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In Germany the x-rays were discovered by Wilhelm Roentgen in 1895 and in 1905 he was awarded the Nobel Prize in recognition of his contributions to physics. After this discovery, the new x-ray technology was rapidly applied in clinical medicine. There is no published information documenting the starting use of ionizing radiation in diagnosis in Saudi Arabia, but in 1950 it began to pay attention to safety & health and established the first Public Health Department in Makah. This was followed by establishing the first hospital of King Saud in Riyadh as early as 1956 (1).
Since 1896 the x-ray in the United States was rapidly applied in clinical medicine and the number of radiologic examinations increased about tenfold between 1980 and 2006 (2). The availability of x-ray technology and the volume of medical imaging can vary extensively from country to country, however, in Saudi Arabia the growing of x-ray technology was increased and potentially increase the radiation dose received by the patients and this has concerned physicians and radiation physicists, as well as regulatory bodies such as the National Center for Radiation Protection (SNCRP) in King Abdul-Aziz City for Science and Technology (KACST).
The relation between the growing of x-ray technology and increasing the dose have also intensified the question of justification and knowledge of physicians about patient dose during radiological examinations. To name a few, the study in Swedish evaluated that 20% of all multi-slice CT performed in Sweden may not be justified (3). On the other hand, two studies estimating the awareness of physicians and they have revealed a lack of knowledge about the hazards of radiological examinations on their health and on their patients (4, 5).
Increasing the dose for patients with the growing of x-ray technology prompted the International Commission on Radiological Protection (ICRP) in 1990 to mention using of diagnostic reference levels (DRLs) as benchmarks for radiation protection and optimization of patient imaging (6) performed in the local area, country or region where they are applied. DRLs should be set the median doses representing typical practice for a patient group for a specific type of examination.
In 1996, the ICRP defined two principles govern the professional use of radiation sources: optimization and justification of radiology examinations. Optimization implies that the exposure of the individuals and of the population should preserve as low as reasonably achievable (ALARA). On the other hand, Justification implies that every human activity involving patient exposure should be justified by the advantages that can give (7).
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