Vesna Ilakovac

Survey of mammography practice in Croatia: equipment performance, image quality and dose

A national audit of mammography equipment performance, image quality and dose has been conducted in Croatia. Film-processing parameters, optical density (OD), average glandular dose (AGD) to the standard breast, viewing conditions and image quality were examined using TOR(MAM) test object. Average film gradient ranged from 2.6 to 3.7, with a mean of 3.1. Tube voltage used for imaging of the standard 45 mm polymethylmethacrylate phantom ranged from 24 to 34 kV, and OD ranged from 0.75 to 1.94 with a mean of 1.26. AGD to the standard breast ranged from 0.4 to 2.3 mGy with a mean of 1.1 mGy. Besides clinical conditions, the authors have imaged the standard phantom in the referent conditions with 28 kV and OD as close as possible to 1.5. Then, AGD ranged from 0.5 to 2.6 mGy with a mean of 1.3 mGy. Image viewing conditions were generally unsatisfying with ambient light up to 500 lx and most of the viewing boxes with luminance between 1000 and 2000 cd per m(2). TOR(MAM) scoring of images taken in clinical and referent conditions was done by local radiologists in local image viewing conditions and by the referent radiologist in good image viewing conditions. Importance of OD and image viewing conditions for diagnostic information were analysed. The survey showed that the main problem in Croatia is the lack of written quality assurance/quality control (QA/QC) procedures. Consequently, equipment performance, image quality and dose are unstable and activities to improve image quality or to reduce the dose are not evidence-based. This survey also had an educational purpose, introducing in Croatia the QC based on European Commission Guidelines.

Medical Informatics in Croatia - a Historical Survey

A historical survey of medical informatics (MI) in Croatia is presented from the beginnings in the late sixties of the 20th century to the present time. Described are MI projects, applications in clinical medicine and public health, start and development of MI research and education, beginnings of international cooperation, establishment of the Croatian Society for MI and its membership to EFMI and IMIA. The current status of computerization of the Croatian healthcare system is sketched as well as the present graduate and postgraduate study MI curricula. The information contained in the paper shows that MI in Croatia developed and still develops along with its advancement elsewhere.

Acute Postoperative Pain in Trauma Patients - The Fifth Vital Sign

AIM: To determine average pain intensity perceived by trauma patients at hospital admission, lowest and highest pain intensity during their hospitalisation and their satisfaction with provided pain treatment. PATIENTS AND METHODS: The research included 114 operated patients at the Clinical Department of Trauma Surgery. We used the standard Numerical Rating Scale (NRS) for a clinical measure of pain. RESULTS: The average pain intensity at hospital admission was NRS median 7 (range 4–10), the severest perceived rate of pain during hospitalisation was NRS median 5 (range 4–7). Ninety-four percent of our respondents were satisfied with provided pain treatment. Thirty-two percent of patients were not asked to assess their pain during their hospitalisation, and 40.4% of patients assessed their pain occasionally. CONCLUSION: Female patients, as well as patients admitted to the emergency department, reported higher NRS scores. Those respondents who perceived severe pain answered more often that medical staff didn’t ask them to assess their pain on any occasion. Good communication between medical staff and patients, together with adequate assessment and evaluation of acute pain are of great importance in its treatment.