1
|
Kopačin V, Brkić H, Ivković A, Kasabašić M, Knežević Ž, Majer M, Nodilo M, Turk T, Faj D. Development and validation of the low-cost pregnant female physical phantom for fetal dosimetry in MV photon radiotherapy. J Appl Clin Med Phys 2024; 25:e14240. [PMID: 38150580 PMCID: PMC10860449 DOI: 10.1002/acm2.14240] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Monte Carlo (MC) simulations or measurements in anthropomorphic phantoms are recommended for estimating fetal dose in pregnant patients in radiotherapy. Among the many existing phantoms, there is no commercially available physical phantom representing the entire pregnant woman. PURPOSE In this study, the development of a low-cost, physical pregnant female phantom was demonstrated using commercially available materials. This phantom is based on the previously published computational phantom. METHODS Three tissue substitution materials (soft tissue, lung and bone tissue substitution) were developed. To verify Tena's substitution tissue materials, their radiation properties were assessed and compared to ICRP and ICRU materials using MC simulations in MV radiotherapy beams. Validation of the physical phantom was performed by comparing fetal doses obtained by measurements in the phantom with fetal doses obtained by MC simulations in computational phantom, during an MV photon breast radiotherapy treatment. RESULTS Materials used for building Tena phantom are matched to ICRU materials using physical density, radiation absorption properties and effective atomic number. MC simulations showed that percentage depth doses of Tena and ICRU material comply within 5% for soft and lung tissue, up to 25 cm depth. In the bone tissue, the discrepancy is higher, but again within 5% up to the depth of 5 cm. When the phantom was used for fetal dose measurements in MV photon breast radiotherapy, measured fetal doses complied with fetal doses calculated using MC simulation within 15%. CONCLUSIONS Physical anthropomorphic phantom of pregnant patient can be manufactured using commercial materials and with low expenses. The files needed for 3D printing are now freely available. This enables further studies and comparison of numerical and physical experiments in diagnostic radiology or radiotherapy.
Collapse
Affiliation(s)
- Vjekoslav Kopačin
- Faculty of MedicineDepartment of RadiologyJ. J. Strossmayer University Osijek, University Hospital Center OsijekDepartment of Diagnostic and Interventional RadiologyOsijekCroatia
| | - Hrvoje Brkić
- Faculty of MedicineDepartment of Biophysics and Medical PhysicsJ. J. Strossmayer University OsijekOsijekCroatia
- Faculty of Dental Medicine and HealthDepartment of BiophysicsBiology and ChemistryJ. J. Strossmayer University OsijekOsijekCroatia
| | - Ana Ivković
- Faculty of MedicineDepartment of Biophysics and Medical PhysicsJ. J. Strossmayer University Osijek, University Hospital Center OsijekDepartment of Medical PhysicsOsijekCroatia
| | - Mladen Kasabašić
- Faculty of MedicineDepartment of Biophysics and Medical PhysicsJ. J. Strossmayer University Osijek, University Hospital Center OsijekDepartment of Medical PhysicsOsijekCroatia
| | - Željka Knežević
- Division of Materials ChemistryRuđer Bošković InstituteZagrebCroatia
| | - Marija Majer
- Division of Materials ChemistryRuđer Bošković InstituteZagrebCroatia
| | - Marijana Nodilo
- Division of Materials ChemistryRuđer Bošković InstituteZagrebCroatia
| | - Tajana Turk
- Faculty of MedicineDepartment of RadiologyJ. J. Strossmayer University Osijek, University Hospital Center OsijekDepartment of Diagnostic and Interventional RadiologyOsijekCroatia
| | - Dario Faj
- Faculty of MedicineDepartment of Biophysics and Medical PhysicsJ. J. Strossmayer University OsijekOsijekCroatia
- Faculty of Dental Medicine and HealthDepartment of BiophysicsBiology and ChemistryJ. J. Strossmayer University OsijekOsijekCroatia
| |
Collapse
|
2
|
Faj D, Bassinet C, Brkić H, De Monte F, Dreuil S, Dupont L, Ferrari P, Gallagher A, Gallo L, Huet C, Knežević Ž, Kralik I, Krstić D, Maccia C, Majer M, Malchair F, O'Connor U, Pankowski P, Sans Merce M, Sage J, Simantirakis G. Management of pregnant or potentially pregnant patients undergoing diagnostic and interventional radiology procedures: Investigation of clinical routine practice. Phys Med 2023; 115:103159. [PMID: 37852021 DOI: 10.1016/j.ejmp.2023.103159] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/26/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
It is well known that foetuses are highly sensitive to ionising radiation and special attention to justification and optimisation of radiological procedures involving a pregnant patient is required. A task to review, validate and compare different approaches to managing the pregnant patient and to estimating the associated foetal doses arising from a diagnostic or interventional radiology (DIR) procedure was designed in the framework of EURADOS working group 12. As a first step, a survey of radiation protection practice including dosimetry considerations among EURADOS members was performed using online questionnaire. Then, to evaluate the possible differences in the estimated foetal doses, a comparison of assessed dose values was made for three cases of pregnant patients that underwent different CT procedures. More than 120 professionals from 108 institutions and 17 countries that are involved in managing pregnant patients undergoing DIR procedures answered the questionnaire. Most of the respondents use national or hospital guidelines on the management of pregnant patients undergoing DIR procedures. However, the guidelines differ considerably among respondents. Comparison of foetal dose assessments performed by dosimetry experts showed the variety of methods used as well as large variability of estimated foetal doses in all three cases. Although European and International commission on radiation protection guidelines already exist, they are more than 20 years old and, in some aspects, they are obsolete. This paper shows that there is a need to revise and update these guidelines.
Collapse
Affiliation(s)
- Dario Faj
- Faculty of Medicine, J. J. Strossmayer University of Osijek, J. Huttlera 4, Osijek, Croatia; Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Crkvena 21, Osijek, Croatia
| | - Céline Bassinet
- Institute for Radiation Protection and Nuclear Safety, 31 avenue de la division Leclerc, Fontenay-aux-Roses, France
| | - Hrvoje Brkić
- Faculty of Medicine, J. J. Strossmayer University of Osijek, J. Huttlera 4, Osijek, Croatia; Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Crkvena 21, Osijek, Croatia.
| | | | - Serge Dreuil
- Institute for Radiation Protection and Nuclear Safety, 31 avenue de la division Leclerc, Fontenay-aux-Roses, France
| | - Laura Dupont
- University Hospital of Geneva, Geneva, Switzerland
| | | | | | - Lara Gallo
- Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Christelle Huet
- Institute for Radiation Protection and Nuclear Safety, 31 avenue de la division Leclerc, Fontenay-aux-Roses, France
| | | | - Ivana Kralik
- Dubrava University Hospital, Avenija Gojka Suska 6, Zagreb, Croatia
| | - Dragana Krstić
- University of Kragujevac, Faculty of Science, R. Domanovica 12, 34000 Kragujevac, Serbia
| | | | - Marija Majer
- Ruđer Boškovć Institute, Bijenička 54, Zagreb, Croatia
| | | | - Una O'Connor
- Medical Physics & Bioengineering Dept, St. James's Hospital, Dublin, Ireland
| | - Piotr Pankowski
- Faculty of Physics and Applied Informatics, University of Lodz, Pomorska St. 149/153, 90-236 Lodz, Poland
| | | | - Julie Sage
- Institute for Radiation Protection and Nuclear Safety, 31 avenue de la division Leclerc, Fontenay-aux-Roses, France
| | - George Simantirakis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| |
Collapse
|
3
|
Granata C, Briers E, Candela-Juan C, Damilakis J, De Bondt T, Faj D, Foley S, Frija G, de Las Heras Gala H, Hiles P, Pauwels R, Sans Merce M, Simantirakis G, Vano E, Gilligan P. European survey on the use of patient contact shielding during radiological examinations. Insights Imaging 2023; 14:108. [PMID: 37336849 DOI: 10.1186/s13244-023-01452-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/09/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Contact shielding (CS) of patients during X-ray studies has been used for decades to protect radiosensitive organs. This practice has not changed much despite increasing evidence that CS is not useful in many cases. The Gonad And Patient Shielding (GAPS) group-founded by representatives of the main European bodies involved in radiology-promoted this survey to assess the current practice of CS among European radiology departments and the attitude towards a non-shielding policy. METHODS Over a four-month period (15 May-15th September 2021) European Society of Radiology and European Society of Paediatric Radiology radiologist members were invited to respond to a web-based questionnaire consisting of 59 questions. RESULTS 225 centres from 35 countries responded to this survey. CS was routinely applied in at least one radiological modality in 49.2% of centres performing studies in adults, 57.5% of centres performing studies in children, and 47.8% of centres performing studies on pregnant women. CS was most frequently used in conventional radiography, where the most frequently shielded organs were the gonads, followed by thyroid, female breasts, and eye lens. 83.6% respondents would follow European recommendations on the use of CS when provided by the main European bodies involved in radiology. CONCLUSIONS This review shows that CS is still largely used across Europe. However, a non-shielding policy could be adopted in most departments if European professional societies provided recommendations. In this regard, a strong commitment by European and national professional societies to educate and inform practitioners, patients and carers is paramount. CLINICAL RELEVANCE STATEMENT According to this survey expectations of patients and carers, and skepticism among professionals about the limited benefits of CS are the most important obstacles to the application of a no-shielding policy. A strong commitment from European and national professional societies to inform practitioners, patients and carers is fundamental.
