Radiological health assessment of infant milk in Erbil Governorate, Iraq.

In this research, the radioactivity caused by natural radionuclides (40 K, 232Th, and 226Ra) was evaluated in infant milk consumed in Erbil, Iraq. The measurements were performed using an HPGe gamma-ray spectrometer. The variation of activity concentrations in milk samples was (99.56-256.9 Bq kg-1) for 40 K, (BDL-0.53 Bq kg-1) for 232Th, and (0.27-5.59 Bq kg-1) for 226Ra, as determined by the results. The radiological parameters of Eing, Dorg, and ELCR were calculated and compared to international standards. The correlation between computed radiological hazard parameters and natural radionuclides was analyzed statistically using Pearson's correlation. Overall, the results indicate that infant milk consumption in Erbil is radiologically safe and that consumers of these brands of milk are unlikely to be directly exposed to radiological health risks.

Evaluation of natural radioactivity in soils of Konya (Turkey) and estimation of radiological health hazards.

Surface soil samples were collected from Konya, Turkey and natural activity concentrations were determined using the ɤ-ray spectroscopy system with HPGe detector. The activity concentrations of 226Ra, 232Th and 40K were found to vary from 14.07 ± 0.71 Bq kg-1 dw to 67.27 ± 1.62 Bq kg-1 dw, 10.19 ± 2.60 Bq kg-1 dw to 46.09 ± 0.76 Bq kg-1 dw and 107.87 ± 13.32 Bq kg-1 dw to 605.95 ± 11.34 Bq kg-1 dry weight (dw), respectively. The radiological hazard parameters such as Raeq, D, AEDE, ELCR, AGDE, Hex, Hin, and Iɤ evaluated the radiological risk for the public and environment. The mean values of D, AEDE and ELCR are lower than the world average value of 57 nGy h-1, 70 µSv y-1, 0.29 × 10-3 respectively. The activity concentration distribution maps of 226Ra, 232Th and 40K and the radiological maps of the radiological hazard parameters were plotted using the Surfer programme. Cluster analysis was carried out to indicate the similarity between the variables.

Chemical, biological, radiological, and nuclear mass casualty medicine: a review of lessons from the Salisbury and Amesbury Novichok nerve agent incidents.

On March 4, 2018, two casualties collapsed on a park bench in Salisbury, Wiltshire, UK. They were later discovered to have been the victims of an attempted murder using the Soviet-era Novichok class of nerve agent. The casualties, along with three further critically ill patients, were cared for in Salisbury District Hospital's Intensive Care Unit. Before the COVID-19 pandemic, the Salisbury and Amesbury incidents were the longest-running major incidents in the history of the UK National Health Service. This narrative review seeks to reflect on the lessons learned from these chemical incidents, with a particular focus on hospital and local organisational responses.

Fluoroless Ureteroscopy: Experience in More Than 100 Patients.

BACKGROUND: Ureteroscopy is becoming the primary treatment for ureteral stones. As a standard of care, ureteroscopy is performed under the supervision of fluoroscopy. Recent advances in endourological technology make the need for fluoroscopy questionable. OBJECTIVES: To summarize our experience with a no-fluoroscopy technique for selected cases of ureteral stones. METHODS: Patients were considered suitable for fluoroless ureteroscopy if they had one or two non-impacted stones, in any location in the ureter, 5-10 mm size, with a normal contralateral renal unit and no urinary tract infection. Procedures were performed using rigid scopes, nitinol baskets/forceps for stone retrieval, and Holmium:YAG laser for lithotripsy. Stents were placed per surgeon's decision. RESULTS: During an 18-month period, 103 patients underwent fluoroless ureteroscopy. In 94 patients stones were removed successfully. In six, the stones were pushed to the kidney and treated successfully on a separate session by shock wave lithotripsy. In three patients no stone was found in the ureter. In five patients, miniature perforations in the ureter were noted and an indwelling double J stent was placed. CONCLUSIONS: Fluoroless ureteroscopy resulted in a high rate of success. We believe that in selected cases it can be used with minimal adverse events.

