.042 1.041 0.239 0.198 0.312 0.275 0.125 Hospital B 0.272 2.593 0.537 0.354 0.734 0.717 0.577 Thyroid Hospital A 0.008 0.190 0.042 0.034 0.053 0.047 0.021 Hospital B 0.023 0.350 0.052 0.033 0.083 0.077 0.071 ED Hospital A 0.005 0.129 0.029 0.023 0.037 0.033 0.015 Hospital B 0.017 0.250 0.040 0.025 0.062 0.059 0.054 Table 5 Comparison of Mean ± Std. of the Results for Male and Female patients in both Centres PARAMETERS HOSPITAL A HOSPITAL B MALE FEMALE MALE FEMALE No of Patients 53 94 33 27 ESAK(mGy) 0.292 ± 0.117 0.240 ± 0.120 0.842 ± 0.648 0.536 ± 0.382 Breasts(mGy) 0.014 ± 0.006 0.024 ± 0.011 0.023 ± 0.023 0.029 ± 0.026 Lungs(mGy) 0.080 ± 0.032 0.105 ± 0.050 0.156 ± 0.141 0.153 ± 0.108 ESD(mGy) 0.303 ± 0.122 0.258 ± 0.124 0.858 ± 0.666 0.544 ± 0.390 Thyroid(mGy) 0.047 ± 0.019 0.047 ± 0.227 0.090 ± 0.083 0.060 ± 0.050 ED(mSv) 0.034 ± 0.013 0.032 ± 0.015 0.071 ± 0.062 0.044 ± 0.038 Age(Yrs) 49.113 ± 15.732 46.521 ± 15.027 44.445 ± 8.912 45.556 ± 9.819 FSD(cm) 131.434 ± 8.505 131.223 ± 9.154 165.515 ± 3.817 164.370 ± 3.894 FFD(cm) 151.887 ± 7.086 152.872 ± 8.875 187.576 ± 4.352 185.926 ± 5.007 KVp 125.000 ± 0.000 125.000 ± 0.000 80.242 ± 7.137 74.852 ± 6.643 mAS 1.368 ± 0.543 1.324 ± 0.661 14.182 ± 8.723 11.259 ± 6.279 Height(m) 1.701 ± 0.073 1.607 ± 0.071 1.734 ± 0.085 1.610 ± 0.060 Weight(Kg) 71.019 ± 13.862 69.149 ± 14.445 81.485 ± 13.103 77.148 ± 16.019 BMI (Kg/m 2 ) 24.461 ± 3.861 26.784 ± 5.282 27.042 ± 3.499 29.715 ± 5.599 Chest Thickness(cm) 20.453 ± 4.639 21.649 ± 4.949 22.061 ± 4.220 21.556 ± 5.964 Discussion From the result in Table 2. The tube potential ranged from 64.0–98.0 KVp in Hospital B and was constant (125.00 KVp) in Hospital A, while the current-time product (mAs) ranged from 0.20–5.10 mAs and 8.00–32.00 mAS in Hospital A, and Hospital B, respectively. It is observed that there is a wide variation in the selection of the technique factors for the same examination in the two facilities. Table 2 shows that the mean tube potential and tube loading factors, mAS of 77.82 KVp and 12.87 mAS was employed by a radiographer at Hospital B, while the radiographer at Hospital A maintained a constant mean potential of 125.00 KVp, with 1.34 mAS as the mean. These variations in the selected exposure factors could affect the dose of x-ray delivered by the machine (IAEA, 2004 ). For the optimisation of protection of the patient without compromising the diagnostic information required, it is recommended that high kVp and low mAs be selected (IAEA, 2004 ) as observed in Hospital A. This observation could be because the facility has experienced workers and it is a State-owned teaching hospital. The mean age (47.46 yrs and 44.95 yrs) of patients at Hospital A and Hospital B was below 50 yrs (in which 66.7 per cent is of age ≤ 50 yrs and 33.3 per cent is of age > 50 yrs all together) and ranges between 20–80 and 20–67 yrs, respectively. The mean weight recorded for all the patients was close to (70 ± 13kg) as recommended in the IAEA ( 2007 ). The heights ranged from 1.45–1.90 m for patients at Hospital A, and 1.48–1.92 m at Hospital B. The FFD used in both centres was varied between two constant numbers of 150.0 and 180.0 cm at Hospital A and 180.0 and 190.0 cm at Hospital B, with mean FSD of 131.30 cm and 165.00 cm, respectively. The BMI and Chest thickness at both centres ranged between 16.65–40.37 Kg/m 2 , 10.00–33.00 cm and 20.32–40.98 Kg/m 2 , 12.00–36.00 cm for patients at Hospital A and Hospital B, respectively. The high values of BMI and chest thickness recorded at Hospital B can be seen as the reason for variation in the exposure parameters used by the radiographer, such that the higher the BMI or chest thickness, the higher the KVp or mAs. Table 3 shows the descriptive dose statistics of the ESAK, Breasts, Lungs, Skin Entrance at 7.2cm×7.2cm, Thyroid and Effective dose at the two centres. The values obtained in Hospital B are higher than those obtained in Hospital A for all doses, these may be attributed to the high values recorded in KVp and mAS used at the centre and also due to the fact that the phantoms used in programming the software (CALDose X 5.0) are widely different from the real human anatomy of the patients undergoing the diagnostic procedure. The mean of the ESAK, absorbed dose to the breasts, the lungs, the thyroid, the skin entrance dose and the effective dose in Hospital A were lower than the values obtained in Hospital B. The values of the ESAK in both centres are 0.258 mGy and 0.704 mGy, respectively and are less than 0.946 mGy recorded by Nsikan and Obed ( 2012 ) for chest PA by a factor 3.7 and 1.3. The breasts received the minimum dose of 0.020 mGy and 0.026 mGy, respectively in both centres and are also less than the value obtained by Nsikan and Obed ( 2012 ) by a factor of 1.6 and 1.2. The values recorded in the lungs were also less than the value reported by the authors with a factor of 2.2 for Hospital A and 1.4 for Hospital B. The skin recorded the highest dose in both centres with 0.275 mGy in Hospital A and 0.717 mGy in Hospital B, and also less than the value reported by the authors, with a factor of 3.5 and 1.3 respectively. The variations in the above doses with those reported by Nsikan and Obed ( 2012 ), may be attributed to the wide difference in values recorded for mAS, FFD and BMI, such that the values recorded by the authors for mAS and FFD were higher than those recorded in this work and lesser for BMI. It may also be due to an increase in awareness of radiographer to the effect of the exposure parameter to the patient's dose. The thyroid was next to breasts in dose received by the patient's body organs for both centres while the whole body effective dose was also higher at Hospital B than Hospital A by a factor of 1.9. The effective dose recorded in Hospital A was below the value (0.04 mSv) recommended by ICRP (ICRP, 60; ICRP, 103), by a factor of 1.2, but the value recorded in Hospital B was higher than the recommended value by a factor of 1.5. Table 4 and Fig. 1, is a comparison of the obtained ESD in this work with established reference doses in the UK (NRPB), IAEA, and UNSCEAR recommendation and with the results obtained by some researchers in Nigeria. In this comparison, the value of the obtained ESD in the study of thorax examination for PA projection in Hospital B is higher than those of UK (NRPB), IAEA, UNSCEAR and Obed et al. ( 2007 ), but lesser than value recorded by Nsikan and Obed ( 2012 ), while the value recorded in Hospital A is in the same range with NRPB (2000), but lesser than those recorded by IAEA, UNSCEAR, Obed et al. ( 2007 ), and Nsikan and Obed ( 2012 ). The ESD for thorax PA recorded in Hospital B was found to be higher than UK and IAEA by a factor of 1.3. Table 5, Figs. 2 and 3, shows the comparison of the mean doses, anthropometrical data and exposure parameters for male and female patients in both centre. The