Collapse
Affiliation(s)
- Claudio Granata
- Department of Paediatric Radiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
| | - Erik Briers
- Member ESR‑Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - Cristian Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands
- Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - John Damilakis
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- University of Crete, Iraklion, Crete, Greece
| | - Timo De Bondt
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- VITAZ, Department of medical physics, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
- AZ Sint-Blasius, Department of medical physics, Kroonveldlaan 50, 9200, Dendermonde, Belgium
| | - Dario Faj
- European Radiation Dosimetry Group, Neuherberg, Germany
- Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Shane Foley
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- European Federation of Radiographer Societies, Utrecht, Belgium
- Radiography and Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Guy Frija
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- Université de Paris, Paris, France
| | | | - Peter Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK
| | - Ruben Pauwels
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Marta Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany
- Geneva University Hospitals, Geneva, Switzerland
| | - Georgios Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany
- Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - Eliseo Vano
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- Radiology Department, Complutense University, Madrid, Spain
| | - Patrick Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands
- Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland
| |
Collapse
|
4
|
Faj D, Edyvean S, Lajunen A, Katukhov A, Vassileva J. Establishment and utilization of diagnostic reference levels in medical imaging: Results from a survey and consultation under the IAEA technical cooperation programme in Europe and Central Asia. Phys Med 2023; 108:102565. [PMID: 36989975 DOI: 10.1016/j.ejmp.2023.102565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/19/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
The paper presents the results of the activities under the IAEA Technical Cooperation programme in Europe and Central Asia, aiming to improve utilization of diagnostic reference levels (DRLs) in the region through identifying status, problems, and gaps in establishing and utilization of the DRLs, and suggesting potential solutions. Status was identified through a survey with two electronic questionnaires answered by the regulatory bodies for radiation protection of 26 IAEA Member States and 34 representatives of relevant professional bodies of medical physics, radiology, nuclear medicine or radiographers. Problems, good practices and potential solutions were identified as a result of the discussion during a regional workshop with 50 nominated representatives of 21 countries. Results were disseminated through open webinars. Existing gaps are related to the lack of adequate regulations in some countries, inadequate awareness of radiological professionals of DRLs as a tool for optimization, insufficient cooperation among relevant stakeholders, education, and staffing. Strengthening of the cooperation between regulatory and professional bodies could benefit the awareness and consequently the utilization of DRLs in clinical practice. The need of improved education and training of the DRL process was highlighted. Improved inspection procedures and education of inspectors would also support the process. Access to clinically qualified medical physicists was found to be critical for the DRL utilization. Suggestions were placed for continuous IAEA assistance through training, guidance and expert support.
Collapse
|
5
|
Huet C, Eakins J, Zankl M, Gómez-Ros JM, Jansen J, Moraleda M, Struelens L, Akar DK, Borbinha J, Brkić H, Bui DK, Capello K, Linh Dang TM, Desorgher L, Di Maria S, Epstein L, Faj D, Fantinova K, Ferrari P, Gossio S, Hunt J, Jovanovic Z, Kim HS, Krstic D, Le NT, Lee YK, Murugan M, Nadar MY, Nguyen NQ, Nikezic D, Patni HK, Santos DS, Tremblay M, Trivino S, Tymińska K. Monte Carlo calculation of organ and effective doses due to photon and neutron point sources and typical X-ray examinations: Results of an international intercomparison exercise. RADIAT MEAS 2022. [DOI: 10.1016/j.radmeas.2021.106695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Hiles P, Gilligan P, Damilakis J, Briers E, Candela-Juan C, Faj D, Foley S, Frija G, Granata C, de Las Heras Gala H, Pauwels R, Sans Merce M, Simantirakis G, Vano E. European consensus on patient contact shielding. Insights Imaging 2021; 12:194. [PMID: 34939154 PMCID: PMC8695402 DOI: 10.1186/s13244-021-01085-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 06/24/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.
Collapse
Affiliation(s)
- Peter Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK.
| | - Patrick Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands.,Mater Private Hospital, Eccles St., Dublin, Ireland
| | - John Damilakis
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria.,University of Crete, Iraklion, Crete, Greece
| | - Eric Briers
- Member ESR-Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - Cristian Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands.,Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - Dario Faj
- European Radiation Dosimetry Group, Neuherberg, Germany.,Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Shane Foley
- European Federation of Radiographer Societies, Utrecht, Belgium.,Radiography and Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Guy Frija
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria.,Université de Paris, Paris, France
| | - Claudio Granata
- European Society of Paediatric Radiology, Le Kremlin-Bicêtre, France.,Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Hugo de Las Heras Gala
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands.,Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Marta Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany.,Geneva University Hospitals, Geneva, Switzerland
| | - Georgios Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany.,Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - Eliseo Vano
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria.,Radiology Department, Complutense University, Madrid, Spain
| |
Collapse
|
7
|
Hiles P, Gilligan P, Damilakis J, Briers E, Candela-Juan C, Faj D, Foley S, Frija G, Granata C, de Las Heras Gala H, Pauwels R, Sans Merce M, Simantirakis G, Vano E. European consensus on patient contact shielding. Radiography (Lond) 2021; 28:353-359. [PMID: 34953726 DOI: 10.1016/j.radi.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.
Collapse
Affiliation(s)
- P Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK.
| | - P Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Mater Private Hospital, Eccles St., Dublin 7, Ireland
| | - J Damilakis
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; University of Crete, Iraklion, Crete, Greece
| | - E Briers
- Member ESR-Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - C Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - D Faj
- European Radiation Dosimetry Group, Neuherberg, Germany; Faculty of Dental Medicine and Health, Osijek, Croatia
| | - S Foley
- European Federation of Radiographer Societies, Utrecht, the Netherlands; Radiography & Diagnostic Imaging, University College Dublin, Ireland
| | - G Frija
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; Université de Paris, France
| | - C Granata
- European Society of Paediatric Radiology, Le Kremlin-Bicêtre, France; Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - H de Las Heras Gala
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - R Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Denmark
| | - M Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany; Geneva University Hospitals, Geneva, Switzerland
| | - G Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany; Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - E Vano
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; Radiology Department, Complutense University, Spain
| |
Collapse
|
8
|
Hiles P, Gilligan P, Damilakis J, Briers E, Candela-Juan C, Faj D, Foley S, Frija G, Granata C, de Las Heras Gala H, Pauwels R, Sans Merce M, Simantirakis G, Vano E. European consensus on patient contact shielding. Phys Med 2021; 96:198-203. [PMID: 34955383 DOI: 10.1016/j.ejmp.2021.12.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.
Collapse
Affiliation(s)
- Peter Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK.
| | - Patrick Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands; Mater Private Hospital, Eccles St., Dublin 7, Ireland
| | - John Damilakis
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria; University of Crete, Iraklion, Crete, Greece
| | - Eric Briers
- Member ESR-Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - Cristian Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands; Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - Dario Faj
- European Radiation Dosimetry Group, Neuherberg, Germany; Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Shane Foley
- European Federation of Radiographer Societies, Utrecht, The Netherlands; Radiography & Diagnostic Imaging, University College Dublin, Ireland
| | - Guy Frija
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria; Université de Paris, France
| | - Claudio Granata
- European Society of Paediatric Radiology, Le Kremlin-Bicêtre, France; Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Hugo de Las Heras Gala
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands; Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Denmark
| | - Marta Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany; Geneva University Hospitals, Geneva, Switzerland
| | - Georgios Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany; Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - Eliseo Vano
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria; Radiology Department, Complutense University, Spain
| |
Collapse
|
9
|
Petrovic B, Faj D, Markovic M, Paunovic D, Stankovic J, Krestic-Vesovic J, Miskovic I, Cicarevic K, Kasabasic M, Bibic J, Budanec M, Kralik I, Galic S, Hrepic D, Ibrisimovic L, Davidovic J, Kolarevic G, Novakovic T. Assessment of different CT simulators used in radiotherapy treatment planning: regional multicentric study. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00375-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
10
|
Merce MS, Candela-Juan C, Dabin J, Faj D, Gallagher A, de las Heras Gala H, Knežević Ž, Malchair F, De Monte F, Simantirakis G, Theodorakou C. Review of guidelines and legislative documents regarding the use of patient contact out-of-field shielding. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
11
|
Mirkov Z, Rajković KM, Stanković JB, Faj D. The empirical formula for calculating the incident air Kerma in intraoral radiographic imaging. Dentomaxillofac Radiol 2021; 50:20210117. [PMID: 34233497 DOI: 10.1259/dmfr.20210117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this paper is to determine the empirical formula for calculating the incident air kerma (Ki), used as a patient dose descriptor in the intraoral radiographic imaging. METHODS The data for the formula were collected during the regular annual inspection of intraoral dental X-ray units in 2018, 2019 and early 2020. The measurement data of 50 X-ray units were processed to develop the formula. Exposure factors for imaging molars of the upper jaw of an average patient in a clinical setting were used in the measurement. The formula validity was statistically evaluated using coefficient of correlation, standard error of the fitted function and the mean relative percentage deviation. RESULTS The measurement values of the radiation doses and calculated values obtained by using the final formula showed good agreement - the mean relative percentage deviation values less than ±15%. CONCLUSIONS Although there are differences in X-ray units, voltages, manufacturers and device architectures (single-phase and high-frequency), the measurement data comply well with computed ones in all cases.
