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Topcagic M, Julardzija F, Pasalic A, Sehic A, Beganovic A, Osmic H, Tinjak E, Huskic A. Electronic On-line Incident Reporting System (IRS) as a Tool for Risk Assessment in Radiation Therapy. Acta Inform Med 2023; 31:222-225. [PMID: 37781492 PMCID: PMC10540742 DOI: 10.5455/aim.2023.31.222-225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023] Open
Abstract
Background Radiotherapy is one of the primary treatment options in cancer management, together with surgery and chemotherapy. Radiation therapy is technologically complex discipline involving professionals with various specialties, and using high energy radiation in treatment of wide range of different cancer types. Technical complexity, increasing number of patients, large workload, and delivery of radiation therapy treatment with lack of human, technical and financial resources in low and middle income countries creates environment with great potential to develop incidents. Emerging need of modern radiation therapy is to develop preventive approach to risk management i to improve the patient safety. Objective The objective of this research is to identify and assess risk associated with radiation therapy practice in Bosnia and Herzegovina. Methods An anonymous, voluntary electronic on-line radiation therapy incident reporting system (IRS) was created. IRS consists of four sections containing questions about working environment, incident occurrence, root causes and contributing factors, and incident severity assessment. Data collected using IRS were used to create taxonomy of incidents in radiation therapy. Risk assessment was made using Risk Matrix method. Research was made using the data collected from first 60 incidents reported to IRS. Results Based on probability and frequency of incident occurrence and severity of consequences, it was assessed that 41.7% of incidents had low risk level (L), 50% of incidents had moderate risk level (M), and 8.3% of incidents had high risk level (H). Radiation therapy risk profile based on risk assessment results clearly shows that incidents with low frequency, low occurrence probability, but high consequences severity level have highest level of risk. Conclusion The results of this research confirm that the electronic on-line radiation therapy IRS allows the identification and classification of the most significant risk factors in radiotherapy and prevention of serious incidents occurrence.
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Affiliation(s)
- Muhamed Topcagic
- Clinic of Oncology and Radiation Therapy, University Clinical Center Tuzla, Tuzla, Bosnia & Herzegovina
| | - Fuad Julardzija
- Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Arzija Pasalic
- Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Adnan Sehic
- Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Adnan Beganovic
- Clinic of Oncology, University Clinical Center Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Hasan Osmic
- Clinic of Oncology and Radiation Therapy, University Clinical Center Tuzla, Tuzla, Bosnia & Herzegovina
| | - Enis Tinjak
- Clinic of Oncology, University Clinical Center Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Adnan Huskic
- Clinic of Oncology and Radiation Therapy, University Clinical Center Tuzla, Tuzla, Bosnia & Herzegovina
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Beslic N, Sadija A, Milardovic R, Ceric T, Ceric S, Beganovic A, Kristic S, Cavaljuga S. Advantages of Combined PET-CT in Mediastinal Staging in Patients with Non-small Cell Lung Carcinoma. Acta Inform Med 2016; 24:99-102. [PMID: 27147799 PMCID: PMC4851521 DOI: 10.5455/aim.2016.24.99-102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/05/2016] [Indexed: 12/28/2022] Open
Abstract
Introduction: Precise mediastinal lymph node staging in patients with non-small cell lung carcinoma (NSCLC) provides important prognostic information and it is obligatory in treatment strategy planning. 18Fluoro-deoxy-glucose (18F-FDG) positron emission tomography - computerized tomography (PET-CT) based on detection of metabolic activity showed superiority in preoperative staging of lung carcinoma. Materials and Methods: Total number of 26 patients diagnosed with NSCLC were included in this retrospective, cross-sectional study. Status of mediastinal lymph nodes was assessed in all patients comparing contrast enhanced CT and 18F-FDG PET-CT findings. Discussion: We found in our study that 50% of patients had different N stage on contrast enhanced CT comparing to 18F-FDG PET-CT findings. Among the total number of patients which had different nodal status on PET-CT comparing to CT alone, we found in our study that 54% of patients had change in further therapy protocol after PET-CT change of nodal stage. Conclusion: Combined PET-CT which offers advantages of both modalities is excellent method for nodal (N) staging, so it is recommended in initial staging in patients with NSCLC. PET-CT used preopratively for mediastinal nodal staging has significant impact on further therapy planning and also has an consequential impact on health system savings.