The role of computed tomography scan in the diagnosis of COVID-19 pneumonia.

PURPOSE OF REVIEW: To summarize current literature evidence on the role of computed tomography (CT) scan in the diagnosis and assessment of coronavirus disease 2019 (COVID-19) pneumonia. RECENT FINDINGS: Recent guidelines on the use of CT scans in COVID-19 vary between countries. However, the consensus is that it should not be used as the first line; a notion supported by the WHO. Currently, several investigations are being used including reverse transcription PCR testing, chest radiographs, and ultrasound scans, and CT scans. They are ideally performed later during the disease process as the sensitivity and specificity are highest by that time. Typical COVID-19 features on CT scans vary but include vascular enlargement, ground-glass opacities, and ground glass opacification together with consolidation. SUMMARY: Since COVID-19 was declared as a global pandemic, there was a push towards identifying appropriate diagnostic tests that are both reliable and effective. There is a general agreement that CT scans have a high sensitivity but low specificity in diagnosing COVID-19. However, the quality of available studies is not optimal, so this must always be interpreted with the clinical context in mind. Clinicians must aim to weigh up the practicalities and drawbacks of CT scans when considering their use for a patient. The ease and speed of use of CT scans must be balanced with their high radiation doses, and infection control considerations.

Measuring Patient Preferences at the FDA Center for Devices and Radiological Health: Reflections and Projections.

OBJECTIVES: Patient preference information (PPI) is a way to incorporate the patient voice in the evaluation of medical devices. The US Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) has been working to encourage the voluntary inclusion of PPI throughout the medical device lifecycle for nearly a decade. This article reflects CDRH's efforts to encourage collection of PPI and offers perspectives on the future of PPI in the evaluation of medical devices. METHODS: CDRH regulatory guidance, public meetings, and collaborations relating to PPI were explored. RESULTS: Since 2012 when CDRH issued guidance on how PPI can be used as scientific evidence in the benefit-risk regulatory submission, CDRH has issued 5 subsequent guidance documents expanding on the use of PPI in medical device evaluations. CDRH remains committed to advancing the science and application of PPI in the medical device ecosystem through many collaborations with professional organizations, patient advocacy groups, and academic institutions. By hosting and actively participating in multiple scientific and regulatory public meetings and conferences, CDRH fosters a continuous learning environment where the experience of using PPI in regulatory submissions can be shared. A September 2020 meeting cosponsored by FDA and International Society for Pharmacoeconomics and Outcomes Research (ISPOR) discussed the state of PPI in regulatory applications and beyond. CONCLUSION: This article describes these pivotal events that have helped to increase the use of PPI in medical device evaluation as well as discusses future applications of PPI.

Diagnostic Imaging: Appropriate and Safe Use.

The use of diagnostic radiography has doubled in the past two decades. Image Gently (children) and Image Wisely (adults) are multidisciplinary initiatives that seek to reduce radiation exposure by eliminating unnecessary procedures and offering best practices. Patients with an estimated glomerular filtration rate less than 30 mL per minute per 1.73 m2 may have increased risk of nephropathy when exposed to iodinated contrast media and increased risk of nephrogenic systemic fibrosis when exposed to gadolinium-based contrast agents. American College of Radiology Appropriateness Criteria can help guide specific diagnostic imaging choices. Noncontrast head computed tomography is the first-line modality when a stroke is suspected. Magnetic resonance imaging stroke protocols and computed tomography perfusion scans can augment evaluation and potentially expand pharmacologic and endovascular therapy timeframes. Imaging should be avoided in patients with uncomplicated headache syndromes unless the history or physical examination reveals red flag features. Cardiac computed tomography angiography, stress echocardiography, and myocardial perfusion scintigraphy (nuclear stress test) are appropriate for patients with chest pain and low to intermediate cardiovascular risk and have comparable sensitivity and specificity. Computed tomography pulmonary angiography is the preferred test for high-risk patients or those with a positive d-dimer test result, and ventilation-perfusion scintigraphy is reserved for patients with an estimated glomerular filtration rate less than 30 mL per minute per 1.73 m2 or a known contrast allergy. Computed tomography with intravenous contrast is preferred for evaluating adults with suspected appendicitis; however, ultrasonography should precede computed tomography in children, and definitive treatment should be initiated if positive. Ultrasonography is the first-line modality for assessing right upper quadrant pain suggestive of biliary disease. Mass size and patient age dictate surveillance recommendations for adnexal masses. Imaging should not be performed for acute (less than six weeks) low back pain unless red flag features are found on patient history. Ultrasonography should be used for the evaluation of suspicious thyroid nodules identified incidentally on computed tomography.