Collapse
Affiliation(s)
- Zoran Mirkov
- Serbian Institute of Occupational Health "Dr Dragomir Karajovic", Belgrade, Serbia
| | - Katarina M Rajković
- Department of Kruševac, Shumadia Academy of Professional Studies, Kruševac, Serbia
| | - Jovan B Stanković
- Academy for Applied Studies Belgrade - The College of Health Sciences, Zemun, Serbia
| | - Dario Faj
- Faculty of medicine Osijek, University of Osijek, Osijek, Croatia.,Faculty of dentalmedicine and health, University of Osijek, Osijek, Croatia
| |
Collapse
|
12
|
Candela-Juan C, Ciraj-Bjelac O, Sans Merce M, Dabin J, Faj D, Gallagher A, de Las Heras Gala H, Knežević Ž, Malchair F, De Monte F, Simantirakis G, Theodorakou C. Use of out-of-field contact shielding on patients in medical imaging: A review of current guidelines, recommendations and legislative documents. Phys Med 2021; 86:44-56. [PMID: 34052671 DOI: 10.1016/j.ejmp.2021.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022] Open
Abstract
The use of patient contact-shielding has become a topic of intensive scientific debate. While it has been common practice during the last decades, some studies have questioned the efficiency of using such shielding while others have highlighted the inconsistencies in its application. The objective of this work is to review current recommendations and legislative documents on the use of out-of-field shielding in X-ray imaging, including those from national authorities and from international and national organisations and professional bodies. The review, performed within the framework of the activities of EURADOS Working Group 12, covers available recommendations on use of contact shielding in adult, pregnant and paediatric patients in general radiography, fluoroscopy, computed tomography, mammography and dental radiology. It includes a comprehensive search of 83 documents from 32 countries and 6 international organisations over the last 39 years. In general, using shielding is recommended only under two conditions: if it does not compromise the diagnostic task and the performance of the procedure and/or if it reassures the patient and comforters that they are appropriately protected against potentially harmful effects of radiation. There are very few specific regulatory requirements to use shielding in a particular imaging modality, although they may consider use of shielding either as part of good radiological practice or as requirements for availability of protective or ancillary tools, without further specification of their use. There is a wide variety of positions among documents that recommend out-of-field shielding, those that do not recommend it and those that are not specific. Therefore, evidence-based consensus is still needed to ensure best and consistent practice.
Collapse
Affiliation(s)
- Cristian Candela-Juan
- Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain.
| | | | - Marta Sans Merce
- University Hospital of Geneva, Geneva, Switzerland; University Hospital of Lausanne, Lausanne, Switzerland
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Dario Faj
- Medical Faculty of Osijek, University of Osijek, Croatia; Faculty of Dental Medicine and Health, University of Osijek, Croatia
| | - Aoife Gallagher
- Medical Physics Department, University Hospital Limerick, Ireland
| | | | - Željka Knežević
- Radiation Chemistry and Dosimetry Laboratory, Ruđer Bošković Institute, Zagreb, Croatia
| | | | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - George Simantirakis
- Licensing and Inspections Department, Greek Atomic Energy Commission, Ag. Paraskevi, Greece
| | - Chrysoula Theodorakou
- Christie Medical Physics and Engineering, The Christie NHS Foundation, Manchester, UK
| |
Collapse
|
13
|
Kolacio MŠ, Brkić H, Faj D, Radojčić ĐS, Rajlić D, Obajdin N, Jurković S. Validation of two calculation options built in Elekta Monaco Monte Carlo based algorithm using MCNP code. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.109237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
14
|
Petrovic B, Faj D, Markovic M, Tot A, Marjanovic M, Kasabasic M, Gencel I, Paunovic D, Stankovic J, Krestic-Vesovic J, Miskovic I, Cicarevic K, Bibic J, Budanec M, Kralik I, Galic S, Hrepic D, Ibrisimovic L, Davidovic J, Kolarevic G. Assessment of computed tomography simulators used in radiotherapy treatment planning in Serbia, Croatia, and Bosnia and Herzegovina. Nucl Technol Radiat Prot 2021. [DOI: 10.2298/ntrp201118009p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this work was to evaluate computed tomography simulators used in radio-therapy treatment planning in Serbia, Croatia, and Bosnia and Herzegovina. A survey of quality assurance programmes of 24 computed tomography simulators in 16 facilities was conducted. A dedicated CT-to-ED phantom was scanned at 120 kV and 140 kV, to obtain CT-to-ED conversion curves as well as CTDIvol. Thoracal phantoms were scanned in the standard and extended field of view to evaluate the dosimetric effect on treatment planning and delivery. The mean age of the measured scanners was 5.5 years. The mean water HU value was ?6.5 (all scanners, all voltages) and air HU value was ?997. Extended field of view computed tomography data differ from the standard field of view and differences between conversion curves have significant dosimetric impact. The CTDI data showed a large range of values between centers. Better quality assurance of computed tomography simulators in all countries is recommended. The CT-to-ED curve could be used as default at one voltage and per manufacturer. Extended field of view imaging can be used, but treatment planning should be avoided in the regions out of the standard field of view.
Collapse
Affiliation(s)
- Borislava Petrovic
- Faculty of Sciences, Department of Physics, Novi Sad, Serbia + Oncology Institute Vojvodina, Radiotherapy department, Sremska Kamenica, Serbia
| | - Dario Faj
- Faculty of medicine, Josip Juraj Strossmayer University Osijek, Osijek, Croatia + Faculty of dental medicine and health sciences, University of Osijek, Osijek, Croatia
| | - Mladen Markovic
- Faculty of Sciences, Department of Physics, Novi Sad, Serbia
| | - Arpad Tot
- Faculty of Sciences, Department of Physics, Novi Sad, Serbia + Vinca institute of nuclear sciences, Belgrade, Serbia
| | - Milana Marjanovic
- Faculty of Sciences, Department of Physics, Novi Sad, Serbia + Oncology Institute Vojvodina, Radiotherapy department, Sremska Kamenica, Serbia
| | - Mladen Kasabasic
- Faculty of medicine, Josip Juraj Strossmayer University Osijek, Osijek, Croatia + Clinical Medical center Osijek, Osijek, Croatia
| | - Ivan Gencel
- Oncology Institute Vojvodina, Radiotherapy department, Sremska Kamenica, Serbia
| | | | | | | | - Ivana Miskovic
- Institute of oncology and radiology Serbia, Belgrade, Serbia
| | | | - Juraj Bibic
- University hospital center Zagreb Rebro, Zagreb, Croatia
| | - Mirjana Budanec
- University Clinical Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Ivana Kralik
- University hospital center Zagreb Rebro, Zagreb, Croatia
| | - Stipe Galic
- University clinical hospital Mostar, Mostar Bosnia and Herzegovina
| | | | | | - Jasna Davidovic
- Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Goran Kolarevic
- International Medical Centers Banja Luka, Banja Luka, Bosnia and Herzegovina
| |
Collapse
|
15
|
Čandrlić M, Perić Kačarević Ž, Ivanišević Z, Tomas M, Včev A, Faj D, Matijević M. Histological and Radiological Features of a Four-Phase Injectable Synthetic Bone Graft in Guided Bone Regeneration: A Case Report. Int J Environ Res Public Health 2020; 18:ijerph18010206. [PMID: 33383971 PMCID: PMC7796133 DOI: 10.3390/ijerph18010206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/17/2020] [Accepted: 12/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Injectable synthetic bone grafts (ISBG) are widely used biomaterials for regeneration purposes. The aim of this case report was to examine the efficacy of ISBG in the management of buccal fenestration in the case of a 25-year-old female. CASE REPORT After a traumatic tooth extraction, the defect was filled with ISBG and covered with a resorbable membrane. The ISBG showed easy handling and the patient had no complications during healing. Six months after augmentation, a bone biopsy was taken during implant bed preparation. The histological results showed good integration of ISBG into the newly formed bone and no signs of tissue inflammation. Additionally, a CBCT (cone beam computed tomography) analysis was performed to support the histological results. CONCLUSION The use of the examined ISBG led to successful treatment of the buccal fenestration defect.
