Dusko Kosutic

Good reasons to implement quality assurance in nationwide breast cancer screening programs in Croatia and Serbia: Results from a pilot study

The purpose of this study is to investigate the need for and the possible achievements of a comprehensive QA programme and to look at effects of simple corrective actions on image quality in Croatia and in Serbia. The paper focuses on activities related to the technical and radiological aspects of QA. The methodology consisted of two phases. The aim of the first phase was the initial assessment of mammography practice in terms of image quality, patient dose and equipment performance in selected number of mammography units in Croatia and Serbia. Subsequently, corrective actions were suggested and implemented. Then the same parameters were re-assessed. Most of the suggested corrective actions were simple, low-cost and possible to implement immediately, as these were related to working habits in mammography units, such as film processing and darkroom conditions. It has been demonstrated how simple quantitative assessment of image quality can be used for optimisation purposes. Analysis of image quality parameters as OD, gradient and contrast demonstrated general similarities between mammography practices in Croatia and Serbia. The applied methodology should be expanded to larger number of hospitals and applied on a regular basis.

Mammography radiation dose: initial results from Serbia based on mean glandular dose assessment for phantoms and patients

The primary objective of this study is to investigate the actual mammography dose levels in Serbia and establish a baseline dose database for the future screening programme. The mean glandular dose (MGD) was assessed for standard size breast substituted by 45 mm polymethyl methacrylate (PMMA) phantom and imaged under typical clinical conditions at 30 screen-film mammography facilities. Average MGD was (1.9 +/- 1.0) mGy, with a range of 0.12-5.2 mGy. These results were used for the calculation of the initial diagnostic reference levels in mammography in Serbia, which was set to 2.1 mGy for a standard breast. At some facilities, high doses were observed and the assessed MGD was supplemented by a patient dose survey. MGD was measured for 53 women having a diagnostic mammography in cranio-caudal (CC) and mediolateral oblique (MLO) projections at the largest mammography facilities in Serbia. The parameters recorded were: age, compressed breast thickness, tube potential (in kV), tube loading (in mAs) and the MLO projection angle. The average MGD per image was 2.8 mGy for the CC projection and 4.3 mGy for the MLO projection. Dose to breast was compared with dose for PMMA phantoms of various sizes, assessed at the same facilities. The results have indicated that phantom dose values can assist in setting optimisation activities in mammography. Both phantom and patient dose values indicated unnecessary high doses in facilities with an extremely high mammography workload. For these facilities, urgent dose-reduction measures and follow-up actions were recommended.

A survey of patient doses from conventional diagnostic radiology examinations: first results from Serbia and Montenegro

Diagnostic reference levels provide framework to reduce variability. The aim of this study is to establish, for the first time, a baseline for national diagnostic reference levels in Serbia and Montenegro for the most common X-ray examination types. Measurements of patient dose using kerma-area product meter and entrance surface air kerma assessment were performed on at least ten patients for each examination type, in each of 16 randomly selected hospitals in Serbia and Montenegro, so that a total of 3,026 procedures for nine different examination categories were included in the survey. Exposure settings and individual data were recorded for each patient. Mean, median and third quartile values of patient doses are reported. Results have shown wide variation of mean hospital doses, with factor of four for barium enema to 23 for thoracic spine radiography. Entrance surface air kerma were compared with previously published diagnostic reference levels (DRL) proposed by Commission of European Communities (CEC). Doses for all studied examination types except chest radiography were within European DRL. The reasons for dose variation are discussed. Survey data are aimed to help in development of an on-going national quality assurance and quality control programme in diagnostic radiology. The findings emphasize the importance of regular patient dose measurement to ensure that patient doses are kept as low as reasonable achievable.

MAMMOGRAPHY PRACTICE IN SERBIA: EVALUATION AND OPTIMISATION OF IMAGE QUALITY AND THE TECHNICAL ASPECTS OF THE MAMMOGRAPHIC IMAGING CHAIN

The purpose of this work was to assess mammography practice in Serbia and its appropriateness for both diagnostic service and potential screening by implementing quality control (QC) protocol in three large teaching hospitals. Corrective actions were suggested, accordingly. In addition to technical aspects of QC, image quality was assessed using image grading before and after the introduction of corrective measures. The survey demonstrated considerable variations in technical parameters that affect image quality and patients doses. Average glandular doses ranged from 1.8 to 2.8 mGy, while reference optical density (OD) ranged from 1.0 to 2.6. Image grading resulted in a very high percentage of images with poor quality (12-70 % for cranio-caudal projection and 8-66 % for medio-lateral oblique projection). Main problems were associated with film processing, viewing conditions and OD control. Following introduction of corrective measures, the image grading results were improved in some hospitals, so the percentage of images without any remarks has been increased.