average male doses were all higher than the average dose estimate of their female counterparts in both centre, except the dose to the breasts, which was a reverse case in both centre and the dose to the lungs at Hospital A. This can be attributed to the fact that females has more conspicuous breasts with large surface area than their male counterparts. In Fig. 3, the mean values of their anthropometrical data and exposure factors are almost at the same range in both centre. Nevertheless, there was a notable difference between the female parameters in both centre and likewise their male counterparts. In both case, Hospital B recorded the highest values, except in KVp where Hospital A had constant value of 125 KVp (but with low mAS, which accounted for their low records in absorbed doses). Conclusion An estimation of entrance surface air kerma (ESAK), body organ doses (BOD) and effective dose (ED) during diagnostic chest X-ray posterior-anterior projection examination of adult patients in Hospital A, and Hospital B, all in Ibadan, Oyo State, has been carried out. The patient's ESAK, BOD and ED values were observed to be consistent with the range of values in the existing knowledge. The ESD (median) values of the present study were compared with the reference levels in existing knowledge and the values obtained in the present study are mostly comparable. The ESD recorded in Hospital A for chest PA examinations was below the DRL of 0.35mGy. The range of FFD, mAS and BMI obtained in this work was moderately low when compared with those reported by Nsikan and Obed ( 2012 ). This accounted for lower values obtained on this present work to those obtained by the authors. The mean effective doses, when compared with those found in existing knowledge (ICRP, 60 and ICRP, 103), was lower for estimate obtained from Hospital A, and higher in the estimate obtained from Hospital B. Though the estimate obtained from Hospital B was in the range of those reported in some literature. This implies that the radiation risk to an average patient in the x-ray diagnostic centres included in this work is low and the risk to workers in the centres is generally low. However, the dose to male patients in both centre was higher than their female counterpart. The findings suggest that there is a serious need for a quality assurance program and monitoring aimed towards reducing patients' dose in Nigeria. This can be achieved by carrying out proper and consistent quality control, with constant monitoring by the regulatory bodies at intervals, also by proper training of the radiographers and technicians on the hazards of x-ray radiation and lastly, by performing diagnostic x-ray examinations with optimized exposure factors. This involves selection of high kV with low mAs. Declarations Acknowledgements The authors appreciate the co-operation of the patients, radiographers and the management of all the centres selected for the study. Also our appreciation goes to Prof. R. Kramer for providing us with the CALDose software program. Ethical Consideration for Postgraduate Research, Physics Department, University of Ibadan In keeping with research ethical requirements, immediately after the research proposal was approved, the researcher obtained an approval from the University Review Board. The University of Ibadan Physics department Review Board gave their clearance to this study. Participants gave their explicit verbal agreement and the research was done in conjunction with local authorities. Confidential and available exclusively to the study team, personal identifiers were protected at all times. The study followed all regulations set forth by the Nigerian National Health Research Ethics Committee (NHREC). Special care is taken to recognize the contributions of other researchers whose work was utilized in this study by providing proper citations for the relevant works and giving appropriate acknowledgment where due. All research papers, scientific journals, publications, and reports utilized in this study were properly cited and referenced, adhering to the university writing guidelines and recommendations. Considerations of ethics in health research include the appropriateness of the study's design, methods, funding, and reporting practices were all considered by the university as part of approval processes. References Gibson, R. S. (1990). 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Bethesda, MD: National Council on Radiation Protection and Measurements; Report No. 160. National Radiological Protection Board (NRPB, 2000) report R263, 1993. Radiation Exposure of the UK population. National Research Council (2005). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. The National Academies Press, Washington, DC page 267 – 312. Nsikan U.E. and Obed R.I. (2012).Doses Received by Patients during Thorax X-Ray Examinations. Iran J Med Phys, Vol. 9, No. 4, autumn 2012. Nsikan U.E. and Obed R.I. (2015). Assessment of Patients’ Entrance Skin Dose from Diagnostic X-ray Examinations at Public Hospitals of Akwa Ibom State, Nigeria. Iranian Journal of Medical Physics Vol. 12, No. 2, spring 2015, 93-100 Received: March 7, 2015; accepted: July 07, 2015 Obed, R.I., Ademola, A.K., Adewoyin, K.A and Okunade, O.A. (2007); Doses to Patients in Routine X-ray Examinations of Chest, Skull, Abdomen and Pelvis in Nine Selected Hospitals in Nigeria. Research Journal of Medical Sciences. 1(4), 209-214 Salat D. and Nikodemova D. (2008). Patient doses and image quality in digital chest radiology. Radiat. Prot. Dosim. 129: 147 - 149. UNSCEAR United Nations Scientific Committee on Effets of Atomic Radiation (1993). Sources and effects of ionising radiation. United Nation Scientific Committee on the Effects of Atomic Radiation. Report to the General Assembly. New York: United Nations. Table 1 and 2 Table 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6432698","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":445905710,"identity":"3cdcdb0d-9db9-4667-a033-564a95a654a6","order_by":0,"name":"Eze King Onwukwe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYHACZoYEGIOBwQaIGRsPkKIlDaSlgbAWJMZhMAuvFn7+w4cNHu6olTOXyDE25qk4b7e2/TDQlhqbaFxaJBuOJScknjlubDkjxziZ58zt5G1nEoFajqXlNuDQYnCwx/hAYtuxxA23c4wP57bdTjY7ANTC2HAYpxb7w/yfkbT8O5dsdv4hfi0GbDzMCYltNWAtybkNB+zMbhCwReIMm7FBYtsBY4P7z4qN/wA9ZnYDaEsCHr/w9x9+LPmzrU7O4MzhzZIzauzszc6nP3zwocYGpxYoOAxnJYJVJuBXDgJ1cJY9YcWjYBSMglEw0gAA/4hmynuhMi8AAAAASUVORK5CYII=","orcid":"","institution":"Nigerian Meteorological Agency, Nnamdi Azikiwe International Airport","correspondingAuthor":true,"prefix":"","firstName":"Eze","middleName":"King","lastName":"Onwukwe","suffix":""}],"badges":[],"createdAt":"2025-04-12 06:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6432698/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6432698/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81201086,"identity":"02267ed4-98f6-4cb5-8e4a-2a1220e599fd","added_by":"auto","created_at":"2025-04-23 