OCCUPATIONAL DOSE ASSESSMENT IN INTERVENTIONAL CARDIOLOGY IN SERBIA.

The objective of this work is to assess the occupational dose in interventional cardiology in a large hospital in Belgrade, Serbia. A double-dosimetry method was applied for the estimation of whole-body dose, using thermoluminescent dosemeters, calibrated in terms of the personal dose equivalent Hp(10). Besides the double-dosimetry method, eye dose was also estimated by means of measuring ambient dose equivalent, H*(10), and doses per procedure were reported. Doses were assessed for 13 physicians, 6 nurses and 10 radiographers, for 2 consequent years. The maximum annual effective dose assessed was 4.3, 2.1 and 1.3 mSv for physicians, nurses and radiographers, respectively. The maximum doses recorded by the dosemeter worn at the collar level (over the apron) were 16.8, 11.9 and 4.5 mSv, respectively. This value was used for the eye lens dose assessment. Estimated doses are in accordance with or higher than annual dose limits for the occupational exposure.

A study to establish international diagnostic reference levels for paediatric computed tomography.

The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.

Radiation exposure to nuclear medicine staff involved in PET/CT practice in Serbia.

The purpose of this work is to evaluate the radiation exposure to nuclear medicine (NM) staff in the two positron emission tomography-computed tomography centres in Serbia and to investigate the possibilities for dose reduction. Dose levels in terms of Hp(10) for whole body and Hp(0.07) for hands of NM staff were assessed using thermoluminescence and electronic personal dosemeters. The assessed doses per procedure in terms of Hp(10) were 4.2-7 and 5-6 µSv, in two centres, respectively, whereas the extremity doses in terms of Hp(0.07) in one of the centres was 34-126 µSv procedure(-1). The whole-body doses per unit activity were 17-19 and 21-26 µSv GBq(-1) in two centres, respectively, and the normalised finger dose in one centre was 170-680 µSv GBq(-1). The maximal estimated annual whole-body doses in two centres were 3.4 and 2.0 mSv, while the corresponding extremity dose in the later one was 45 mSv. Improvements as introduction of automatic dispensing system and injection and optimisation of working practice resulted in dose reduction ranging from 12 up to 67 %.

Eye lens dosimetry in interventional cardiology: results of staff dose measurements and link to patient dose levels.

Workers involved in interventional cardiology procedures receive high eye lens dose if protection is not used. Currently, there is no suitable method for routine use for the measurement of eye dose. Since most angiography machines are equipped with suitable patient dosemeters, deriving factors linking staff eye doses to the patient doses can be helpful. In this study the patient kerma-area product, cumulative dose at an interventional reference point and eye dose in terms of Hp(3) of the cardiologists, nurses and radiographers for interventional cardiology procedures have been measured. Correlations between the patient dose and the staff eye dose were obtained. The mean eye dose was 121 µSv for the first operator, 33 µSv for the second operator/nurse and 12 µSv for radiographer. Normalised eye lens doses per unit kerma-area product were 0.94 µSv Gy⁻¹ cm⁻² for the first operator, 0.33 µSv Gy⁻¹ cm⁻² for the second operator/nurse and 0.16 µSv Gy⁻¹ cm⁻² for radiographers. Statistical analysis indicated that there is a weak but significant (p < 0.01) correlation between the eye dose and the kerma-area product for all three staff categories. These values are based on a local practice and may provide useful reference for other studies for validation and for wider utilisation in assessing the eye dose using patient dose values.

Radiation doses in cerebral perfusion computed tomography: patient and phantom study.

The purpose of this study was to investigate radiation doses in cerebral perfusion computed tomography (CT) examination. As a part of routine patient monitoring, data were collected on patients in terms of the skin dose and CT dose index (CTDIvol) and dose-length product (DLP) values. For the estimation of the dose to the lens a phantom study was performed. Dose values for skin and lens were below the threshold for deterministic effects. The results were also compared with already published data. For better comparison, the effective dose was also estimated. The values collected on patients were in the ranges 230-680 mGy for CTDI and 2120-2740 mGy cm for DLP, while the skin dose and estimated effective dose were 340-800 mGy and 4.9-6.3 mSv, respectively. These values measured in the phantom study were similar, while the doses estimated to the lens were 53 and 51 mGy for the right and left lens, respectively.

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.

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.