Glandular doses and diagnostic reference levels (DRLs) for Saudi breast cancer screening programme (2012-2021).

The aim of this study was to report the diagnostic reference levels (DRLs) corresponding to different compressed breast thickness (CBT) ranges. To achieve this, mammographic examinations with 187,788 exposures were analysed. The mean average glandular (AGD) dose was calculated per view, examination, and center. Moreover, the DRL values corresponding to different CBT ranges were reported. The result of the mean AGD per view was found to be 1.36 mGy for craniocaudal (CC) and 1.54 mGy for Mediolateral oblique (MLO), while the mean AGD per examination for all women was 1.45 mGy. The DRL values corresponding to CBTs between 20 to 79 mm ranges were below 2 mGy. These results were from a population of mean age = 49 ± 8 years and mean CBT = 58 ± 8 mm, and was imaged with mean exposures of 29 ± 1 kVp and 74 ± 31 mAs, and a mean compression force of 135±37 N. In conclusion, good mammography practice has been shown, as DRL values are within the limits suggested by the international organizations.

The prevalence of harassment of diagnostic radiography and radiation therapy students whilst on clinical placement in the Republic of Ireland.

Objective: To determine if student radiographers and radiation therapists experience harassment (verbal, physical or sexual) while on clinical placement and their awareness of policies in place to report such incidents.Methods: An online questionnaire developed from the World Health Organisation's questionnaire on workplace violence in healthcare and the higher education authority (HEA) national survey of student experiences of sexual violence and harassment in Irish HEIs was used. Undergraduate and postgraduate diagnostic radiography and radiation therapy students in the Republic of Ireland to be included and have completed a minimum of four weeks of clinical placement. Our of 256 students, 98 filled out the survey.Results: Forty-one per cent (n = 40) of students reported experiencing at least one incident of harassment. Thirteen per cent reported experiencing two forms of harassment, and 2 students reported experiencing verbal, physical and sexual harassment. Verbal harassment (n = 33) and sexual (n = 16) were the most common form of harassment while physical harassment was experienced 7 participants. Ninety-one per cent (n = 88) of participants reported they don't believe they have received sufficient training in dealing with incidents of physical, verbal or sexual harassment.Conclusion: Harassment of student radiographers and radiation therapists is occurring while on placement. Male patients are the modal perpetrator, and most incidents go unreported. Students are not empowered to report an incident of harassment and are sometimes unaware of how to report harassment.

Reporting Diagnostic Reference Levels for Paediatric Patients Undergoing Brain Computed Tomography.

Brain computed tomography (CT) is a diagnostic imaging tool routinely used to assess all paediatric neurologic disorders and other head injuries. Despite the continuous development of paediatric CT imaging, radiation exposure remains a concern. Using diagnostic reference levels (DRLs) helps to manage the radiation dose delivered to patients, allowing one to identify an unusually high dose. In this paper, we propose DRLs for paediatric brain CT examinations in Saudi clinical practices and compare the findings with those of other reported DRL studies. Data including patient and scanning protocols were collected retrospectively from three medical cities for a total of 225 paediatric patients. DRLs were derived for four different age groupings. The resulting DRL values for the dose-length product (DLP) for the age groups of newborns (0-1 year), 1-y-old (1-5 years), 5-y-old (5-10 years) and 10-y-old (10-15 years) were 404 mGy cm, 560 mGy cm, 548 mGy cm, and 742 mGy cm, respectively. The DRLs for paediatric brain CT imaging are comparable to or slightly lower than other DRLs due to the current use of dose optimisation strategies. This study emphasises the need for an international standardisation for the use of weight group categories in DRL establishment for paediatric care in order to provide a more comparable measurement of dose quantities across different hospitals globally.

The effect of contact radiation shielding on breast dose during CT abdomen-pelvis: a phantom study.

This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen-pelvis examinations using automatic tube current modulation to protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 µSv without ODM (1.92-1.91 µSv, p = 0.49) and increased by 0.03 µSv with ODM (1.53-1.56 µSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 µSv with shielding (1.91-1.56 µSv, p = 0.24) and by 0.39 µSv without shielding (1.92-1.53 µSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen-pelvis.