Collapse
Affiliation(s)
- Marija Čandrlić
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, 31 000 Osijek, Croatia; (M.Č.); (Z.I.); (M.T.)
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31 000 Osijek, Croatia
| | - Željka Perić Kačarević
- Department of Anatomy, Histology, Embriology, Pathology Anatomy and Pathology Histology, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, 31 000 Osijek, Croatia;
| | - Zrinka Ivanišević
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, 31 000 Osijek, Croatia; (M.Č.); (Z.I.); (M.T.)
| | - Matej Tomas
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, 31 000 Osijek, Croatia; (M.Č.); (Z.I.); (M.T.)
| | - Aleksandar Včev
- Department of Pathophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, 31 000 Osijek, Croatia;
| | - Dario Faj
- Department of Biophysics and Radiology, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, 31 000 Osijek, Croatia;
| | - Marko Matijević
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, 31 000 Osijek, Croatia; (M.Č.); (Z.I.); (M.T.)
- Correspondence: or
| |
Collapse
|
16
|
Gershan V, Homayounieh F, Singh R, Avramova-Cholakova S, Faj D, Georgiev E, Girjoaba O, Griciene B, Gruppetta E, Hadnadjev Šimonji D, Kharuzhyk S, Klepanec A, Kostova-Lefterova D, Kulikova A, Lasic I, Milatovic A, Paulo G, Vassileva J, Kalra MK. CT protocols and radiation doses for hematuria and urinary stones: Comparing practices in 20 countries. Eur J Radiol 2020; 126:108923. [DOI: 10.1016/j.ejrad.2020.108923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
|
17
|
Galić S, Kovačević M, Lasić I, Brkić H, Faj D. A Method of High-Resolution Radiotherapy Delivery Fluences with a Pair of Fields with Orthogonal Collimator Settings: A Study on Ten Head-and-Neck Cancer Patients. J Med Phys 2020; 45:36-43. [PMID: 32355433 PMCID: PMC7185711 DOI: 10.4103/jmp.jmp_51_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/18/2019] [Revised: 10/12/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022] Open
Abstract
Context: Introduction of dual-layer multileaf collimator (MLC) radiotherapy linear accelerators into clinical practice is an important development in advanced external beam radiotherapy. A method of delivering comparable high-resolution fluences with a single-layer MLC is presented. Aims: The aims of this study are to present new algorithms and approaches to define high-resolution hypermodulated fluences, obtain orthogonal decomposition of fluences, and deliver them on a linear accelerator with single MLC from two perpendicular collimator settings. Materials and Methods: High-resolution fluences were defined using Monte Carlo (MC) calculation. A novel use of a limited-memory, bounded, Broyden–Fletcher–Goldfarb–Shanno algorithm was used to decompose such fluences to ones deliverable with a pair of fields with mutually orthogonal collimator settings. Such a technique, here named cross motion leaf calculator (XMLC), is compared against single sliding window (SSW) technique typically used in intensity-modulated radiation therapy (IMRT). An electronic portal imaging device (EPID) is used, and the results were compared with gamma analysis. Furthermore, MC was used to determine dose distributions for computed tomography images of ten head-and-neck cancer patients. Results: Gamma analysis (3%, 3 mm) against ideal fluence is considerably more favorable to XMLC (94% ± 4%) versus SSW (76% ± 5%). Furthermore, the dose–volume histogram (DVH) analysis showed that XMLC enables delivery of fluences superior to that of IMRT and these results in clinically relevant enhancements in DVH results. Conclusions: At the time of writing of this study, there were more than 12,000 medical linear accelerators in clinical use, and XMLC can prove itself useful wherever linac is equipped with MLC but cannot delivery latest techniques, such as volumetric modulated arc therapy.
Collapse
Affiliation(s)
- Stipe Galić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina, Croatia
| | - Marin Kovačević
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina, Croatia
| | - Ivan Lasić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina, Croatia
| | | | - Dario Faj
- Faculty of Medicine, Osijek, Croatia
| |
Collapse
|
18
|
Ferrari P, Becker F, Jovanovic Z, Khan S, Bakhanova E, Principi S, Kristic D, Pierotti L, Mariotti F, Faj D, Turk T, Nikezic D, Bertolini M. Simulation of H p (10) and effective dose received by the medical staff in interventional radiology procedures. J Radiol Prot 2019; 39:809-824. [PMID: 31234160 DOI: 10.1088/1361-6498/ab2c42] [Citation(s) in RCA: 7] [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: 06/09/2023]
Abstract
Interventional radiology and cardiology are widespread employed techniques for diagnosis and treatment of several pathologies because they avoid the majority of the side-effects associated with surgical treatments, but are known to increase the radiation exposure to patient and operators. In recent years many studies treated the exposure of the operators performing cardiological procedures. The aim of this work is to study the exposure condition of the medical staff in some selected interventional radiology procedures. The Monte Carlo simulations have been employed with anthropomorphic mathematical phantoms reproducing the irradiation scenario of the medical staff with two operators and the patient. A personal dosemeter, put on apron, was modelled for comparison with measurements performed in hospitals, done with electronic dosemeters, in a reduced number of interventional radiology practices. Within the limits associated to the use of numerical anthropomorphic models to mimic a complex interventional procedure, the personal dose equivalent, H p (10), was evaluated and normalised to the simulated Kerma-Area Product, KAP, value, indeed the effective dose has been calculated. The H p (10)/KAPvalue of the first operator is about 10 μSv/Gy.cm2, when ceiling shielding is not used. This value is calculated on the trunk and it varies of +/-30% moving the dosemeter to the waist or to the neck. The effective dose, normalised to the KAP value, varies between 0.03 and 0.4 μSv/Gy.cm2. Considering all the unavoidable approximation of this kind of investigations, the comparisons with hospital measurement and literature data showed a good agreement allowing to use of the present results for dosimetric characterisation of interventional radiology procedures.
Collapse
Affiliation(s)
- P Ferrari
- ENEA-IRP, Radiation Protection Institute, 4 Via Martiri di Monte Sole, 40129 Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Kralik I, Faj D, Lauc T, Škarica M, Popić J, Brkic H. Dose area product in estimation of effective dose of the patients undergoing dental cone beam computed tomography examinations. J Radiol Prot 2018; 38:1412-1427. [PMID: 30264736 DOI: 10.1088/1361-6498/aae4e8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the relationship of the effective dose and dose area product (DAP) in dental cone beam computed tomography (CBCT) examinations and to propose conversion factors for estimation of effective doses of the patients using DAP. Dependence of organ doses on DAP was also investigated. MATERIALS AND METHODS Different exposure geometries in Cranex3Dx CBCT device were simulated using Monte Carlo simulation and computational anthropomorphic phantom. Then organ doses and effective dose for every exposure geometry was compared to DAP and analysed. RESULTS The effective dose in all simulated CBCT protocols and positions with 180° tube rotation ranged from 5 μSv for 50 × 50 mm2 field of view (FOV) localised on one tooth using lowest resolution to 265 μSv for the largest FOV and highest resolution. In case of 360° tube rotation the effective dose ranges from 6 to 332 μSv for the same FOV sizes and positions as well as resolutions as in 180° tube rotation. CONCLUSIONS Though the DAP introduces a large uncertainty in the risk measure in dental CBCT, it represents the dose and FOV size which are the most important scanning parameters affecting the dose. To decrease uncertainty in the risk measure, the effective dose has to be estimated for usual clinical positions of the FOV.