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Affiliation(s)
- Nermina Beslic
- Clinic for Nuclear Medicine, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Amera Sadija
- Clinic for Nuclear Medicine, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Renata Milardovic
- Clinic for Nuclear Medicine, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Timur Ceric
- Clinic for Oncology, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Sejla Ceric
- Clinic for Nuclear Medicine, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Adnan Beganovic
- Department of Medical Physics and Radiation Safety, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Spomenka Kristic
- Clinic for Radiology, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Semra Cavaljuga
- Medical Faculty, University in Sarajevo, Bosnia and Herzegovina
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Beganovic A, Sefic-Pasic I, Skopljak-Beganovic A, Kristic S, Sunjic S, Mekic A, Gazdic-Santic M, Drljevic A, Samek D. Doses to skin during dynamic perfusion computed tomography of the liver. Radiat Prot Dosimetry 2013; 153:106-11. [PMID: 22728469 DOI: 10.1093/rpd/ncs100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Many new computed tomography (CT) techniques have been introduced during the recent years, one of them being CT-assisted dynamic perfusion imaging (perfusion CT, PCT). Many concerns were raised when first cases of deterministic radiation effects were reported. This paper shows how radiochromic films can be utilised as passive dosemeters for use in PCT. Radiochromic dosemeters undergo a colour change directly and do not require chemical processing. Prior to their use, they need to be calibrated. Films are placed on top and on the right side of the patient and exposed during the procedure. Readout is performed using a densitometer. Results show that average local skin doses are 0.51±0.07 and 0.42±0.04 Gy on top and on the lateral side of the patient, respectively. Results of the patient dosimetry (local skin doses) are consistent. This is due to the fact that each patient had the same CT protocol used for imaging (120 kV, 60 mA and C(vol) of 247.75 mGy). Radiochromic films designed for interventional radiology can be effectively used for local skin dose measurements in perfusion CT. Dose values obtained are below the threshold needed for deterministic effects (erythema, hair loss, etc.). These effects might happen if inappropriate CT protocol is used; one that is usually used for routine imaging.
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Affiliation(s)
- Adnan Beganovic
- Department of Medical Physics and Radiation Safety, Clinical Centre of Sarajevo University, Bolnička, Sarajevo, Bosnia and Herzegovina.
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Vassileva J, Rehani MM, Applegate K, Ahmed NA, Al-Dhuhli H, Al-Naemi HM, Al Suwaidi JS, Arandjic D, Beganovic A, Benavente T, Dias S, El-Nachef L, Faj D, Gamarra-Sánchez ME, Aguilar JG, Gershan V, Gershkevitsh E, Gruppetta E, Hustuc A, Ivanovic S, Jauhari A, Kharita MH, Kharuzhyk S, Khelassi-Toutaoui N, Khosravi HR, Kostova-Lefterova D, Kralik I, Liu L, Mazuoliene J, Mora P, Muhogora W, Muthuvelu P, Nikodemova D, Novak L, Pallewatte AS, Shaaban M, Shelly E, Stepanyan K, Teo ELHJ, Thelsy N, Visrutaratna P, Zaman A, Zontar D. IAEA survey of paediatric computed tomography practice in 40 countries in Asia, Europe, Latin America and Africa: procedures and protocols. Eur Radiol 2012; 23:623-31. [PMID: 22940731 DOI: 10.1007/s00330-012-2639-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 07/25/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries. METHODS Under a project of the International Atomic Energy Agency, 146 CT facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses. RESULTS Modern MDCT systems are available in 77 % of the facilities surveyed with dedicated paediatric CT protocols available in 94 %. However, protocols for some age groups were unavailable in around 50 % of the facilities surveyed. Indication-based protocols were used in 57 % of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDI(vol) values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49 % of sites. CONCLUSION There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA.
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Affiliation(s)
- Jenia Vassileva
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
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Ciraj-Bjelac O, Beganovic A, Faj D, Gershan V, Ivanovic S, Videnovic IR, Rehani MM. Radiation protection of patients in diagnostic radiology: Status of practice in five Eastern-European countries, based on IAEA project. Eur J Radiol 2011; 79:e70-3. [DOI: 10.1016/j.ejrad.2011.03.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 03/16/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
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Ciraj-Bjelac O, Avramova-Cholakova S, Beganovic A, Economides S, Faj D, Gershan V, Grupetta E, Kharita MH, Milakovic M, Milu C, Muhogora WE, Muthuvelu P, Oola S, Setayeshi S, Schandorf C, Ursulean I, Videnovic IR, Zaman A, Ziliukas J, Rehani MM. Image quality and dose in mammography in 17 countries in Africa, Asia and Eastern Europe: results from IAEA projects. Eur J Radiol 2011; 81:2161-8. [PMID: 21665395 DOI: 10.1016/j.ejrad.2011.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 05/13/2011] [Accepted: 05/19/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective is to study mammography practice from an optimisation point of view by assessing the impact of simple and immediately implementable corrective actions on image quality. MATERIALS AND METHODS This prospective multinational study included 54 mammography units in 17 countries. More than 21,000 mammography images were evaluated using a three-level image quality scoring system. Following initial assessment, appropriate corrective actions were implemented and image quality was re-assessed in 24 units. RESULTS The fraction of images that were considered acceptable without any remark in the first phase (before the implementation of corrective actions) was 70% and 75% for cranio-caudal and medio-lateral oblique projections, respectively. The main causes for poor image quality before corrective actions were related to film processing, damaged or scratched image receptors, or film-screen combinations that are not spectrally matched, inappropriate radiographic techniques and lack of training. Average glandular dose to a standard breast was 1.5 mGy (mean and range 0.59-3.2 mGy). After optimisation the frequency of poor quality images decreased, but the relative contributions of the various causes remained similar. Image quality improvements following appropriate corrective actions were up to 50 percentage points in some facilities. CONCLUSIONS Poor image quality is a major source of unnecessary radiation dose to the breast. An increased awareness of good quality mammograms is of particular importance for countries that are moving towards introduction of population-based screening programmes. The study demonstrated how simple and low-cost measures can be a valuable tool in improving of image quality in mammography.