Radiation Reduction Strategies in Pediatric Orthopaedics.

INTRODUCTION: Pediatric orthopaedic patients have the potential for significant radiation exposure from the use of imaging studies, such as computed tomography and bone scintigraphy. With the potential for long-term treatment, such as is required for scoliosis or osteogenesis imperfecta, patients are at even greater risk of radiation-induced carcinogenesis. DISCUSSION: Although an association between radiation and cancer risk is evident, causation is difficult to prove because comorbidities or genetic predispositions may play a role in the higher baseline rates of malignancy later in life. Efforts have been made over the years to reduce exposure using more modern imaging techniques and simple radiation reduction strategies. Educational efforts and clinical practice guidelines are decreasing the rate of computed tomography scan use in pediatrics. Although considerable work is being done on the development of radiation-free imaging modalities, imaging that uses ionizing radiation will, in the near term, be necessary in specific circumstances to provide optimal care to pediatric orthopaedic patients. CONCLUSION: Knowledge of the ionizing radiation exposure associated with commonly used tests as well as radiation-reduction strategies is essential for the optimal and safe care of pediatric orthopaedic patients.

Temporal Trends in X-Ray Exposure during Coronary Angiography and Percutaneous Coronary Intervention.

BACKGROUND: Percutaneous coronary intervention exposes patient and staff to ionizing radiation. Although staff only receive a small fraction of patient dose through scatter radiation, there are concerns about the potential health effects of repeated exposure. Minimizing both patient and occupational exposure is needed. OBJECTIVE: This article investigates patient and operator X-ray exposure over time in coronary intervention in relation to upgraded X-ray equipment, improved shielding, and enhanced operator awareness. MATERIALS AND METHODS: Data regarding irradiation time, patient dose, and patient characteristics were extracted from the Norwegian Registry for Invasive Cardiology (NORIC) for procedures performed from 2013 to mid-2019. Personal operator dosimetry records were provided by the Norwegian Radiation and Nuclear Safety Authority. Improved operator shielding and awareness measures were introduced in 2018. RESULTS: In the period 2013 through June 2019, 21499 procedures were recorded in our institution. Mean dose area product (DAP) for coronary angiography decreased 37% from 2981 µGy·m2 in 2013 to 1891 µGy·m2 in 2019 (p < 0.001). For coronary intervention, DAP decreased 39% from 8358 µGy·m2 to 5055 µGy·m2. Personal dosimetry data indicate a 70% reduction in operator dose per procedure in 2019 compared to 2013. The most pronounced reduction occurred after improved radiation protection measures were implemented in 2018 (-48%). CONCLUSIONS: This study shows a temporal trend towards considerable reduction in X-ray doses received by the patient and operator during cardiac catheterization. Upgraded X-ray equipment, improved shielding, and enhanced operator awareness are likely contributors to this development.

Diagnostic Imaging and Outcomes for Nonobstetric Surgery During Pregnancy.

