Enhancing Nuclear Medicine Practice in Saudi Arabia: Advocating for Comprehensive Guidelines and Local Diagnostic Reference Levels.

INTRODUCTION:  Diagnostic reference levels (DRLs) were initially introduced by the International Commission on Radiation Protection (ICRP). It refers to the measured quantity of administered activity (MBq) in nuclear medicine imaging studies and is a type of investigation level. DRL is recommended to prevent excessive radiation exposure to patients while maintaining adequate image quality. It should not be implemented as a dose constraint or dose limit. The Saudi Food and Drug Authority (SFDA) is the primary government body responsible for reporting national diagnostic reference levels (NDRLs) for diagnostic medical imaging technologies in Saudi Arabia. Only NDRLs for computed tomography, general X-ray, and mammography have been published and enforced locally. This study aims to establish local DRLs for nuclear medicine imaging procedures at King Abdulaziz University Hospital, Saudi Arabia, preparing for compliance proof once required by local authorities. METHOD:  Data were collected from all machines, and six common protocols were studied, with data from 50 patients of standard body size for each identified protocol. The study was conducted retrospectively, and the 50th percentile was then calculated for each scan. RESULTS: Both protocols for renal scans administered the lowest doses to patients (130 MBq and 148 MBq), respectively. The highest dose administered to patients was found to be in bone scans (1110 MBq). CONCLUSION: The study establishes local DRLs for nuclear medicine imaging in our institution. Median activity dosages in renal, thyroid, and parathyroid imaging were comparable to locally and internationally published DRLs. However, they are higher in cardiac and bone imaging compared to local Saudi DRL and DRL in the European Union and the USA, likely due to the adopted protocols. These highlight the need for modifying the protocols to fulfill optimization efforts. These findings serve as a foundation for compliance with future regulatory requirements, ensuring patient safety and maintaining imaging quality in Saudi healthcare.

Accuracy of Ultrasound and Computed Tomography in Diagnosing Acute Cholecystitis Patients in a Tertiary Care Center in Saudi Arabia.

Background Acute cholecystitis (AC) is a gallbladder inflammatory disease often associated with gallbladder stones. It accounts for up to 5% of emergency department visits. The majority of patients present with pain in the right upper quadrant, Murphy's sign, and fever. Furthermore, Saudi Arabia has been noted to have a significant prevalence of AC. According to the 2018 Tokyo Guidelines, imaging is an essential element, combined with local and systemic evidence of inflammation, for a confirmed diagnosis of AC. The definitive therapy is conducted surgically by cholecystectomy either urgently or electively. However, there are insufficient studies that focus on the accuracy of imaging in diagnosing AC patients in Saudi Arabia. Objective The aim of this study is to assess the accuracy of ultrasound (US) versus computed tomography (CT) in diagnosing AC patients at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods and material A retrospective record review was conducted at KAUH during the period of June to July 2022. The study included 192 patients diagnosed with AC in the emergency department or outpatient department by US or CT or both and confirmed by laparoscopic cholecystectomy and histopathology between 2016 and 2022. Results The most common modality used was US (79.7%), followed by both US and contrast CT (10.9%). For CT, sensitivity was 81.3%, specificity was 62.5%, positive predictive value (PPV) was 59.1%, and negative predictive value (NPV) was 83.3%. For US, sensitivity was 37.9%, specificity was 81.7%, PPV was 50%, and NPV was 73.1%. A significant relationship was observed between both genders and high use of US (P = 0.0001). Conclusion We found that CT is more sensitive than US, while US is more specific in diagnosing AC.

Measurement of Occupational Eye and Thyroid Radiation Doses in Pediatric Interventional Cardiologists at a Tertiary Hospital.

Background Advances in imaging techniques have led to increased utilization of imaging devices in catheterization laboratories. Invasive surgical procedures for cardiac disorders have been largely replaced by fluoroscopic cardiac catheterization. With this increase, concerns and risks associated with exposure to ionizing radiation among interventional cardiologists are growing. This study aims to measure and compare the occupational doses to the eye lens and thyroid of pediatric interventional cardiologists during different procedures in the catheterization laboratory and its significance. Methodology In this study, cardiologists wore bandanas with attached dosimeters to measure the absorbed doses to the eyes and thyroid gland. The dosimeters were collected for reading. The procedure types were also collected. In addition, the total fluoroscopy time and tube voltage of the biplane machine were measured. SPSS version 23 (IBM Corp., Armonk, NY, USA) was used to analyze the data. The characteristics of the study sample were described using simple counts and percentages, whereas means and standard deviations were used for continuous variables. Statistical significance was set at p-values <0.05. Results A total of 93 procedures were evaluated. The mean absorbed doses for all 93 procedures in both eyes and thyroid were 0.09 mGy and 0.08 mGy, respectively. A significant difference was found between the left and right eye measurements (p = 0.034), with higher doses administered to the left eye. However, no significant difference was observed between the right and left thyroid doses (p = 0.281). Significant correlations were found between the eye and thyroid doses and the procedure type (p = 0.02 and p = 0.009, respectively). Conclusions A significant amount of radiation was measured in the measurements of both organs. In addition, radiation dose measurements varied between different types of procedures. Our current results indicate the importance and necessity of applying the radiation protection concept of dose optimization.

Motivators and barriers to research participation among medical students in Saudi Arabia.

Little is known about the obstacles medical students face when conducting research in Saudi Arabia. Moreover, the proportion of medical students in research has been unknown in our region compared to other regions. We sought to identify the barriers and motivators that influence undergraduate medical students in pursuing research. This was a cross-sectional study design, utilizing an online survey distributed through social media platforms from the 17th of December 2021 to the 8th of April 2022. The survey was distributed to four universities in Saudi Arabia. Participants' characteristics, details regarding involvement in research, and attitude towards research were collected. Frequency measures were used to characterize the demographics and chi-squared tests to determine associations. A total of 435 students were included in the final analysis. The highest proportion of students that responded were second year, followed by first year medical students. Less than half (47.6%) of medical students were involved in research. A significant correlation was revealed between the involvement in research and higher participants' Grade Point Average (GPA). The top three incentives for pursuing undergraduate research were "admission into residency programs" (44.8%), "interest in research" (28.7%), and "financial return" (10.8%). However, the top three limitations were "lack of time" (29.2%), "lack of mentoring" (16.8%), and "lack of interest in research" (14.7%). System-related barriers and motivators were the main reasons behind the involvement of medical students in research. Our study is a call for action to raise awareness among medical students about the importance of research and to provide solutions to overcome these barriers.

Environmental risk assessment associated with acidic volcanics in Egypt.

The present work aims to study gamma rays emitted by radionuclides such as 238U, 232Th and 40K from acidic Monqul volcanics. The studied volcanics are represented by a thick stratified lava flows interbanded with their pyroclastics. They are composed of thick lava flows of andesite and, to a lesser extent of basalt, and acidic volcanics including rhyolite and dacite. The average values of 238U, 232Th and 40K are (46 ± 24 Bq kg-1), (62 ± 11 Bq kg-1) and (1227 ± 318 Bq kg-1) in the rhyolite-dacite samples are greater than the worldwide average. The variation of radioactive bearing minerals observed inside granite faults produced the great amounts of radioactivity perceived in the samples. Calculating radiological risks is used to assess the public's radioactive risk from radionuclides revealed in the studied Rhyolite-dacite samples. The acceptable limit for excess lifetime cancer (ELCR) evaluations has been exceeded. As a result, Rhyolite-dacite are inappropriate for apply in building materials.