The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study.

PURPOSE: The purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety of axial skeleton X-ray examinations. METHODS: Using an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds technique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (µSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student's t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding. RESULTS: A total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 µSv (P = 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant. CONCLUSION: This study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols.

Radiation Dose Assessment for Myocardial Perfusion Imaging: A Single Institution Survey.

OBJECTIVE: This study aims to establish a local diagnostic reference level (LDRL) for single-photon emission tomography/computed tomography (SPECT/CT) and positron emission tomography/CT (PET/CT) with respect to myocardial perfusion imaging (MPI). MATERIALS AND METHODS: The acquisition protocol and dosimetry data on the MPI procedures of five SPECT/CT scans and one PET/CT scan were collected. Data on technitum-99m sestamibi (99mTc-sestamibi), 99mTc-tetrofosmin, thallium-201 (201Tl), and rubidium-82 (82RB) were all collected from one centre via questionnaire booklets. Descriptive data analysis was used to analyse all variables, and the 50th percentile was used to analyse each radiation dose quantity. RESULTS: The reported 50th percentile dose for a one-day stress/rest protocol using 99mTc-sestamibi (445/1147 MBq) and 99mTc-tetrofosmin (445/1147 MBq) and for a two-day stress/rest protocol using 99mTc-sestamibi (1165/1184 MBq) and 99mTc-tetrofosmin (1221/1184 MBq) are in good agreement with reported national diagnostic reference levels (NDRLs). However, the dose from the study data on a one-day stress/rest protocol using 99mTc-sestamibi was more than the 50th percentile dose from the Brazilian data (370/1110 MBq) on a similar protocol, and the dose from the study data on a two-day stress/rest protocol using 99mTc-tetrofosmin was more than the 50th percentile dose (1084/1110 MBq) from the United States data on MPI scans. Regarding the computed tomography (CT) portion of the SPECT/CT framework, the 50th percentile doses were lower than all the identified doses in the data considered in the literature reviewed. However, regarding the CT component of the PET/CT MPI scans, the 82RB dose was more than the recorded doses in the CT data in the published literature. CONCLUSION: This study determined the LDRL of five SPECT/CT protocols and one PET/CT MPI protocol. The results suggest that there may be opportunities to optimise the patient radiation burden from administered activities in patients undergoing SPECT examinations and the CT components associated with 82RB PET/CT scans without compromising diagnostic image quality.

Assessment of Knowledge and Awareness About Breast Self-Examination Among University Female Students in Saudi Arabia.

Objective: This study aims to evaluate the knowledge and awareness of female university students in Saudi Arabia about breast self-examination (BSE). Methods: From January to March 2022, an online self-administered questionnaire covering socio-demographic data and BSE Knowledge was distributed to female students enrolled in Saudi universities. The survey link was disseminated online and through student leaders. Mann-Whitney and Kruskal-Wallis tests were used to determine associations between the categorical variables and the BSE knowledge scores. Logistic regression was used to report the best predictor(s) for BSE knowledge. Results: Among 668 respondents, 65.5% were aged between 20 and 24 years, 47.8% were taking health-related courses, 69.2% were from urban localities, and 90.6% had no family history of breast cancer. Only 4.2% showed adequate knowledge about BSEs. Students studying in health sciences had a significantly better BSE knowledge score (p = 0.01). Moreover, 26.5% knew that a BSE has to be completed each month, and a similar percentage of students were aware that a BSE should not be completed during the menstrual cycle. Approximately half of the students knew that 20 years old is the recommended age to start BSEs. Seventy-two percent were aware that they must look for abnormal breast changes and the importance of feeling the axillary area when performing a BSE. Additionally, 55.2% were aware that most breast masses are detected by women themselves. Conclusion: Saudi female students' knowledge about BSEs is inadequate. It is advisable that BSE knowledge and practice be incorporated into the curriculum of middle and high schools, as well as university students' programs.