A surgical disease occurring during pregnancy can present a diagnostic dilemma due to the desire to make a timely and accurate diagnosis within the constraints of limiting radiation exposure to the fetus. However, required diagnostic imaging should be pursued when indicated and attempts made to minimize the radiation dose by utilizing abdominal shielding and low-dose protocols when feasible. When surgery is indicated due to disease processes, treatment should not be altered or delayed due to pregnancy as the evidence for adverse pregnancy outcomes including early pregnancy loss and preterm delivery are overall of low quality due to substantial confounding by the disease process itself.

A Standardized Protocol for Cervical Spine Evaluation in Children Reduces Imaging Utilization: A Pilot Study of the Pediatric Cervical Spine Clearance Working Group Protocol.

BACKGROUND: Cervical spine injuries (CSI) have the potential to cause severe morbidity in children. Multiple imaging studies are used during evaluation of CSIs but come at a cost, both financially and in radiation exposure. To reduce resource utilization and radiation exposure, we implemented the Pediatric Cervical Spine Clearance Working Group (PCSCWG) standardized protocol (SP) for evaluating CSIs in children. METHODS: Children below 18 years old presenting with concern for CSI at a level 1 pediatric trauma center were reviewed before (July 2015 to May 2016) and after (November 2017 to June 2018) protocol implementation. Demographics, injuries, and imaging utilization were extracted. The primary outcomes were the proportion of patients cleared with clinical exam, and the proportion undergoing x-ray, computed tomography, or magnetic resonance image. The secondary outcome was the estimated difference in imaging charges based on the annual reduction in radiographic studies. RESULTS: During the study 359 children were evaluated for CSIs (248 pre-SP, 111 post-SP). Patients were similar with respect to age, injury severity score, and mechanism of injury. Protocol adherence was 87.4%. The prevalence of CSI was similar in the preprotocol and postprotocol cohorts (2.8% vs. 1.8%, P=0.567). Children treated after protocol implementation were significantly more likely to be cleared by clinical exam (15.3% vs. 43.2%, P<0.001). Significantly fewer children had x-rays (70.2% vs. 55.0%, P=0.005) and computed tomography scans (14.5% vs. 5.4%, P=0.013) in the postprotocol period. There was no difference in the utilization of magnetic resonance image (6.9% vs. 7.2%, P=0.904) or the proportion of children discharged with a cervical collar (10.1% vs. 12.6%, P=0.476). No patients in either group were found to have a previously undiagnosed injury at follow-up. The reduction in radiographic studies translates to an estimated annual reduction in imaging charges of $396,476. CONCLUSIONS: The PCSCWG protocol for evaluating CSIs reduced the number of radiographic studies performed and estimated imaging charges while reliably identifying CSIs.

Is pelvis x-ray essential in stable trauma patients? Step towards lowering the treatment cost.

OBJECTIVE: To determine the diagnostic accuracy of clinical examination in detecting pelvic fractures in patients with blunt trauma.. METHODS: The cross-sectional prospective study was conducted at Aga Khan University Hospital, Karachi, from January to June 2015, and comprised alert, awake blunt-trauma patients. Pelvis examination findings were compared to routine pelvic X-rays. SPSS 19 was used for data analysis.. RESULTS: Of the 133 patients, 122 (92%) were males. Overall mean age was 37 ±14.2 years. There were 14 (10%) patients who were true positives with pelvic fracture diagnosis on both clinical examination and pelvic X-ray, while 14 (10%) were false negative on examination. Clinical examination missed 2 patients with evidence of fracture on X-ray and were considered false positive. Besides, 103 (77.4%) patients were true negative as both clinical exam and X-ray showed no evidence of fracture. CONCLUSION: Omitting pelvic X-ray in the recommended protocol can avoid unnecessary financial burden and reduce undesirable radiation exposure..

CT scans to exclude spine fractures in children after negative radiographs may lead to increase in future cancer risk.