Collapse
|
20
|
Radojcic ĐS, Rajlic D, Casar B, Kolacio MS, Obajdin N, Faj D, Jurkovic S. Evaluation of two-dimensional dose distributions for pre-treatment patient-specific IMRT dosimetry. Radiol Oncol 2018; 52:346-352. [PMID: 30210046 PMCID: PMC6137356 DOI: 10.2478/raon-2018-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/13/2018] [Indexed: 11/22/2022] Open
Abstract
Background The accuracy of dose calculation is crucial for success of the radiotherapy treatment. One of the methods that represent the current standard for patient-specific dosimetry is the evaluation of dose distributions measured with an ionization chamber array inside a homogeneous phantom using gamma method. Nevertheless, this method does not replicate the realistic conditions present when a patient is undergoing therapy. Therefore, to more accurately evaluate the treatment planning system (TPS) capabilities, gamma passing rates were examined for beams of different complexity passing through inhomogeneous phantoms. Materials and methods The research was performed using Siemens Oncor Expression linear accelerator, Siemens Somatom Open CT simulator and Elekta Monaco TPS. A 2D detector array was used to evaluate dose distribution accuracy in homogeneous, semi-anthropomorphic and anthropomorphic phantoms. Validation was based on gamma analysis with 3%/3mm and 2%/2mm criteria, respectively. Results Passing rates of the complex dose distributions degrade depending on the thickness of non-water equivalent material. They also depend on dose reporting mode used. It is observed that the passing rate decreases with plan complexity. Comparison of the data for all set-ups of semi-anthropomorphic and anthropomorphic phantoms shows that passing rates are higher in the anthropomorphic phantom. Conclusions Presented results raise a question of possible limits of dose distribution verification in assessment of plan delivery quality. Consequently, good results obtained using standard patient specific dosimetry methodology do not guarantee the accuracy of delivered dose distribution in real clinical cases.
Collapse
Affiliation(s)
| | - David Rajlic
- University Hospital Rijeka, Medical Physics Department, Rijeka, Croatia
| | - Bozidar Casar
- Institute of Oncology LJubljana, Department of Radiation Physics, Ljubljana, Slovenia
| | | | - Nevena Obajdin
- University Hospital Rijeka, Medical Physics Department, Rijeka, Croatia
| | - Dario Faj
- Faculty of Medicine, University of Osijek, Osijek, Croatia
- Faculty of Dental Medicine and Health, University of Osijek, Osijek, Croatia
| | - Slaven Jurkovic
- University Hospital Rijeka, Medical Physics Department, Rijeka, Croatia
- Department of Medical Physics and Biophysics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| |
Collapse
|
21
|
Radojčić ÐS, Kolacio MŠ, Radojčić M, Rajlić D, Casar B, Faj D, Jurković S. Comparison of calculated dose distributions reported as dose-to-water and dose-to-medium for intensity-modulated radiotherapy of nasopharyngeal cancer patients. Med Dosim 2018; 43:363-369. [PMID: 29306538 DOI: 10.1016/j.meddos.2017.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022]
Abstract
Advanced dose calculation algorithms for radiation therapy treatment planning can report external beam photon dose 2-sided, in terms of dose-to-medium (Dm) and dose-to-water (Dw). The purpose of our study was to determinate the effect of Dw and Dm reporting modes built in Elekta Monaco treatment planning system on intensity-modulated radiotherapy dose distributions for patients with nasopharyngeal cancer. For 13 patients involved in this retrospective study, 2 plans were created: 1 using Dw and another according to Dm reporting mode. Treatment plans were normalized such that 100% planning target volume should be covered by 95% of prescribed dose. Dose-volume constraints were assigned according to international standards. The comparison between dose distributions was performed evaluating quantities important for respective volumes of interest. For target volumes, heterogeneity index and conformity index methodology were used along with the maximum dose concept. Also, for the comparisons over particular organ at risk, maximum dose or mean dose as well as dose-volume concepts were used. For all target volumes and majority of organs at risk, the differences between 2 reporting modes are statistically insignificant, but this is not the case for bony structured organs at risks: mandible and cochlea. It was observed that Dw is higher than Dm with mean difference of 9.91% (p = 0.000009) of the mandible volume covered with 70 Gy. The same trend was observed for left and right cochlea with difference in mean dose of 8.74% (p = 0.037) and 6.87% (p = 0.029), respectively. The comparative analysis of dosimetric parameters in this study shows that the selection of reporting modes in Monaco treatment planning system can produce dose differences up to 15% in high-density volumes such as mandible and cochlea, which might have clinical consequences.
Collapse
Affiliation(s)
| | | | - Milan Radojčić
- Clinic for Radiotherapy and Oncology, University Hospital Rijeka, Rijeka, Croatia
| | - David Rajlić
- Medical Physics Department, University Hospital Rijeka, Rijeka, Croatia
| | - Božidar Casar
- Department of Radiation Physics, Institute of Oncology, Ljubljana, Slovenia
| | - Dario Faj
- Faculty of Medicine, University of Osijek, Osijek, Croatia; Faculty of Dental Medicine and Health, University of Osijek, Osijek, Croatia
| | - Slaven Jurković
- Medical Physics Department, University Hospital Rijeka, Rijeka, Croatia; Department of Physics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
| |
Collapse
|
22
|
Kralik I, Štefanić M, Brkić H, Šarić G, Težak S, Grbac Ivanković S, Griotto N, Štimac D, Rubin O, Salha T, Ivanišević Z, Jurković S, Faj D. Estimated collective effective dose to the population from nuclear medicine diagnostic procedures in Croatia: A comparison of 2010 and 2015. PLoS One 2017; 12:e0180057. [PMID: 28662092 PMCID: PMC5491126 DOI: 10.1371/journal.pone.0180057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 06/08/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study presents national surveys of patient exposure from nuclear medicine (NM) diagnostic procedures in 2010 and 2015 in the Republic of Croatia. METHODS The survey was performed according to the European Commission Dose DataMed (DDM) project methodology. 28 most frequent NM diagnostic procedures were identified. Data about frequencies of procedures and average administered activities of radioisotopes used in those procedures were collected. Average administered activities were converted to effective doses according to the dose conversion coefficients. Then the collective effective dose to the population and an effective dose per capita were calculated based on the number of the most frequent NM diagnostic procedures and the average effective dose per procedure. RESULTS In 2010, 41200 NM diagnostic procedures led to 146.7 manSv collective effective dose to the population and in 2015, 42000 NM diagnostic procedures led to 146.8 manSv collective effective dose to the population. The frequencies of NM diagnostic procedures were 9.7 and 9.8 annually per 1000 population with 34.1 μSv and 34.2 μSv effective dose per capita for 2010 and 2015, respectively. The main contributors to the annual collective dose from NM in Croatia are examinations of the bone, heart, thyroid and PET/CT tumour diagnostic. Average administered activities have not changed considerably from 2010 to 2015. Nevertheless, within the frequency of some of the procedures, significant changes were found in five-year period. CONCLUSIONS Frequencies, average administered activities and collective effective dose to the population from NM diagnostic procedures in Croatia are comparable to the values reported by other European surveys. Changes were found between 2010 and 2015 and we intend to perform this study periodically to identify possible trends, but also to raise awareness about the potential dose optimization.
Collapse
Affiliation(s)
- Ivana Kralik
- State Office for Radiological and Nuclear Safety, Zagreb, Croatia
| | - Mario Štefanić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- University Hospital Centre Osijek, Osijek, Croatia
| | - Hrvoje Brkić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Gordan Šarić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- University Hospital Centre Osijek, Osijek, Croatia
| | - Stanko Težak
- University Hospital Centre Zagreb, Zahreb, Croatia
| | - Svjetlana Grbac Ivanković
- University Hospital Centre Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Neva Griotto
- University Hospital Centre Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Damir Štimac
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- University Hospital Centre Osijek, Osijek, Croatia
| | - Otmar Rubin
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- University Hospital Centre Osijek, Osijek, Croatia
| | - Tamer Salha
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- University Hospital Centre Osijek, Osijek, Croatia
| | - Zrinka Ivanišević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Slaven Jurković
- University Hospital Centre Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Dario Faj
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| |
Collapse
|
23
|
Brkić H, Ivković A, Kasabašić M, Poje Sovilj M, Jurković S, Štimac D, Rubin O, Faj D. The influence of field size and off-axis distance on photoneutron spectra of the 18 MV Siemens Oncor linear accelerator beam. RADIAT MEAS 2016. [DOI: 10.1016/j.radmeas.2016.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
24
|
Brkić H, Ivković A, Sovilj MP, Kasabašić M, Jurković S, Faj D. Analysis of neutron flux around medical electron linear accelerator placed in the room reconstructed after decommissioning of 60Co units using monte carlo simulation. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
25
|
Radojčić ÐS, Rajlić D, Kolacio MŠ, Faj D, Jurković S. Dosimetric evaluation of Monte Carlo based treatment planning system in antorphomorpic phantom. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
26
|
Krpan T, Faj D, Brnić Z, Baraban V, Mišir M. Patient radiation doses during coronary interventions in four Croatian hospitals: 4-y comparison. Radiat Prot Dosimetry 2015; 165:259-262. [PMID: 25848111 DOI: 10.1093/rpd/ncv104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The number of coronary interventions increased substantially in the recent years. Although of great benefit to patients, these procedures can subject patients to considerable radiation doses. There is a legal framework for patient dose measurements in Croatia during radiological procedures, but in practice, it applies only occasionally. A quality control manual, established at the University Hospital Osijek, was accepted by other major cardiology centres in Croatia; besides checking the technical characteristics of the device, it provides constant measurement and analysis of patient doses in interventional cardiology. It also includes patient examination for radiation skin injuries in case of dose of >2 Gy. The aim of the study was to determine and compare patient radiation doses during cardiological interventions measured within 4 y in four major cardiology centres with the values proposed by the European Commission and other professional bodies. The local reference dose levels were also set.