Radioactivity of mining sites of lead, zinc and phosphate ores in Serbia

Natural resources such as ores contain radioactive nuclides at various concentrations. Therefore it is important to investigate the radioactivity in these resources as well as in the soil at the locations of ore deposits. For that reason we conducted preliminary measurements in the soil samples taken from the locations of lead and zinc ore deposits in Bosilegrad and Raška and from the locations of phosphate ore deposits in Bosilegrad to estimate the environmental conditions prior to the ore excavation. The activity concentrations of radionuclides in soil, water and plant samples were determined by gamma spectrometry (HPGe detector, relative efficiency 23%). Results showed the presence of natural radionuclides 226Ra, 232Th, 40K, 235U, 238U as well as the produced radionuclide 137Cs (from the Chernobyl accident). Ambient gamma radiation dose rate in ground level air was also measured. In order to estimate the influence of subsequent mining on the working and living environment, radium equivalent (Raeq), external hazard index (Hex), external gamma absorbed dose rate () and annual effective dose (DE) were determined.

Comparison of different methods for shielding design in computed tomography.

The purpose of this work is to compare different methods for shielding calculation in computed tomography (CT). The BIR-IPEM (British Institute of Radiology and Institute of Physics in Engineering in Medicine) and NCRP (National Council on Radiation Protection) method were used for shielding thickness calculation. Scattered dose levels and calculated barrier thickness were also compared with those obtained by scatter dose measurements in the vicinity of a dedicated CT unit. Minimal requirement for protective barriers based on BIR-IPEM method ranged between 1.1 and 1.4 mm of lead demonstrating underestimation of up to 20 % and overestimation of up to 30 % when compared with thicknesses based on measured dose levels. For NCRP method, calculated thicknesses were 33 % higher (27-42 %). BIR-IPEM methodology-based results were comparable with values based on scattered dose measurements, while results obtained using NCRP methodology demonstrated an overestimation of the minimal required barrier thickness.

A radiological incident with a radioactive lightning rod source found in a vehicle used by film crewmembers: a case study

An overview of radiological incident involving radiation source from a lightning rod (152Eu/154Eu), together with dose estimation for individuals exposed to ionising radiation is given in the paper. The cause of the incident was an orphaned source from a lightning rod. The dose received by individuals was assessed using a retrospective dosimetry technique, based on the information on behaviour of individuals and results of dose rate measurements in the vicinity of the source. Several people have been exposed to relatively high dose rates for an extended period of time. The conservatively estimated cumulative dose values for two categories of individuals were 50 and 40 mSv, respectively, which are significantly higher than annual dose limit for public exposure of 1 mSv. The need to identify radioactive sources incorporated in radioactive lightning rods, to maintain control and accountability and to remove and dispose of them properly along with appropriate record keeping in Serbia was highlighted. These activities would reduce the probability of occurrence of radiation incidents in Serbia.

Patient Dosimetry and Image Quality in Conventional Diagnostic Radiology: A Practical Optimization Experience from a Serbian Hospital

The optimization of image quality vs. patient dose is an important task in medical imaging. Maximal validity of optimization has to be based on clinical images. Simultaneous measurement of patient dose levels and image quality assessment is used to investigate possibilities for dose reduction and maintain image quality. The survey was conducted in a general hospital performing more than 60000 images annually and representing typical Serbian practice. For five most frequent diagnostic projections patient exposure was measured using kerma area product meter. Image quality was assessed by experienced radiologists using “European Guidelines on Quality Criteria for Diagnostic radiographic Images”. Following examination types were included into the survey: chest PA, chest LAT, pelvis AP, lumbar spine AP, lumbar spine LAT and pelvis. Comparing actual radiographic technique with recommended technique in European Guidelines, modification of practice was proposed and implemented and image quality was re-assessed. At least 10 adult patients were followed for each projection, before and after corrective actions. Large dose saving without compromising diagnostic information were found for some examination types, showing that this simple method is very efficient dose reduction tool in conventional diagnostic radiology. Also, need for staff training and difficulties related to practical implementation of optimization methods in Serbia were discussed.

Patient Doses from Conventional Diagnostic Radiology Procedures in Serbia and Montenegro

Abstract The objective of this work is to assess the patient doses for most frequent X-ray examinations in Serbia and Montenegro. A total 491 procedures, for 11 different examination categories were analyzed. Using X-ray tube output data, entrance surface dose for each plane radiography was calculated, as well as effective dose for each patient. Except for chest PA examination, all estimated doses are less than stated reference levels for plane film examinations. For fluoroscopy examinations total kerma-area product was measured and contributions from fluoroscopy and radiography were assessed. The study of kerma-area product reference doses confirms that dose level for complex fluoroscopy investigations are closely related to technique and individual patient variation, in terms of fluoroscopy time and number of radiography exposures. Survey data are aimed to help in development of national quality control and radiation protection programme for medical exposures.