INTRODUCTION: National Institute for Health and Care Excellence guidelines recommend computed tomography (CT) scanning for children who fulfill the criteria of significant mechanism or focal spinal pathology. Resulting radiation might subsequently increase the risk of cancer. METHODS: Children with spinal CT scans and radiographs from August 2015 to July 2017 were reviewed retrospectively. Data were obtained from the formal radiology reports and case notes. The radiation exposure and risk of cancer were estimated. RESULTS: Thirty-five children had spine CT scans, and 757 spine radiographs were undertaken. Nine (25%) children had their spines scanned as a part of trauma series due to a severe mechanism of injury. Two patients (6%) had abnormalities in their radiographs prior to CT scans, and the rest were obtained to exclude injuries with negative radiographs. The mean radiation dose from CT scan was 20.3 (SD: 11.3) mSV. The relative risk of missing a spine fracture in a child with a normal radiograph was not statistically significant (RR1.14 95% CI 0.3-4.3 and P = 0.8), and the NNT for detecting a spine fracture with a normal radiograph with further CT scan was 56. The mean lifetime additional cancer risk with CT scan in this group was 0.37%. A significant (P < 0.0001) positive correlation between the radiation dose and increased cancer risk was found. CONCLUSION: Children with clinically suspected spinal fracture in the absence of red flag signs/symptoms and negative radiographs might be considered for alternative assessments or investigations to reduce the risk of CT-related radiation hazards.

Assessment of natural radioactivity in coals and coal combustion residues from a coal-based thermoelectric plant in Bangladesh: implications for radiological health hazards.

To study the level of radioactivity concentrations from a coal-based power plant (Barapukuria, Bangladesh) and to estimate the associated radiological hazards, coal and associated combustion residuals from the power plant were analyzed by gamma-ray spectrometry with high-purity germanium (HPGe) detector. The results reveal that the mean radioactivity (Bq kg-1) concentrations in feed coal samples are 66.5 ± 24.2, 41.7 ± 18.2, 62.5 ± 26.3, and 232.4 ± 227.2 for U-238, Ra-226, Th-232, and K-40, respectively, while in coal combustion residuals (CCRs), they are 206.3 ± 72.4, 140.5 ± 28.4, 201.7 ± 44.7, and 232.5 ± 43.8, respectively. With the exception of K-40, all the determined natural radionuclides are considerably higher in the investigated feed coal and associated combustion residues as compared with the world soil and world coal mean activities. On the average, CCRs contains 3.10-3.37 times more natural radionuclides than the feed coal, except for K-40. The radioactivity of fly ash and bottom ash is fractionated, and ratio ranges from 1.40 to 1.57. The mean values of the radiological hazard indices in the coal and their associated residuals are 153.1 and 446.8 Bq kg-1 for radium equivalent activity, 0.41 and 1.21 for the external hazard index, 70 and 200.1 nGy h-1 for the absorbed gamma dose rate, 0.09 and 0.25 mSv year-1 for the annual effective dose rate, and 3.0 × 10-4 and 8.6 × 10-4 Sv-1 for the excess lifetime cancer risk, respectively, most of which exceed the UNSCEAR-recommended respective threshold limits. The outcome of this study suggests a potential radiological threat to the environment as well as to the health of occupational workers and nearby inhabitants from the examined samples.

[Long-term results of dental health examinations of employees of industrial enterprises with hazardous working conditions]. / Otdalennye rezul'taty stomatologicheskoi dispanserizatsii rabotnikov promyshlennykh predpriyatii s opasnymi usloviyami truda.

The article analyzes the results of dental examination of employees with hazardous and normal working conditions in Atomenergomash enterprise with various dental care organization regimens and provides clear evidence of the effectiveness of serial attendances care in enterprise dental offices in terms of reduction in the dental treatment needs. Additional funding for departmental dental services was calculated by comparing the real cost of dental treatment and MHI tariffs allowing implementation of proposed dental care program.