11:17:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65775,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of ESDs (mGy) And Dose Reference Levels\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6432698/v1/6fc151e67627c00d9194f0ee.png"},{"id":81200462,"identity":"7e0064b5-bb1f-4dca-a19c-251d066df4da","added_by":"auto","created_at":"2025-04-23 11:09:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19306,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of Male/Female Patients Doses in Both Centres\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6432698/v1/6dc0412aa66f6cffb9b4047b.png"},{"id":81200463,"identity":"14028577-b308-42f4-9fb3-3335dbd6f0ba","added_by":"auto","created_at":"2025-04-23 11:09:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":39962,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of Patients Parameters in Both Centres\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6432698/v1/8419aec5dc64e3f17e5feaef.png"},{"id":96917346,"identity":"c424c1f1-545b-4e09-9283-9f4d4806b5e5","added_by":"auto","created_at":"2025-11-27 14:09:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1035994,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6432698/v1/86bd6f1a-f4dd-4952-b82c-4a9f8da1c5c1.pdf"},{"id":81200460,"identity":"0c7042b3-564d-4071-a93b-7e43a7ef6f2d","added_by":"auto","created_at":"2025-04-23 11:09:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18808,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6432698/v1/68efe08b24f1979420f2e7de.docx"},{"id":81200459,"identity":"2c1d4737-d6ad-45ec-a55b-bead87141d4d","added_by":"auto","created_at":"2025-04-23 11:09:40","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19683,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6432698/v1/09ad3d307bd4c5c5012cabf5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Estimation of the Entrance Surface Air Kerma, Patients Body Organ Doses and Effective Dose from Diagnostic X-Ray Examinations in Some Centres in Ibadan","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRadiation has been known to impart a causal relationship to malignant growth for over 50 years (NCRPM, 2009). It has been perceived that ionizing radiation makes the most noteworthy commitment to man-made radiation dose and an estimation of over 90% of the all-out exposure of the populace to ionizing radiation originates from X-ray machine.\u003c/p\u003e \u003cp\u003eOne of the most often required diagnostic procedures utilized in clinical practice is chest X-ray assessment and it may likewise be actualized in screening programs for huge populaces with noteworthy impact on the aggregate dose (Salat and Nikodemova, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePatient dose determination and optimization have gotten progressively topical lately in medical applications. Patient dosimetry is generally founded on the determination of the quantifiable dose quantities associated with the primary X-ray beam attributes, for example incident air kerma (INAK), entrance surface air kerma (ESAK) and kerma-area product (KAP). These quantities are utilized for the establishment of good clinical practice guidelines with the fundamental aim of optimizing the radiation protection of the patients. However, estimation of the absorbed dose in the organs and tissues of the patients are required for the radiation risk evaluation, subsequently, permitting to justify the radiological practice and to perform a comparative risk assessment (ICRU, 2005). Organ or tissue doses cannot be straightforwardly estimated in patients. There are two distinct ways to deal with the organ dose estimation: direct estimations in physical phantoms and computational methods. The calculation is considered to be a more practical approach because the measurements using physical phantoms are complicated and time-consuming (Golikov et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe objective of radiation protection is to prevent or limit exposures that have no benefit; therefore, patient dose estimation is fundamental in radiation protection and quality assurance programs (Morgan, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Radiologists always face the issue of attempting to limit patient exposure whenever possible, while still utilizing exposures that are sufficiently high to create images of good quality as to be able to provide a proper diagnosis. Regular control and dosimetry can support the doctor and physicist to guarantee that the dose received by patients who undergo diagnostic/interventional procedures following the ALARA (As Low As Reasonably Achievable) principle does not surpass the amount required to get great radiographic scan.\u003c/p\u003e \u003cp\u003eIn Nigeria, a few investigations on patient dosimetry have been done on the estimation of entrance skin doses to patients in four common diagnostic assessments by thermoluminescence dosimetry (TLD) (Obed et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Notwithstanding, with few works on indirect method of patient dose measurement with respect to the machine parameters such as tube potential (KVp), tube current-time product (mAS), focus-film distance (FFD), focus-skin distance (FSD) and tube filtration and patient\u0026rsquo;s anthropometrical information (patient\u0026rsquo;s height, weight, age, gender, BMI and chest thickness for chest x-rays) calls for review. In addition, it is basic that, because of evolving equipment, imaging staff and the expansion in the number of cancer incidence in the country, a broad dose overview is important to find out the degree of patient dose and compliance with acceptable dose limit in Nigeria.\u003c/p\u003e \u003cp\u003eMoreover, Nsikan and Obed (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), assessed the doses received by patients during thorax posterior-anterior (PA) and right lateral (RLAT) X-ray examinations at the University Teaching Hospital Port Harcourt (UPTH), Rivers State, Nigeria using CALDose_X5 software program. The estimated ESD median values were 0.96 and 1.85 mGy for thorax posterior-anterior (PA) and right lateral (RLAT), respectively. The obtained results were comparable to the international reference dose levels, except for the PA projection of the thorax.\u003c/p\u003e \u003cp\u003eTherefore, this research work is aimed at Estimating the Entrance Surface Air Kerma (ESAK), Patients Body Organ Doses (BOD) And Effective Dose (ED) from Diagnostic X-Ray Examinations in Some Centres in Ibadan. Achievement of this goal will go a long way in reducing patient dose in Nigeria through an appropriate feedback mechanism.