Diagnostic reference levels in Africa: a protocol for systematic review and meta-analysis.

Background: Despite its wide acceptance and recommendation as an essential tool for radiation exposure optimization and the increasing influx of high-technology imaging facilities, there is still a paucity of available data on the Diagnostic reference level (DRL) of ionizing radiation radiological examinations and its use in many African countries. Objectives: This review aims to evaluate published work on DRLs in Africa and to establish the status of DRL in common radiological examinations in Africa. Methods: The electronic databases, namely; Embase, PubMed, Scopus, Google Scholar, CINAHL, AJOL, and Web of Science, will be searched using a developed search strategy to include only published articles and survey studies retrieved in English from 1996 to December 2022. Information to be extracted will include the World Bank income level, World Bank geographical region, country of origin, research sponsorship, year of publication, age group of the patients, imaging modality, local/regional/national DRL, type of examination, study design, type of DRL quantity, and whether DRLs were established as the 75th percentile or mean of the median or mean of DRL quantity measured. Descriptive statistics will be formulated and a narrative synthesis of the information from selected studies measured. If required, we will include a subgroup analysis based on the income level of the countries, geographical regions, and year of publication. Results: This study will provide information on the status of diagnostic reference levels of common radiological examinations in Africa. Conclusion: The result of this study will be useful in healthcare policymaking and by the end-users of medical radiation facilities, thereby ensuring the optimization of radiation exposure in patients undergoing medical ionizing-radiation imaging.