Patient selection essential for computed tomography coronary angiography.

OBJECTIVE: Computed tomography coronary angiography (CTCA) has become a commonly used imaging modality in patients with suspected anginal symptoms but also in asymptomatic populations. This practice has raised concerns due to potential high radiation exposure in terms of adequate benefit to risk profile. DESIGN: Demographics and CTCA scan details were collected from a consecutive series of 586 patients referred to a single community radiology practice for a CTCA. RESULTS: Of the 586 patients, 271 (46.2%) were women. Mean age was 58.3 standard deviation (SD) 12.2, range 15-90 years, body mass index (BMI) 28.6 SD 5.9 kg/m(2), and heart rate 60 SD 10 beats per minute. Mean total radiation was 4.79 SD 3.45 mSv (range 0.64-31.34). The mean radiation exposure in the lowest quartile of BMI and heart rate were 3.01 SD 1.84 mSv and 3.95 SD 2.72 mSv, compared to the highest 7.32 SD 3.51 mSv and 6.20 SD 4.38 mSv (p for trend <0.0001 in both). CONCLUSION: The radiation exposure in this consecutive series of patients is low in general but patient selection for CTCA imaging appears to be paramount. Patients with a high BMI and especially with high heart rate receive a higher dose of radiation.

Comparison of DXA Scans and Conventional X-rays for Spine Morphometry and Bone Age Determination in Children.

Conventional lateral spine and hand radiographs are the standard tools to evaluate vertebral morphometry and bone age in children. Beside bone mineral density analyses, dual-energy X-ray absorptiometry (DXA) measurements with lower radiation exposure provide high-resolution scans which are not approved for diagnostic purposes. Data about the comparability of conventional radiographs and DXA in children are missing yet. The purpose of the trial was to evaluate whether conventional hand and spine radiographs can be replaced by DXA scans to diminish radiation exposure. Thirty-eight children with osteogenesis imperfecta or secondary osteoporosis or short stature (male, n=20; age, 5.0-17.0 yr) were included and assessed once by additional DXA (GE iDXA) of the spine or the left hand. Intraclass correlation coefficients (ICCs) were used to express agreement between X-ray and iDXA assessment. Evaluation of the spine morphometry showed reasonable agreement between iDXA and radiography (ICC for fish-shape, 0.75; for wedge-shape, 0.65; and for compression fractures, 0.70). Bone age determination showed excellent agreement between iDXA and radiography (ICC, 0.97). IDXA-scans of the spine in a pediatric population should be used not only to assess bone mineral density but also to evaluate anatomic structures and vertebral morphometry. Therefore, iDXA can replace some radiographs in children with skeletal diseases.

A safety radiation marker in the cardiac catheterization lab.

OBJECTIVE: Nowadays, in order to deal with cardiovascular disease, coronary angiography (CRA) is the best tool and gold standard for diagnosis and assessment. CRA inevitably exposes both patient and operator to radiation. The purpose of this study was to calculate the radiation exposure in association with the radiation absorbed by interventional cardiologists, in order to estimate a safety radiation marker in the catheterization laboratory. METHODS AND RESULTS: In 794 successive patients undergoing CRA and in three interventional cardiologists the following parameters were examined: radioscopy duration, radiation exposure during fluoroscopy, total radiation exposure and the number of stents per procedure. Every interventional cardiologist was exposed to 562,936 µGym2 of total radiation during CRA procedures, to 833,371 µGym2 during elective CRA + percutaneous coronary intervention (PCI) procedures and to 328,250 µGym2 during primary CRA + PCI. Hence, the total amount of radiation that every angiographer was exposed to amounted to 1,724,557.5 µGym2 (median values). During the same period, the average radiation that every angiographer absorbed was 15,253 while the average dose of radiation absorbed during one procedure was 0.06 mSv for each operator. Therefore, the ratio between radiation exposure and the radiation finally absorbed by every operator was 113:1 µGym2/mSv. CONCLUSIONS: The present study, indicating the ratio above, offers a safety marker in order to realistically estimate the dose absorbed by interventional cardiologists, suggesting a specified number of permitted procedures and an effective level of radiation use protection tools.