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA total sample of 207 patients of the adults\u0026rsquo; population within the age range of 20\u0026ndash;80 years undergoing chest x-ray examinations were carefully considered for the study. One hundred and forty-seven (147) patients from Hospital A (53 males and 94 females) and 60 patients from Hospital B (33 males and 27 females). For each patient selected in each of the diagnostic centre considered in this study, the following patient\u0026rsquo;s anthropometrical data and machine parameters were recorded during exposure, namely; sex, age, weight, height, body mass index, chest thickness, focus-to-film distance, focus-to-skin distance, kVp and mAs. The patient\u0026rsquo;s chest thickness was estimated from FFD and FSD (FFD minus FSD) while the body mass index (BMI), were derived from weight/(height) \u003csup\u003e2\u003c/sup\u003e, which is a useful classification scheme for the size and shape of a person (Gibson, \u003cspan class=\"CitationRef\"\u003e1990\u003c/span\u003e). The data collection took place from the 19th of August to the 2nd of September, 2019.\u003c/p\u003e\n\u003cp\u003eThe model of x-ray machine used for the study in Hospital A, is Philips and was installed on February 2019, this implies that the machine was five months old at the time of this study. The tube head was manufactured on May 2018, with E7252X and 18E1501 as the model and serial numbers respectively, the transformer was manufactured on July 2018, with 180090 as the serial number, while the receptor with serial and model number J8-644515-1204 and PoxScan 4336WV4 respectively was manufactured on July 2018. The total filtration in the x-ray tube was 2mm Al. In Hospital B, the x-ray machine used was General Electric DX-300 with serial number SI-10-52-34786A and total tube filtration of 2mm Al.\u003c/p\u003e\n\u003cp\u003eA window-based software CALDose X5.0 was utilized in the investigation. Kramer et al. (\u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e), created CALDose X, a software tool that provides the possibility of calculating incident air kerma (INAK) and entrance surface air kerma (ESAK), two significant quantities utilized in x-ray diagnosis, in view of the output of the x-ray machine. Also, the software uses conversion coefficients (CCs) to assess the committed dose to organs and tissues of the human body, the effective dose as well as the patient\u0026rsquo;s cancer risk for radiographic examinations. The CCs, ratios between organ or tissue absorbed doses and measurable quantities, have been calculated with the FAX06 and the MAX06 phantoms for 34 projections of 10 commonly performed x-ray examinations, for 40 combinations of tube potential and filtration ranging from 50 to 120 kVcp (60 to 150 KVcp for the current version used in this work) and from 2.0 to 5.0 mm Al, respectively, for various field positions, for 29 selected organs and tissues and simultaneously for the measurable quantities, INAK, ESAK and kerma area product (KAP). Based on the x-ray irradiation parameters defined by the user, CALDose X shows images of the phantom together with the position of the x-ray beam. By using true to nature voxel phantoms, CALDose X improves earlier software tools, which were mostly based on mathematical MIRD5-type phantoms, by using a less representative human anatomy (Hart et al., \u003cspan class=\"CitationRef\"\u003e1994\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe patients\u0026rsquo; anthropometrical data and exposure parameters were inputted into the software. Based on the x-ray output, the software estimates the INAK, ESAK and BSF, hence assessed the BODs using CCs and any of the first two quantities (the ESAK was used in this study) as show in table 1. The last dose quantity shown on the table is the \u0026lsquo;Weighted Male Whole Body Dose\u0026rsquo;. A similar quantity appears at the end of the corresponding list for the FAX06 phantom/patient. According to ICRP103 (ICRP \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e), the arithmetic mean (Eq.\u0026nbsp;1) of these two sex-specific weighted absorbed doses is the effective dose.\u003c/p\u003e\n\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e$$\\:\\mathbf{E}=\\left[\\varvec{H}\\right(\\varvec{m}\\varvec{a}\\varvec{l}\\varvec{e})+\\varvec{H}(\\varvec{f}\\varvec{e}\\varvec{m}\\varvec{a}\\varvec{l}\\varvec{e}\\left)\\right]/2$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eE = - [\u0026sum; H (male\u0026thinsp;+\u0026thinsp;H (female)] (\u003c/strong\u003e1)\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean (range) of patient\u0026rsquo;s anthropometric data and exposure parameters selected for the chest x-ray examinations are presented in Table\u0026nbsp;2.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3 is the descriptive dose statistics of the ESAK, Breasts, Lungs, ESD at 7.2cm\u0026times;7.2cm, thyroid and Effective dose at the two centres.\u003c/p\u003e\n\u003cp\u003eTable 4 and figure 1, is a comparison of the obtained ESD in this work with established reference doses in the UK (NRPB), IAEA, and UNSCEAR recommendation and with the results obtained by some researchers in Nigeria.\u003c/p\u003e\n\u003cp\u003eLastly, Table 5, figure 2 and 3, shows the\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ecomparison of the mean doses, anthropometrical data and exposure parameters for male and female patients in both centres.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Descriptive statistics of ESAK (mGy), dose to the Breasts (mGy), Lungs (mGy), ESD (mGy), dose to the Thyroid (mGy) and the Effective dose (mSv) at the centres\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"590\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCentres \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003csup\u003est\u003c/sup\u003e Quartile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003csup\u003erd\u003c/sup\u003e Quartile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. D\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eESAK\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.040\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.230\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.190\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.258\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.121\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.270\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.520\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.530\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.350\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.720\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.704\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.562\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreasts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.095\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.115\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.026\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLungs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.420\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.085\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.067\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.109\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.096\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.055\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.601\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.107\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.076\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.175\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.154\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.126\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eESD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.239\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.198\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.312\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.275\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.125\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.272\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.593\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.537\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.354\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.734\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.717\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.577\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.190\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.053\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.350\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.052\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.083\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n 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\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.129\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.250\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.040\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.062\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.059\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.054\u003c/strong\u003e\u003c/p\u003e\n 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\"\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std. of the Results for Male and Female patients in both Centres\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePARAMETERS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHOSPITAL A\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHOSPITAL B\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMALE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFEMALE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMALE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFEMALE\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo of Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eESAK(mGy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.292\u0026thinsp;\u0026plusmn;\u0026thinsp;0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.240\u0026thinsp;\u0026plusmn;\u0026thinsp;0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.842\u0026thinsp;\u0026plusmn;\u0026thinsp;0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.536\u0026thinsp;\u0026plusmn;\u0026thinsp;0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreasts(mGy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.014\u0026thinsp;\u0026plusmn;\u0026thinsp;0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u0026thinsp;\u0026plusmn;\u0026thinsp;0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u0026thinsp;\u0026plusmn;\u0026thinsp;0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.029\u0026thinsp;\u0026plusmn;\u0026thinsp;0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLungs(mGy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.080\u0026thinsp;\u0026plusmn;\u0026thinsp;0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.105\u0026thinsp;\u0026plusmn;\u0026thinsp;0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.156\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.153\u0026thinsp;\u0026plusmn;\u0026thinsp;0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eESD(mGy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.303\u0026thinsp;\u0026plusmn;\u0026thinsp;0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.258\u0026thinsp;\u0026plusmn;\u0026thinsp;0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.858\u0026thinsp;\u0026plusmn;\u0026thinsp;0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.544\u0026thinsp;\u0026plusmn;\u0026thinsp;0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThyroid(mGy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.047\u0026thinsp;\u0026plusmn;\u0026thinsp;0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.047\u0026thinsp;\u0026plusmn;\u0026thinsp;0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.090\u0026thinsp;\u0026plusmn;\u0026thinsp;0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.060\u0026thinsp;\u0026plusmn;\u0026thinsp;0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eED(mSv)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u0026thinsp;\u0026plusmn;\u0026thinsp;0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u0026thinsp;\u0026plusmn;\u0026thinsp;0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.071\u0026thinsp;\u0026plusmn;\u0026thinsp;0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.044\u0026thinsp;\u0026plusmn;\u0026thinsp;0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(Yrs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.113\u0026thinsp;\u0026plusmn;\u0026thinsp;15.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.521\u0026thinsp;\u0026plusmn;\u0026thinsp;15.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.445\u0026thinsp;\u0026plusmn;\u0026thinsp;8.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.556\u0026thinsp;\u0026plusmn;\u0026thinsp;9.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFSD(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131.434\u0026thinsp;\u0026plusmn;\u0026thinsp;8.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131.223\u0026thinsp;\u0026plusmn;\u0026thinsp;9.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e165.515\u0026thinsp;\u0026plusmn;\u0026thinsp;3.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e164.370\u0026thinsp;\u0026plusmn;\u0026thinsp;3.894\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFFD(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e151.887\u0026thinsp;\u0026plusmn;\u0026thinsp;7.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152.872\u0026thinsp;\u0026plusmn;\u0026thinsp;8.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e187.576\u0026thinsp;\u0026plusmn;\u0026thinsp;4.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e185.926\u0026thinsp;\u0026plusmn;\u0026thinsp;5.