Collapse
Affiliation(s)
- Tomislav Krpan
- Department of Interventional and Diagnostic Radiology, University Hospital Center Sisters of Mercy, Zagreb, Croatia
| | - Dario Faj
- University JJ Strossmayer Medical Faculty, Osijek, Croatia
| | - Zoran Brnić
- Department of Interventional and Diagnostic Radiology, University Hospital Center Sisters of Mercy, Zagreb, Croatia
| | - Vedrana Baraban
- University JJ Strossmayer Medical Faculty, Osijek, Croatia Department of Cardiology, University Hospital Center Osijek, Osijek, Croatia
| | - Mihael Mišir
- University JJ Strossmayer Medical Faculty, Osijek, Croatia Department of Neurology, University Hospital Center Osijek, Osijek, Croatia
| |
Collapse
|
27
|
Tomas I, Kotoromanović Z, Belaj N, Margaretić D, Ivezić Z, Katić M, Zibar L, Faj D, Stimac D, Matić M. Computer-aided evaluation of radiologist's reproducibility and subjectivity in mammographic density assessment. Coll Antropol 2013; 37:1121-1126. [PMID: 24611323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mammographic density is an independent risk of breast cancer. This study has evaluated the radiologists' reproducibility and subjectivity in breast density estimation and in order to decrease the radiologists' subjective errors the computer software was developed. The very good reproducibility existed in the strong correlation with the first and the second mammogram assessment after three month period for each radiologist (correlation coefficient 0.73-1, p < 0.001). The strong correlation was present in the case of all 5 radiologists when compared among themselves and compared with software aided MDEST-Mammographic Density Estimation (correlation coefficient 0.651-0.777, p < 0.001). Detected differences in glandular tissue percentage determination occurred in the case of two experienced radiologists, out of 5 (one radiologist with more than 5 year experience and one with more than 10 year experience, p < 0.01), but in the case of breast type determination (American College of Radiology-ACR I-IV), the detected difference occurred in one radiologist with the least experience (less than 5 years, p < 0.001). It can be concluded that the estimation of glandular tissue percentage in breast density is rather subjective method, especially if it is expressed with absolute percentage, but the determination of type of breast (ARCI-IV) depends on the radiologist's experience. This study showed that software aided determination of glandular tissue percentage and breast type can be of a great benefit in the case of less experienced radiologists.
Collapse
Affiliation(s)
- Ilijan Tomas
- University Josip Juraj Strossmayer, University Hospital Osijek, Department of Oncology and Radiotherapy, Osijek, Croatia.
| | - Zdenka Kotoromanović
- University Josip Juraj Strossmayer, University Hospital Osijek, Department of Oncology and Radiotherapy, Osijek, Croatia
| | - Nenad Belaj
- University Josip Juraj Strossmayer, University Hospital Osijek, Department of Oncology and Radiotherapy, Osijek, Croatia
| | - Damir Margaretić
- University Josip Juraj Strossmayer, University Hospital Osijek, Department of Oncology and Radiotherapy, Osijek, Croatia
| | - Zdravko Ivezić
- University Josip Juraj Strossmayer, University Hospital Osijek, Department of Radiology, Osijek, Croatia
| | - Miroslav Katić
- University Josip Juraj Strossmayer, Department of Physics, Osijek, Croatia
| | - Lada Zibar
- University Josip Juraj Strossmayer, University Hospital Osijek, Clinic of Internal Medicine, Osijek, Croatia
| | - Dario Faj
- University Josip Juraj Strossmayer, University Hospital Osijek, Department of Oncology and Radiotherapy, Osijek, Croatia
| | - Damir Stimac
- University Josip Juraj Strossmayer, University Hospital Osijek, Department of Radiology, Osijek, Croatia
| | - Mate Matić
- University Josip Juraj Strossmayer, University Hospital Osijek, Department of Oncology and Radiotherapy, Osijek, Croatia
| |
Collapse
|
28
|
Jurković S, Svabić M, Diklić A, Smilović Radojčić D, Dundara D, Kasabašić M, Ivković A, Faj D. Reinforcing of QA/QC programs in radiotherapy departments in Croatia: results of treatment planning system verification. Med Dosim 2012; 38:100-4. [PMID: 23246197 DOI: 10.1016/j.meddos.2012.07.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/12/2012] [Accepted: 07/30/2012] [Indexed: 11/26/2022]
Abstract
Implementation of advanced techniques in clinical practice can greatly improve the outcome of radiation therapy, but it also makes the process much more complex with a lot of room for errors. An important part of the quality assurance program is verification of treatment planning system (TPS). Dosimetric verifications in anthropomorphic phantom were performed in 4 centers where new systems were installed. A total of 14 tests for 2 photon energies and multigrid superposition algorithms were conducted using the CMS XiO TPS. Evaluation criteria as specified in the International Atomic Energy Agency Technical Reports Series (IAEA TRS) 430 were employed. Results of measurements are grouped according to the placement of the measuring point and the beam energy. The majority of differences between calculated and measured doses in the water-equivalent part of the phantom were in tolerance. Significantly more out-of-tolerance values were observed in "nonwater-equivalent" parts of the phantom, especially for higher-energy photon beams. This survey was done as a part of continuous effort to build up awareness of quality assurance/quality control (QA/QC) importance in the Croatian radiotherapy community. Understanding the limitations of different parts of the various systems used in radiation therapy can systematically improve quality as well.
Collapse
Affiliation(s)
- Slaven Jurković
- Clinic for Radiotherapy and Oncology, Physics Division, University Hospital Rijeka, Rijeka, Croatia
| | | | | | | | | | | | | | | |
Collapse
|
29
|
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.
Collapse
Affiliation(s)
- Jenia Vassileva
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Poje M, Vuković B, Radolić V, Miklavčić I, Faj D, Varga Pajtler M, Planinić J. Mapping of cosmic radiation dose in Croatia. J Environ Radioact 2012; 103:30-33. [PMID: 22036155 DOI: 10.1016/j.jenvrad.2011.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 07/01/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
The Earth is continually bombarded by high-energy particles coming from the outer space and the sun. These particles, termed cosmic radiation, interact with nuclei of atmospheric constituents and decrease in intensity with depth in the atmosphere. Measurements of photon and gamma radiation, performed with a Radiameter at 1 m above the ground, indicated dose rates of 50-100 nSv/h. The neutron dose rate was measured with the CR-39 track etch detector calibrated by the CERN-EU high-energy Reference Field (CERF) facility. Correlation between neutron dose rates and altitudes at 36 sites was examined in order to obtain a significant positive correlation coefficient; the resulting linear regression enabled estimation of a neutron dose at particular altitude. The measured neutron dose rate in Osijek (altitude of 89 m, latitude of 45.31° N) was 110 nSv/h.
Collapse
Affiliation(s)
- M Poje
- Department of Physics, University of Osijek, P.O. Box 125, Gajev trg 6, 31000 Osijek, Croatia
| | | | | | | | | | | | | |
Collapse
|
31
|
Ciraj-Bjelac O, Beganović A, Faj D, Ivanovic S, Videnovic I, Rehani M. Status of radiation protection in interventional cardiology in four East European countries. Radiat Prot Dosimetry 2011; 147:62-67. [PMID: 21725081 DOI: 10.1093/rpd/ncr268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Level of staff and patient radiation protection in interventional cardiology in four counties (Bosnia and Herzegovina, Croatia, Montenegro and Serbia) as a part of International Atomic Energy Agency project (RER/9/093) are presented. Patient doses were assessed in terms of air kerma area product (KAP), peak skin dose (PSD) or air kerma at interventional reference point (K(IRP)). Results were available from nine hospitals: 775 patients for KAP, 157 for PSD and 437 for K(IRP). Eight centres reported KAP >100 Gy cm(2) and five centres reported values >200 Gy cm(2). From patients monitored in terms of PSD, 14 (9 %) had PSD >2 Gy and 6 (3 %) patients from those monitored in terms of K(IRP) had value >5 Gy, indicating risk of skin injury. The results indicate need for optimisation and dose monitoring in complex fluoroscopically guided cardiology interventions.
