Proposal of National Diagnostic Reference Levels for Selected General Radiography Procedures in Ghana

Background: Diagnostic reference levels (DRLs) are integral to optimizing the patient dose in diagnostic radiology, and yet data for low-and middle-income countries are limited. Here, we propose the first Ghanan national DRLs (NDRLs) for selected radiographic procedures, aiming to enhance dose standardization and patient safety. Materials and Methods: A nationwide cross-sectional dosimetry survey of 41 radiologic systems reviewed eight frequently performed examinations across 7,643 adult patients. An indirect method based on X-ray tube output measurements and technical exposure factors was used to evaluate entrance surface dose in those patients. The 75 th percentile of each facility’s median entrance surface dose for each examination/projection was proposed as the NDRL. The resulting NDRLs were compared with international NDRLs to assess dose variability and levels against global standards. Results and Discussion: The proposed NDRLs are chest posterior–anterior (PA, 0.36 mGy), chest lateral (LAT, 0.97 mGy), pelvis anterior–posterior (AP, 2.77 mGy), skull AP/PA (2.00 mGy), skull LAT (1.75 mGy), lumbar spine AP (3.64 mGy), lumbar spine LAT (7.12 mGy), and abdomen AP (2.44 mGy). Although doses sometimes varied across facilities, particularly in high-attenuation procedures such as lumbar spine LAT, the chest PA values aligned closely with the international references. The results highlight the need to optimize imaging protocols and equipment performance and to invest in modern imaging equipment with advanced dose reduction capabilities to augment patient dose optimization initiatives in Ghana. Conclusion: We propose Ghana’s first NDRLs for general radiography procedures to guide national dose optimization efforts. Implementing these NDRLs would help to standardize imaging protocols, minimize patient exposures, and bolster diagnostic efficacy. Ongoing collaboration between regulatory authorities, healthcare facilities, and researchers is essential to implement and ensure sustained improvements in patient radiologic safety.