JUSTIFICATION OF IMAGING IN DENTAL CLINICS: DOES RADIATION KNOWLEDGE PLAY A ROLE?

The study aims to investigate dentists' knowledge and consideration of radiation in relation to their referral practices and use of referral guidelines for imaging in Saudi Arabia. A cross-sectional study was conducted among dentists in different occupational positions in Saudi Arabia. The analysis showed that 68% of the dentists knew of imaging referral guidelines to consult before ordering an imaging exam. However, more than a quarter of the sample did not use them. More than half of responders estimated the average effective dose correctly for intraoral radiography, 44.8% for panoramic radiography, 53.4% for cone beam dental computed tomography (CT) and 47.8% for a study of dental implants/jaws using CT. Limited radiation knowledge and lack of use of proper referral guidelines among dentists indicate that the imaging referral justification process must be improved. The study concluded that radiation knowledge plays a critical role regarding image justification in dental clinics.

Variations in breast cancer detection rates during mammogram-reading sessions: does experience have an impact?

OBJECTIVES: To examine whether radiologists' performances are consistent throughout a reading session and whether any changes in performance over the reading task differ depending on experience of the reader. METHODS: The performance of ten radiologists reading a test set of 60 mammographic cases without breaks was assessed using an ANOVA, 2 × 3 factorial design. Participants were categorized as more (≥2,000 mammogram readings per year) or less (<2,000 readings per year) experienced. Three series of 20 cases were chosen to ensure comparable difficulty and presented in the same sequence to all readers. It usually takes around 30 min for a radiologist to complete each of the 20-case series, resulting in a total of 90 min for the 60 mammographic cases. The sensitivity, specificity, lesion sensitivity, and area under the ROC curve were calculated for each series. We hypothesized that the order in which a series was read (i.e. fixed-series sequence) would have a significant main effect on the participants' performance. We also determined if significant interactions exist between the fixed-series sequence and radiologist experience. RESULTS: Significant linear interactions were found between experience and the fixed sequence of the series for sensitivity (F[1] =5.762, p = .04, partial η2 = .41) and lesion sensitivity. (F[1] =6.993, p = .03, partial η2 = .46). The two groups' mean scores were similar for the first series but progressively diverged. By the end of the third series, significant differences in sensitivity and lesion sensitivity were evident, with the more experienced individuals demonstrating improving and the less experienced declining performance. Neither experience nor series sequence significantly affected the specificity or the area under the ROC curve. CONCLUSIONS: Radiologists' performance may change considerably during a reading session, apparently as a function of experience, with less experienced radiologists declining in sensitivity and lesion sensitivity while more experienced radiologists actually improve. With the increasing demands on radiologists to undertake high-volume reporting, we suggest that junior radiologists be made aware of possible sensitivity and lesion sensitivity deterioration over time so they can schedule breaks during continuous reading sessions that are appropriate to them, rather than try to emulate their more experienced colleagues. ADVANCES IN KNOWLEDGE: Less-experienced radiologists demonstrated a reduction in mammographic diagnostic accuracy in later stages of the reporting sessions. This may suggest that extending the duration of reporting sessions to compensate for increasing workloads may not represent the optimal solution for less-experienced radiologists.

Can Breast Self-examination and Clinical Breast Examination Along With Increasing Breast Awareness Facilitate Earlier Detection of Breast Cancer in Populations With Advanced Stages at Diagnosis?

Breast cancer is the most common form of cancer among women worldwide. Early detection is central to improving disease outcomes. Three main screening methods - mammography, breast self-examination (BSE), and clinical breast examination (CBE) - have been developed and tested in Western nations. There is ongoing debate regarding the efficacy of BSE and CBE in terms of mortality reduction, and a number of international organizations no longer recommend them as screening methods. In technically less developed countries, however, where women are usually diagnosed with breast cancer at advanced stages and younger ages, the benefits of BSE and CBE might outweigh the harm and facilitate early detection of breast cancer. This paper reviews the history of BSE and CBE and discusses their value as early detection methods. It can contribute to informed decision-making by health policy-makers and clinicians who are involved in breast cancer screening in the developing world to improve women's well-being.