Collapse
Affiliation(s)
- O Ciraj-Bjelac
- Radiation and Environmental Protection Department, Vinca Institute of Nuclear Sciences, MP Alasa 12-14, Vinca, PO Box 522, 11001 Belgrade, Serbia.
| | | | | | | | | | | |
Collapse
|
32
|
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]
|
33
|
Brnić Z, Blašković D, Klasić B, Ramač JP, Flegarić-Bradić M, Stimac D, Lubina IZ, Brnić V, Faj D. Image quality of mammography in Croatian nationwide screening program: comparison between various types of facilities. Eur J Radiol 2011; 81:e478-85. [PMID: 21715115 DOI: 10.1016/j.ejrad.2011.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 06/01/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE The study was aimed to provide objective evidence about the mammographic image quality in Croatia, to compare it between different types of MG facilities and to identify the most common deficiencies and possible reasons as well as the steps needed to improve image quality. MATERIALS AND METHODS A total of 420 mammographic examinations collected from 84 mammographic units participating in the Croatian nationwide breast cancer screening program were reviewed in terms of four image quality categories: identification of patient and examination, breast positioning and compression, exposure and contrast, and artifacts. Those were rated using image evaluating system based on American College of Radiology and European Commission proposals. The results were compared among different types of mammographic units, and common image quality deficiencies were identified. RESULTS Total image quality scores of 12.8, 16.1, 13.0 and 13.7 were found for general hospitals, university hospitals, private clinics and public healthcare centres, respectively. Average score for all mammographic units was 13.5 (out of 25 points). University hospitals were significantly better than all other mammography units in overall image quality, which was mostly contributed by better breast positioning practices. Private clinics showed the worst results in identification, exposure, contrast and artifacts. CONCLUSIONS Serious deficiencies in identification and breast positioning, which might compromise breast cancer screening outcome, were detected in our material. They occur mainly due to subjective reasons and could be corrected through additional staff training and improvement of working discipline.
Collapse
Affiliation(s)
- Zoran Brnić
- Department of Radiology, University Hospital Merkur, Zajčeva 19, 10000 Zagreb, Croatia.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
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.
Collapse
|
35
|
Vuković B, Poje M, Varga M, Radolić V, Miklavcić I, Faj D, Stanić D, Planinić J. Measurements of neutron radiation in aircraft. Appl Radiat Isot 2010; 68:2398-402. [PMID: 20620072 DOI: 10.1016/j.apradiso.2010.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 06/14/2010] [Accepted: 06/17/2010] [Indexed: 10/19/2022]
Abstract
Radiation environment is a complex mixture of charged particles of the solar and galactic origin, as well as of secondary particles created in an interaction of galactic cosmic particles with the nuclei of the Earth's atmosphere. A radiation field at aircraft altitude consists of different types of particles, mainly photons, electrons, positrons and neutrons, with a large energy range. In order to measure a neutron component of the cosmic radiation, we investigated a few combinations of a track etch detector (CR-39, LR-115) with a plastic converter or boron foil. Detector calibration was performed on neutrons coming from the nuclear reactor, as well as in the CERN-EU high-energy Reference Field (CERF) facility. From November 2007 to September 2008, the neutron dose equivalent was measured by the track detectors during five aircraft flights, in the north geographical latitude from 21° to 58°; the respective average dose rate, determined by using the D-4 detector (CR-39/B), was Ḣ(n)=5.9 μSv/h. The photon dose rate, measured by the electronic dosimeter RAD-60 SE, had the average value of Ḣ(f)=1.4 μSv/h.
Collapse
Affiliation(s)
- B Vuković
- Department of Physics, University of Osijek, Osijek, P.O. Box 125, Croatia
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Brnić Z, Krpan T, Faj D, Kubelka D, Ramac JP, Posedel D, Steiner R, Vidjak V, Brnić V, Visković K, Baraban V. Patient radiation doses in the most common interventional cardiology procedures in Croatia: first results. Radiat Prot Dosimetry 2010; 138:180-186. [PMID: 19880413 DOI: 10.1093/rpd/ncp237] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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
Apart from its benefits, the interventional cardiology (IC) is known to generate high radiation doses to patients and medical staff involved. The European Union Medical Exposures Directive 97/43/Euroatom strongly recommend patient dosimetry in interventional radiology, including IC. IC patient radiation doses in four representative IC rooms in Croatia were investigated. Setting reference levels for these procedures have difficulties due to the large difference in procedure complexity. Nevertheless, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high-dose procedures. Local and national diagnostic reference levels (DRLs) were proposed as a guidance. A total of 138 diagnostic (coronary angiography, CA) and 151 therapeutic (PTCA, stenting) procedures were included. Patient irradiation was measured in terms of kerma-area product (KAP), fluoroscopy time (FT) and number of cine-frames (F). KAP was recorded using calibrated KAP-meters. DRLs of KAP, FT and F were calculated as third quartile values rounded up to the integer. Skin doses were assessed on a selected sample of high skin dose procedures, using radiochromic films, and peak skin doses (PSD) were presented. A relative large range of doses in IC was detected. National DRLs were proposed as follows: 32 Gy cm(2), 6.6 min and 610 frames for CA and 72 Gy cm(2), 19 min and 1270 frames for PTCA. PSD <1 Gy were measured in 72 % and PSD >2 Gy in 8 % of selected patients. Measuring the patient doses in radiological procedures is required by law, but rarely implemented in Croatia. The doses recorded in the study are acceptable when compared with the literature, but optimisation is possible. The preliminary DRL values proposed may be used as a guideline for local departments, and should be a basis for radiation reduction measures and quality assurance programmes in IC in Croatia.
Collapse
Affiliation(s)
- Z Brnić
- Department of Radiology, University Hospital Merkur, Zagreb, Croatia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Ciraj-Bjelac O, Faj D, Stimac D, Kosutic D, Arandjic D, Brkic H. Good reasons to implement quality assurance in nationwide breast cancer screening programs in Croatia and Serbia: results from a pilot study. Eur J Radiol 2009; 78:122-8. [PMID: 19896314 DOI: 10.1016/j.ejrad.2009.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/11/2009] [Accepted: 10/05/2009] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Olivera Ciraj-Bjelac
- Vinca Institute of Nuclear Sciences, Radiation Protection Laboratory, M. P. Alasa 12-14, Vinca, P.O. Box 522, 11001 Belgrade, Serbia.
| | | | | | | | | | | |
Collapse
|
38
|
Jurković S, Zauhar G, Faj D, Radojcić DS, Svabić M. Radiation therapy photon beams dose conformation according to dose distribution around intracavitary-applied brachytherapy sources. Med Dosim 2009; 35:49-52. [PMID: 19931015 DOI: 10.1016/j.meddos.2009.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 01/21/2009] [Indexed: 11/16/2022]
Abstract
Intracavitary application of brachytherapy sources followed by external beam radiation is essential for the local treatment of carcinoma of the cervix. Due to very high doses to the central portion of the target volume delivered by brachytherapy sources, this part of the target volume must be shielded while being irradiated by photon beams. Several shielding techniques are available, from rectangular block and standard cervix wedge to more precise, customized step wedge filters. Because the calculation of a step wedge filter's shape was usually based on effective attenuation coefficient, an approach that accounts, in a more precise way, for the scattered radiation, is suggested. The method was verified under simulated clinical conditions using film dosimetry. Measured data for various compensators were compared to the numerically determined sum of the dose distribution around brachytherapy sources and one of compensated beam. Improvements in total dose distribution are demonstrated, using our method. Agreement between calculation and measurements were within 3%. Sensitivity of the method on sources displacement during treatment has also been investigated.
Collapse
Affiliation(s)
- Slaven Jurković
- Department of Radiotherapy and Oncology, University Hospital, Rijeka, Croatia.
| | | | | | | | | |
Collapse
|
39
|
Tomić S, Soldo-Butković S, Kovac B, Faj D, Jurić S, Misević S, Knezević L, Vukasinović D. Lumbosacral radiculopathy--factors effects on it's severity. Coll Antropol 2009; 33:175-178. [PMID: 19408622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Want to demonstrate factors which effect appearance and severity of lumbosacral radiculopathy. We analysed 100 electromyoneurographically examined patients. Patients were categorised on bases of their BMI (body mass index), sex, age, job type (physical or intellectual job), and chronic diseases (diabetes mellitus, arterial hypertension and hyperlipidemia). Data were evaluated using the chi2 test with the significance of p < 0.05. Obese patients had severe radiculopathy more often than non-obese patients (p < 0.044). Severe radiculopathy appeared more frequently in male (p < 0.001), elderly patients (p < 0.023), and patients doing physically intensive jobs (p < 0.002). No statistic significance was found in relationship between patients suffering from diabetes mellitus, arterial hypertension, and hyperlipidemia, and the severity of lumbosacral radiculopathy. Obese patients, males, elderly patients, and patients doing physically intensive jobs are at a bigger risk of suffering from severe radiculopathy. Diabetes mellitus, arterial hypertension, and hyperlipidemia do not influence the severity of lumbosacral radiculopathy.