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKVp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80.242\u0026thinsp;\u0026plusmn;\u0026thinsp;7.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74.852\u0026thinsp;\u0026plusmn;\u0026thinsp;6.643\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.368\u0026thinsp;\u0026plusmn;\u0026thinsp;0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.324\u0026thinsp;\u0026plusmn;\u0026thinsp;0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.182\u0026thinsp;\u0026plusmn;\u0026thinsp;8.723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.259\u0026thinsp;\u0026plusmn;\u0026thinsp;6.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeight(m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.701\u0026thinsp;\u0026plusmn;\u0026thinsp;0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.607\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.734\u0026thinsp;\u0026plusmn;\u0026thinsp;0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.610\u0026thinsp;\u0026plusmn;\u0026thinsp;0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight(Kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.019\u0026thinsp;\u0026plusmn;\u0026thinsp;13.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.149\u0026thinsp;\u0026plusmn;\u0026thinsp;14.445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81.485\u0026thinsp;\u0026plusmn;\u0026thinsp;13.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.148\u0026thinsp;\u0026plusmn;\u0026thinsp;16.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.461\u0026thinsp;\u0026plusmn;\u0026thinsp;3.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.784\u0026thinsp;\u0026plusmn;\u0026thinsp;5.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.042\u0026thinsp;\u0026plusmn;\u0026thinsp;3.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.715\u0026thinsp;\u0026plusmn;\u0026thinsp;5.599\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChest Thickness(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.453\u0026thinsp;\u0026plusmn;\u0026thinsp;4.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.649\u0026thinsp;\u0026plusmn;\u0026thinsp;4.949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.061\u0026thinsp;\u0026plusmn;\u0026thinsp;4.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.556\u0026thinsp;\u0026plusmn;\u0026thinsp;5.964\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eFrom the result in Table\u0026nbsp;2. The tube potential ranged from 64.0\u0026ndash;98.0 KVp in Hospital B and was constant (125.00 KVp) in Hospital A, while the current-time product (mAs) ranged from 0.20\u0026ndash;5.10 mAs and 8.00\u0026ndash;32.00 mAS in Hospital A, and Hospital B, respectively. It is observed that there is a wide variation in the selection of the technique factors for the same examination in the two facilities. Table\u0026nbsp;2 shows that the mean tube potential and tube loading factors, mAS of 77.82 KVp and 12.87 mAS was employed by a radiographer at Hospital B, while the radiographer at Hospital A maintained a constant mean potential of 125.00 KVp, with 1.34 mAS as the mean. These variations in the selected exposure factors could affect the dose of x-ray delivered by the machine (IAEA, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). For the optimisation of protection of the patient without compromising the diagnostic information required, it is recommended that high kVp and low mAs be selected (IAEA, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) as observed in Hospital A. This observation could be because the facility has experienced workers and it is a State-owned teaching hospital.\u003c/p\u003e \u003cp\u003eThe mean age (47.46 yrs and 44.95 yrs) of patients at Hospital A and Hospital B was below 50 yrs (in which 66.7 per cent is of age\u0026thinsp;\u0026le;\u0026thinsp;50 yrs and 33.3 per cent is of age\u0026thinsp;\u0026gt;\u0026thinsp;50 yrs all together) and ranges between 20\u0026ndash;80 and 20\u0026ndash;67 yrs, respectively. The mean weight recorded for all the patients was close to (70\u0026thinsp;\u0026plusmn;\u0026thinsp;13kg) as recommended in the IAEA (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). The heights ranged from 1.45\u0026ndash;1.90 m for patients at Hospital A, and 1.48\u0026ndash;1.92 m at Hospital B. The FFD used in both centres was varied between two constant numbers of 150.0 and 180.0 cm at Hospital A and 180.0 and 190.0 cm at Hospital B, with mean FSD of 131.30 cm and 165.00 cm, respectively. The BMI and Chest thickness at both centres ranged between 16.65\u0026ndash;40.37 Kg/m\u003csup\u003e2\u003c/sup\u003e, 10.00\u0026ndash;33.00 cm and 20.32\u0026ndash;40.98 Kg/m\u003csup\u003e2\u003c/sup\u003e, 12.00\u0026ndash;36.00 cm for patients at Hospital A and Hospital B, respectively. The high values of BMI and chest thickness recorded at Hospital B can be seen as the reason for variation in the exposure parameters used by the radiographer, such that the higher the BMI or chest thickness, the higher the KVp or mAs. Table\u0026nbsp;3 shows the descriptive dose statistics of the ESAK, Breasts, Lungs, Skin Entrance at 7.2cm\u0026times;7.2cm, Thyroid and Effective dose at the two centres. The values obtained in Hospital B are higher than those obtained in Hospital A for all doses, these may be attributed to the high values recorded in KVp and mAS used at the centre and also due to the fact that the phantoms used in programming the software (CALDose X 5.0) are widely different from the real human anatomy of the patients undergoing the diagnostic procedure. The mean of the ESAK, absorbed dose to the breasts, the lungs, the thyroid, the skin entrance dose and the effective dose in Hospital A were lower than the values obtained in Hospital B. The values of the ESAK in both centres are 0.258 mGy and 0.704 mGy, respectively and are less than 0.946 mGy recorded by Nsikan and Obed (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) for chest PA by a factor 3.7 and 1.3. The breasts received the minimum dose of 0.020 mGy and 0.026 mGy, respectively in both centres and are also less than the value obtained by Nsikan and Obed (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) by a factor of 1.6 and 1.2. The values recorded in the lungs were also less than the value reported by the authors with a factor of 2.2 for Hospital A and 1.4 for Hospital B. The skin recorded the highest dose in both centres with 0.275 mGy in Hospital A and 0.717 mGy in Hospital B, and also less than the value reported by the authors, with a factor of 3.5 and 1.3 respectively. The variations in the above doses with those reported by Nsikan and Obed (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), may be attributed to the wide difference in values recorded for mAS, FFD and BMI, such that the values recorded by the authors for mAS and FFD were higher than those recorded in this work and lesser for BMI. It may also be due to an increase in awareness of radiographer to the effect of the exposure parameter to the patient's dose. The thyroid was next to breasts in dose received by the patient's body organs for both centres while the whole body effective dose was also higher at Hospital B than Hospital A by a factor of 1.9. The effective dose recorded in Hospital A was below the value (0.04 mSv) recommended by ICRP (ICRP, 60; ICRP, 103), by a factor of 1.2, but the value recorded in Hospital B was higher than the recommended value by a factor of 1.5. Table\u0026nbsp;4 and Fig.