Reduction of Fluoroscopic Exposure Using a New Fluoroscopy Integrating Technology in a 3D-Mapping System During Pulmonary Vein Isolation With a Circular Multipolar Irrigated Catheter.

Pulmonary vein isolation (PVI) is a cornerstone therapy in patients with atrial fibrillation (AF). With increasing numbers of PVI procedures, demand arises to reduce the cumulative fluoroscopic radiation exposure for both the physician and the patient. New technologies are emerging to address this issue. Here, we report our first experiences with a new fluoroscopy integrating technology in addition to a current 3D-mapping system. The new fluoroscopy integrating system (FIS) with 3D-mapping was used prospectively in 15 patients with AF. Control PVI cases (n = 37) were collected retrospectively as a complete series. Total procedure time (skin to skin), fluoroscopic time, and dose-area-product (DAP) data were analyzed. All PVI procedures were performed by one experienced physician using a commercially available circular multipolar irrigated ablation catheter. All PVI procedures were successfully undertaken without major complications. Baseline characteristics of the two groups showed no significant differences. In the group using the FIS, the fluoroscopic time and DAP were significantly reduced from 571 ± 187 seconds versus 1011 ± 527 seconds (P = 0.0029) and 4342 ± 2073 cGycm(2) versus 6208 ± 3314 cGycm(2) (P = 0.049), respectively. Mean procedure time was not significantly affected and was 114 ± 31 minutes versus 104 ± 24 minutes (P = 0.23) by the FIS.The use of the new FIS with the current 3D-mapping system enables a significant reduction of the total fluoroscopy time and DAP compared to the previous combination of 3D-mapping system plus normal fluoroscopy during PVI utilizing a circular multipolar irrigated ablation catheter. However, the concomitant total procedure time is not affected. Thus, the new system reduces the radiation exposure for both the physicians and patients.

Overview of radiation dose to patients from medical X-ray examinations in Nigeria.

OBJECTIVES: Medical Imaging accounts for the largest radiation exposure of population from artificial sources of radiation. The radiation dose rcceivedby patients from iedicail x-ray examinations in Nigeria has shown large variations within and among diagnostic centers for similar examinations. This could be traced to lack of imaging protocols and on avalability of local/national diagnostic reference, levels. Hence, the need to assess the trend of radiation doseto patients from radiological practice in Nigeria. Methocls:Entrance surface doses(ESDs) reported by, Nigerian authors for common x-ray examinations from 2000 - 2014 were extracted from articles published in peer reviewed journals, analyzed and compared with ifiternationally recommended Diagnostic Reference Levels (DkLs). RESULTS: Among x-ray examinations, skull accounted for 32% followed by chest (22%), lumbar spine (13%), abdomen (12%), pelvis (8%), extremitics(8%), thorax and cervical spine(5%). The range of mean ESDs reported for various projections of x-ray examination are chest (2.28 - 3.70 mGy); Abdomen (4.42 - 7.22 mGy); Skull (3.81 - 5.19 mGy); Pelvis (5.93 mGy); Lumbar spine (5.73 - 10.98 mGy); Thorax (0.96 - 1.85 mGy); Cervical spine (1.45 - 1.49mGy) and Extremitics (0.31 -0.49 mGy). In this study, it was found that the mean ESDs received by patients from chest, skull and pelvis ex'aminations were higher than the published DRLs for similar x-ray examinations. CONCLUSION: The results of this study showed that to harmonize radiation protection of patients and improve radiological practice in Nigeria there is need for development of comprehensive national diagnostic reference levels.