Web Implementation of Quality Assurance (QA) for X-ray Units in Balkanic Medical Institutions.

Diagnostic radiology is the major contributor to the total dose of the population from all artificial sources. In order to reduce radiation exposure and optimize diagnostic x-ray image quality, it is necessary to increase the quality and efficiency of quality assurance (QA) and audit programs. This work presents a web application providing completely new QA solutions for x-ray modalities and facilities. The software gives complete online information (using European standards) with which the corresponding institutions and individuals can evaluate and control a facility's Radiation Safety and QA program. The software enables storage of all data in one place and sharing the same information (data), regardless of whether the measured data is used by an individual user or by an authorized institution. The software overcomes the distance and time separation of institutions and individuals who take part in QA. Upgrading the software will enable assessment of the medical exposure level to ionizing radiation.

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 Raska 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 (226)Ra, (232)Th, (40)K, (235)U, (238)U as well as the produced radionuclide (137)Cs (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 (Ra(eq)), external hazard index (H(ex)), external gamma absorbed dose rate ([Formula: see text]) and annual effective dose (D(E)) were determined.

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.

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.

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.

Patient doses for barium meal examination in Serbia and Montenegro and potentials for dose reduction through changes in equipment settings.

Patient doses for barium meal examination performed at three general hospitals in Serbia and Montenegro were measured using a kerma-area product (KAP) meter. The results were analysed in order to obtain dose-related parameters. Although the observed doses were within the range reported in other studies, intra-hospital and inter-hospital dose variations were significant. Mean KAP values for total examination in three hospitals were 8.4, 24.4 and 13.9 Gy cm2, respectively. Contribution from fluoroscopy was greater than from radiography. Factors contributing to the increased dose delivery were determined and the recommendations on radiographic techniques were made. Changes in radiography settings allowed dose reduction up to 48% in the radiographic part of examination, that is, up to 12% in total dose without loss of image quality. In addition, fluoroscopy time was noted as the second major contributor to the dose variations. The results demonstrated the need for standardisation of practice for barium meal examination in the country.

First results on patient dose measurements from conventional diagnostic radiology procedures in Serbia and Montenegro.

The objective of this work is to assess patient doses for the most frequent X-ray examinations for the first time in Serbia and Montenegro. A total of 510 procedures for 11 different examination categories in 3 general hospitals were analysed. Mean and median entrance surface air kerma (ESAK) and kerma area product (KAP) values followed by mean effective doses were reported. Using X-ray tube output data, ESAK for each radiographic examination was calculated, as well as the effective dose for each patient. Except for chest PA examination, all estimated doses are less than stated European and International Atomic Energy Agency (IAEA) reference levels for simple radiographic examinations. For complex examinations involving fluoroscopy and radiography total KAP was measured and contributions from fluoroscopy and radiography were assessed. The study of KAP confirms that the dose level for complex fluoroscopy investigations is closely related to the technique and individual patient variation in terms of fluoroscopy time and number of radiography exposures. The obtained values are comparable to those reported in the UK. Survey data are aimed aid development of a national quality control and radiation protection programme for medical exposures.

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.