\u0026nbsp;1, is a comparison of the obtained ESD in this work with established reference doses in the UK (NRPB), IAEA, and UNSCEAR recommendation and with the results obtained by some researchers in Nigeria. In this comparison, the value of the obtained ESD in the study of thorax examination for PA projection in Hospital B is higher than those of UK (NRPB), IAEA, UNSCEAR and Obed et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), but lesser than value recorded by Nsikan and Obed (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), while the value recorded in Hospital A is in the same range with NRPB (2000), but lesser than those recorded by IAEA, UNSCEAR, Obed et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), and Nsikan and Obed (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The ESD for thorax PA recorded in Hospital B was found to be higher than UK and IAEA by a factor of 1.3. Table\u0026nbsp;5, Figs.\u0026nbsp;2 and 3, shows the comparison of the mean doses, anthropometrical data and exposure parameters for male and female patients in both centre. The average male doses were all higher than the average dose estimate of their female counterparts in both centre, except the dose to the breasts, which was a reverse case in both centre and the dose to the lungs at Hospital A. This can be attributed to the fact that females has more conspicuous breasts with large surface area than their male counterparts. In Fig.\u0026nbsp;3, the mean values of their anthropometrical data and exposure factors are almost at the same range in both centre. Nevertheless, there was a notable difference between the female parameters in both centre and likewise their male counterparts. In both case, Hospital B recorded the highest values, except in KVp where Hospital A had constant value of 125 KVp (but with low mAS, which accounted for their low records in absorbed doses).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAn estimation of entrance surface air kerma (ESAK), body organ doses (BOD) and effective dose (ED) during diagnostic chest X-ray posterior-anterior projection examination of adult patients in Hospital A, and Hospital B, all in Ibadan, Oyo State, has been carried out. The patient's ESAK, BOD and ED values were observed to be consistent with the range of values in the existing knowledge. The ESD (median) values of the present study were compared with the reference levels in existing knowledge and the values obtained in the present study are mostly comparable. The ESD recorded in Hospital A for chest PA examinations was below the DRL of 0.35mGy. The range of FFD, mAS and BMI obtained in this work was moderately low when compared with those reported by Nsikan and Obed (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). This accounted for lower values obtained on this present work to those obtained by the authors. The mean effective doses, when compared with those found in existing knowledge (ICRP, 60 and ICRP, 103), was lower for estimate obtained from Hospital A, and higher in the estimate obtained from Hospital B. Though the estimate obtained from Hospital B was in the range of those reported in some literature. This implies that the radiation risk to an average patient in the x-ray diagnostic centres included in this work is low and the risk to workers in the centres is generally low. However, the dose to male patients in both centre was higher than their female counterpart. The findings suggest that there is a serious need for a quality assurance program and monitoring aimed towards reducing patients' dose in Nigeria. This can be achieved by carrying out proper and consistent quality control, with constant monitoring by the regulatory bodies at intervals, also by proper training of the radiographers and technicians on the hazards of x-ray radiation and lastly, by performing diagnostic x-ray examinations with optimized exposure factors. This involves selection of high kV with low mAs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreciate the co-operation of the patients, radiographers and the management of all the centres selected for the study. Also our appreciation goes to Prof. R. Kramer for providing us with the CALDose software program.\u003c/p\u003e\u003cp\u003e\u0026nbsp;Ethical Consideration for Postgraduate Research, Physics Department, University of Ibadan In keeping with research ethical requirements, immediately after the research proposal was approved, the researcher obtained an approval from the University Review Board. The University of Ibadan Physics department Review Board gave their clearance to this study. Participants gave their explicit verbal agreement and the research was done in conjunction with local authorities. Confidential and available exclusively to the study team, personal identifiers were protected at all times. The study followed all regulations set forth by the Nigerian National Health Research Ethics Committee (NHREC). Special care is taken to recognize the contributions of other researchers whose work was utilized in this study by providing proper citations for the relevant works and giving appropriate acknowledgment where due. All research papers, scientific journals, publications, and reports utilized in this study were properly cited and referenced, adhering to the university writing guidelines and recommendations. Considerations of ethics in health research include the appropriateness of the study\u0026apos;s design, methods, funding, and reporting practices were all considered by the university as part of approval processes.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGibson, R. S. (1990). Principles of nutritional assessment. New York: Oxford University Press: 178 \u0026ndash; 82.\u003c/li\u003e\n\u003cli\u003eGolikov, V., Barkovsky, A., Wallstrom, E., and Cederblad, A, (2018); A Comparative study of organ doses assessment for patients undergoing conventional x-ray examinations: phantom experiments vs. Calculations. Radiation Protection Dosimetry (2017), pp. 1\u0026ndash;12; doi:10.1093/rpd/ncx102\u003c/li\u003e\n\u003cli\u003eHart, D., Jones, D. G., \u0026amp; Wall, B. F. (1994). Normalised organ dose for medical x-ray examinations calculated using Monte Carlo techniques. NRPB-SR262. Health protection Agency, Chilton.