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Muhogora WE, Ahmed NA, Alsuwaidi JS, Beganovic A, Ciraj-Bjelac O, Gershan V, Gershkevitsh E, Grupetta E, Kharita MH, Manatrakul N, Maroufi B, Milakovic M, Ohno K, Ben Omrane L, Ptacek J, Schandorf C, Shaaban MS, Toutaoui N, Sakkas D, Wambani JS, Rehani MM. Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiat Prot Dosimetry 2010; 140:49-58. [PMID: 20154022 DOI: 10.1093/rpd/ncq015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aims of this study were to investigate the frequency of computed tomography (CT) examinations for paediatric patients below 15 y of age in 128 CT facilities in 28 developing countries of Africa, Asia and Eastern Europe and to assess the magnitude of CT doses. Radiation dose data were available from 101 CT facilities in 19 countries. The dose assessment was performed in terms of weighted CT dose index (CTDI(w)), volume CT index and dose length product (DLP) for chest, chest (high resolution), lumbar spine, abdomen and pelvis CT examinations using standard methods. The results show that on average the frequency of paediatric CT examinations was 20, 16 and 5 % of all CT examinations in participating centres in Africa, Asia and Eastern Europe, respectively. Eleven CT facilities in six countries were found to use adult CT exposure parameters for paediatric patients, thus indicating limited awareness and the need for optimisation. CT images were of adequate quality for diagnosis. The CTDI(w) variations ranged up to a factor of 55 (Africa), 16.3 (Asia) and 6.6 (Eastern Europe). The corresponding DLP variations ranged by a factor of 10, 20 and 8, respectively. Generally, the CTDI(w) and DLP values in Japan are lower than the corresponding values in the three regions in this study. The study has indicated a stronger need in many developing countries to justify CT examinations in children and their optimisation. Awareness, training and monitoring of radiation doses is needed as a way forwards.
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Affiliation(s)
- W E Muhogora
- Tanzania Atomic Energy Commission, PO Box 743, Arusha, Tanzania
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Muhogora WE, Ahmed NA, Beganovic A, Benider A, Ciraj-Bjelac O, Gershan V, Gershkevitsh E, Grupetta E, Kharita MH, Manatrakul N, Milakovic M, Ohno K, Ben Omrane L, Ptacek J, Schandorf C, Shabaan MS, Stoyanov D, Toutaoui N, Wambani JS, Rehani MM. Patient doses in CT examinations in 18 countries: initial results from International Atomic Energy Agency projects. Radiat Prot Dosimetry 2009; 136:118-126. [PMID: 19687134 DOI: 10.1093/rpd/ncp144] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The purpose of this prospective study at 73 facilities in 18 countries in Africa, Asia and Eastern Europe was to investigate if the CT doses to adult patients in developing countries are higher than international standards. The dose assessment was performed in terms of weighted computed tomography dose index (CTDIw) and dose length product (DLP) for chest, chest (high resolution), lumbar spine, abdomen and pelvis CT examinations using standard methods. Except in one case, the mean CTDIw values were below diagnostic reference level (DRL) while for DLP, 17 % of situations were above DRLs. The resulting CT images were of adequate quality for diagnosis. The CTDIw and DLP data presented herein are largely similar to those from two recent national surveys. The study has shown a stronger need to create awareness and training of radiology personnel as well as monitoring of radiation doses in many developing countries so as to conform to the ALARA principle.
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Affiliation(s)
- W E Muhogora
- Tanzania Atomic Energy Commission, PO Box 743, Arusha, Tanzania
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de Kemp VF, Beganovic A, Stapper G, Moll FL, Boer WH, Lock MTWT. [Fatigue, loss of appetite and anuria due to retroperitoneal fibrosis]. Ned Tijdschr Geneeskd 2007; 151:1373-4; author reply 1374. [PMID: 17665630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Beganovic A, de Kemp VF, Stapper G, Lock MTWT. [Isolated orchidodynia as the initial symptom of aneurysm of the abdominal aorta]. Ned Tijdschr Geneeskd 2007; 151:1101; author reply 1101-2. [PMID: 17552424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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