Preliminary investigation of mammographic density among women in Riyadh: association with breast cancer risk factors and implications for screening practices.

PURPOSE: Improved mammographic sensitivity is associated with reduced mammographic density. This study aims to: provide a preliminary report on mammographic density among women in Riyadh; identify risk factors associated with mammographic density; and consider the potential implications for screening practices. METHODS: Based on a cross-sectional design, we examined a total of 792 women using an area-based mammographic density method (LIBRA). Spearman's correlation, Mann-Whitney U, Kruskal-Wallis and binary logistic regression were used for analyses. RESULTS: The study population had a mean age of 49.6 years and a high proportion of participants were overweight or obese (90%). A large number of women had low mammographic density, with a mean dense breast area of 19.1 cm2 and percent density of 10.3 cm2. Slightly more than half of the variations in the dense breast area and percent density models were explained by BMI. In the adjusted analyses, BMI, menopausal status, age at menarche and number of children remained statistically significant predictors. CONCLUSION: Given the high proportion of women with low mammographic density, our findings suggest that women living in Riyadh may not require additional imaging strategies beyond mammography to detect breast cancers. The high proportion of obese women reported here and across Saudi Arabia suggests that mammographic density is less likely to have an adverse impact on mammographic sensitivity. Thus and to improve clinical outcomes among Saudi women, annual mammography and commencing screening at a younger age are suggested. Additional studies are required to shed further light on our findings.

Mammographic Density Distribution in Ras Al Khaimah (RAK): Relationships with Demographic and Reproductive Factors

Objective: Mammographic density is an important risk factor for breast cancer and determines to a large extent mammographic screening efficacy. This study aims to provide baseline data for mammographic density profiling of women living in Ras Al Khaimah (RAK) and to identify risk factors associated with high mammographic density. Methods: A cross-sectional design was used to examine a series of 366 mammography cases. The Breast Imaging Reporting and Data System (BI-RADS, 5th edition) was used to evaluate mammographic density. Pearson's chi-squared, Mann-Whitney U test and multivariate logistic regression were used for statistical analysis. Results: Most participants (67%) fell into BI-RADS b and c mammographic density categories. Of the total sample, women who were aged ≤ 45 years (p=0.004, OR=1.9), weighed ≤ 71kg (p=<0.0001, OR=4.8), had a body mass index of ≤ 27 kg/m2 (p=<0.0001, OR=5.1) and were of non-Arab descent (p=0.007, OR=1.8) were significantly more likely to have denser breast tissue. Adjusted ethnicity regression analysis showed that Emirati women were significantly less likely to have dense breast tissue compared with Western women (p=0.04, OR=0.4). Among the sample of survey participants, increased odds of having mammographic density were among women who were full-time workers (p=0.02, OR=2.8), of Christian faith (p=0.007, OR=4.4), nulliparous (p=0.003, OR=10.8), had three or fewer children (p=0.03, OR=3.8), and had used oral contraceptives for three years or more (p=0.01, OR=6.1). Conclusion: This study indicated that because Emirati women have a low mammographic density profile, screening mammography can be considered as an effective early detection imaging modality.

Breast Cancer Epidemiology in Gulf Cooperation Council Countries: A Regional and International Comparison.

Breast cancer is the most frequently diagnosed noncutaneous malignancy in women living in Gulf Cooperation Council countries. The present report aimed to highlight the similarities and variations in breast cancer incidence, age at diagnosis, clinicopathologic features, molecular characteristics, and lifestyle factors that contribute to an increasing incidence of breast cancer compared with neighboring Arab and westernized countries. The data presented, although having important implications for policy makers, also highlights the need for further research. Such research would ensure that effective prevention and detection strategies are tailored to the specific needs of the Gulf women such that the management of breast cancer is optimized.