\u003c/li\u003e\n\u003cli\u003eHart, D., Jones, D.G. and Wall, B.F. (1994). Estimation of effective dose in diagnostic radiology from entrance surface dose and dose-area product measurements. NRPB-R262 (Chilton: National Radiological Protection Board).\u003c/li\u003e\n\u003cli\u003eIAEA (2004). Optimization of radiological protection of patients undergoing radiography, fluoroscopy and computed tomography, a final report of coordinated research projects in Africa, Asia and Eastern Europe, IAEATECDOC-1423, Vienna\u003c/li\u003e\n\u003cli\u003eIAEA. (1996). International Basic Safety Standard for Protection against Ionizing Radiation and for the Safety of Radiation Sources. Safety Series No 115. IAEA: Vienna, Austria.\u003c/li\u003e\n\u003cli\u003eIAEA. (2007). Technical report series, no.457. Dosimetry in Diagnostic Radiology: An International Code of Practice, 330-334.\u003c/li\u003e\n\u003cli\u003eICRP (2001), Draft ICRP Report: Basic Anatomical and Physiological Data for Use in Radiological Protection: Reference Values, http://www.icrp.org/download_anatomical.htm\u003c/li\u003e\n\u003cli\u003eICRP, (2007) \u0026ldquo;Recommendations of the International Commission on Radiological Protection\u0026rdquo; ICRP Publication 103 Ann. ICRP 37 (2-3) Elsevier Science Ltd., Oxford.\u003c/li\u003e\n\u003cli\u003eICRU (2003). International Commission on Radiation Units and Measurements. Image quality in chest radiography. ICRU Report 70, ISBN 1473 \u0026ndash; 6691.\u003c/li\u003e\n\u003cli\u003eInternational Commission on Radiation Units and Measurements (2005). Patient dosimetry for X-rays used in medical imaging. ICRU Report No. 74, Bethesda, MD, USA \u003c/li\u003e\n\u003cli\u003eInternational Commission on Radiological Protection, (2000). Avoidance of Radiation Injuries from Medical Interventional Procedures ICRP Publication 85 Anal of ICRP, 30: 7 \u0026ndash; 57.ational Radiological Protection Board (NRPB) report R263, 1993. Radiation Exposure of the UK population \u0026ndash; 1993 Review (NRPB, Chilton, Didcot, UK).\u003c/li\u003e\n\u003cli\u003eKramer R, Khoury H, Vieira J. CALDose_X\u0026mdash;a software tool for the assessment of organ and tissue absorbed doses, effective dose and cancer risks in diagnostic radiology. Physics in medicine and biology. 2008; 53(22):6437.\u003c/li\u003e\n\u003cli\u003eMorgan, K. Z. (1999). Ionizing radiation: benefits versa risks. Health Phys. 77, 361\u0026ndash;372. \u003c/li\u003e\n\u003cli\u003eNational Council on Radiation Protection and Measurements (2009). Ionizing radiation exposure of the population of the United States. Bethesda, MD: National Council on Radiation Protection and Measurements; Report No. 160.\u003c/li\u003e\n\u003cli\u003eNational Radiological Protection Board (NRPB, 2000) report R263, 1993. Radiation Exposure of the UK population. \u003c/li\u003e\n\u003cli\u003eNational Research Council (2005). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. The National Academies Press, Washington, DC page 267 \u0026ndash; 312.\u003c/li\u003e\n\u003cli\u003eNsikan U.E. and Obed R.I. (2012).Doses Received by Patients during Thorax X-Ray Examinations. Iran J Med Phys, Vol. 9, No. 4, autumn 2012. \u003c/li\u003e\n\u003cli\u003eNsikan U.E. and Obed R.I. (2015). Assessment of Patients\u0026rsquo; Entrance Skin Dose from Diagnostic X-ray Examinations at Public Hospitals of Akwa Ibom State, Nigeria. Iranian Journal of Medical Physics Vol. 12, No. 2, spring 2015, 93-100 Received: March 7, 2015; accepted: July 07, 2015 \u003c/li\u003e\n\u003cli\u003eObed, R.I., Ademola, A.K., Adewoyin, K.A and Okunade, O.A. (2007); Doses to Patients in Routine X-ray Examinations of Chest, Skull, Abdomen and Pelvis in Nine Selected Hospitals in Nigeria. Research Journal of Medical Sciences. 1(4), 209-214 \u003c/li\u003e\n\u003cli\u003eSalat D. and Nikodemova D. (2008). Patient doses and image quality in digital chest radiology. Radiat. Prot. Dosim. 129: 147 - 149. \u003c/li\u003e\n\u003cli\u003eUNSCEAR United Nations Scientific Committee on Effets of Atomic Radiation (1993). Sources and effects of ionising radiation. United Nation Scientific Committee on the Effects of Atomic Radiation. Report to the General Assembly. New York: United Nations.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1 and 2","content":"\u003cp\u003eTable 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Entrance Surface Air Kerma, Body Organ Dose, Entrance Skin Dose, Effective Dose, PA Diagnostic X-ray Examination","lastPublishedDoi":"10.21203/rs.3.rs-6432698/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6432698/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eEntrance surface air kerma (ESAK), body organ dose (BOD), and effective dose (ED) from two hospitals/diagnostic centres in Ibadan, Oyo State, Nigeria for adult patients undergoing routine thorax posterior-anterior (PA) x-ray examination were assessed in this study.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eA totally of 207 patients were carefully selected and considered for the study. CALDose_X 5.0 software program was used. The software makes use of the patients\u0026rsquo; anthropometrical data, technical exposure parameters and the tube output of the X-ray machine.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe estimated values of the ESAK in both centres were 0.258 mGy and 0.704 mGy, respectively. The skin recorded the highest BOD in both centres with 0.275 mGy in Hospital A and 0.717 mGy in Hospital B. Similarly, the whole body effective dose (ED) were also higher in Hospital B than Hospital A by a factor of 1.9. The effective dose recorded in Hospital A were below the value (0.04 mSv) reported in literatures for chest PA x-ray examination.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIt was observed that the median values obtained for ESD in both centres are comparable with the established dose reference levels and the dose to male patients were higher than their female counterparts. Nevertheless, these results call for a quality assurance program (QAP) in diagnostic X-ray units in Nigerian hospitals.\u003c/p\u003e","manuscriptTitle":"Estimation of the Entrance Surface Air Kerma, Patients Body Organ Doses and Effective Dose from Diagnostic X-Ray Examinations in Some Centres in Ibadan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-23 11:09:35","doi":"10.21203/rs.3.rs-6432698/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"391b78fd-c71c-4f2b-9670-82d09a203892","owner":[],"postedDate":"April 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T13:53:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-23 11:09:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6432698","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6432698","identity":"rs-6432698","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}