Collapse
Affiliation(s)
- Svetlana Tomić
- Department of Neurology, University Hospital "Osijek", Osijek, Croatia.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Faj D, Posedel D, Stimac D, Ivezic Z, Kasabasic M, Ivkovic A, Kubelka D, Ilakovac V, Brnic Z, Bjelac OC. Survey of mammography practice in Croatia: equipment performance, image quality and dose. Radiat Prot Dosimetry 2008; 131:535-540. [PMID: 18940818 DOI: 10.1093/rpd/ncn283] [Citation(s) in RCA: 5] [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: 05/26/2023]
Abstract
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.
Collapse
Affiliation(s)
- Dario Faj
- University Hospital of Osijek, J. Huttlera 4, 31000 Osijek, Croatia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Kasabasić M, Faj D, Smilović Radojcić D, Svabić M, Ivković A, Jurković S. Verification of the patient positioning in the bellyboard pelvic radiotherapy. Coll Antropol 2008; 32 Suppl 2:211-215. [PMID: 19140284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The size and shape of the treatment fields applied in radiotherapy account for uncertainties in the daily set-up of the patients during the treatment. We investigated the accuracy of daily patient positioning in the bellyboard pelvic radiotherapy in order to find out the magnitude of the patients movement during the treatment. Translational as well as rotational movements of the patients are explored. Film portal imaging is used in order to find patient positioning error during the treatment of the pelvic region. Patients are treated in the prone position using the bellyboard positioning device. Thirty six patients are included in the study; 15 patients were followed during the whole treatment and 21 during the first 5 consecutive treatment days. The image acquisition was completed in 85% and systematic and random positioning errors in 453 images are analyzed. Translation of the patient during the treatment caused set-up errors that ranged up to 30 mm and rotation of the sacrum ranged up to 14 degrees. We found out that most of the patients had time trend (drift of the position or angle during the time). This is predominant in the first few days while patient accommodate to uncomfortable prone position in the bellyboard. Safety margins that will ensure 90% probability of depositing at least 95% of the prescribed dose in the target are calculated according to translational movement of the patient. No action level, off line, set-up protocol is employed to correct patient position because of the translational movement. To correct for the rotation of the patient anatomy, correction of the custom shielding blocks should be employed.
Collapse
Affiliation(s)
- Mladen Kasabasić
- Radiotherapy Department, University Hospital Osijek, Osijek, Croatia.
| | | | | | | | | | | |
Collapse
|
42
|
Svabić M, Jurković S, Faj D, Kasabasić M, Smilović Radojcić D, Ivković A. Practices of radiotherapy equipment quality control in radiotherapy centres in Croatia. Coll Antropol 2008; 32 Suppl 2:217-219. [PMID: 19138027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
From the prescription to the delivery of a radiotherapy treatment, a team of professionals from a number of disciplines is involved. In this way significant potential for errors leading to an accidental exposure becomes apparent. Comprehensive quality assurance/quality control (QA/QC) program to minimize such errors is, therefore, required. One aspect of QA/QC program is quality control of the equipment. In this paper we present experiences in establishing QC procedures in our centers. Also differences in QC practices in Croatian radiotherapy centers are reviewed in the light of recommendations given by international reports and publications. To obtain insight into the current employed protocols a questionnaire based on our QC protocols was made and it was sent to all radiotherapy institutions in Croatia. QC procedures and tools used, professionals involved, performance frequencies of the tests and tolerance/action levels are compared. All centers perform the great majority of QC tests, but some variations in the performance frequencies of QC tests and in personnel responsible for performing particular tests are found. Reviewing of QC practices and exchanging experience could help in evolving uniform protocol for QC procedures at national level.
Collapse
Affiliation(s)
- Manda Svabić
- Physics Division, Radiotherapy Department, University Hospital Rijeka, Rijeka, Croatia.
| | | | | | | | | | | |
Collapse
|
43
|
Kurbel S, Gulam D, Kovacić D, Mihaljević I, Faj D. Mutations that modulate receptor-hormone congruency as a cause of the primate GH receptor species specificity. Theory Biosci 2008; 123:435-40. [PMID: 18202875 DOI: 10.1016/j.thbio.2004.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Accepted: 10/29/2004] [Indexed: 11/26/2022]
Abstract
Peptide hormones depend on reliable recognition by their receptors. Any mutation that compromises recognition of hormone and receptor molecules is dangerous, the carrier animal would not procreate and the mutation would be lost. Although, most of the hormones from one mammalian species are active when injected into another, the incompatibility of human GH receptor toward nonprimate GHs is a notable exception. It is reported that the coevolution of GH and GHR in primates includes two crucial steps (Mol. Biol. Evol. 18 (2001) 945). The first was mutation of GH His-->Asp at position 171 that happened before the split of Old world and New world monkeys. The second event was Leu-->Arg change at position 43 in the GH receptor molecule that happened in the ancestor of Old world monkeys. The proposed model is based on the possibility that certain mutations can modify the surface of one of interacting molecules to form a confined empty space, a niche in the otherwise congruent hormone/receptor interface. Altoough affinity between molecules is probably slightly reduced, recognition and function are not compromised in this special case. Further mutations of hormone and receptor molecules are allowed under the condition that they remain confined to the niche space. Mutations that do not compromise hormone function can be passed to offsprings. If the consequent mutation of one molecule change its shape to fill the niche space, further mutations without function loss will become less probable. Without the niche space, the phase of fast evolution is closed and both genes become conserved. In this setting, accumulated mutations before the niche closing mutation are the cause of species specificity. To become a dominant variety, carrier animals must possess survival advantage in comparison to the carriers of other less advantageous mutations.
Collapse
Affiliation(s)
- Sven Kurbel
- Department of Physiology, Osijek Medical Faculty, Osijek Clinical Hospital, Huttlera 4, 31000, Osijek, Croatia,
| | | | | | | | | |
Collapse
|
44
|
Faj D, Steiner R, Trifunovic D, Faj Z, Kasabasic M, Kubelka D, Brnic Z. Patient dosimetry in interventional cardiology at the University Hospital of Osijek. Radiat Prot Dosimetry 2007; 128:485-490. [PMID: 17921512 DOI: 10.1093/rpd/ncm435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The interventional cardiology was recently implemented at the University Hospital of Osijek. Patients' absorbed doses during coronary angiography (CA) and the percutaneous transluminal coronary angioplasty (PTCA) procedures were measured and compared with published data and international standards. All patients undergoing CA or PTCA procedures during a 1-month period were included in the study. Patients' doses are expressed in terms of dose area product (DAP) per procedure. The patients' DAPs ranged from 2.6 to 210 Gy cm2 (average of 59 Gy cm2) during CAs, and from 61 to 220 Gy cm2 (average of 120 Gy cm2) during PTCAs. Patients' doses during CAs and PTCAs at the University Hospital of Osijek are in good agreement with the published ones. In complex cases, the radiochromic dosimetry films were used to show possible dose distributions across patient's skin. The film dosimetry showed a limitation of using only DAP values for the estimation of skin injuries risk.
Collapse
Affiliation(s)
- Dario Faj
- University Hospital of Osijek, J. Huttlera 4, 31000 Osijek, Croatia.
| | | | | | | | | | | | | |
Collapse
|
45
|
Vuković B, Faj D, Radolić V, Planinić J. Indoor radon and lung cancer: a case-control study. Isotopes Environ Health Stud 2005; 41:169-76. [PMID: 16191768 DOI: 10.1080/10256010412331314274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Lung-cancer risk to the general population from indoor radon remains controversial, although studies of radon exposure have established that radon decay products have been a cause of lung cancer among miners. For the case group of patients, suffering from lung cancer, and the control group distributions of the number of homes with high indoor levels of radon were compared with the log-normal distribution, the empirical frequency distribution of the control group obeyed the theoretical log-normal distribution. Using the ratio of frequencies of the case group to the control groups, or the relative frequencies, an association between the relative frequencies and indoor radon concentrations was found, and a positive correlation coefficient was obtained, thus enabling the rate of lung cancer to be estimated for certain indoor radon concentrations. The significant difference between the mean radon levels for the case sample and the control led to the conclusion that patients with lung cancer lived in homes with radon concentrations which were significantly higher than those of Osijek's inhabitants for the control sample.
Collapse
Affiliation(s)
- Branko Vuković
- Faculty of Education, Josip Jurai Strossmayer University of Osijek, L. Jagerova 9, 31000 Osijek, Croatia
| | | | | | | |
Collapse
|
46
|
Kurbel S, Faj D. Association of skin rash and tumor response to HER1/EGFR inhibition: does HER1 stimulated tumor growth depend on circulatory instead of paracrine ligands? Med Hypotheses 2005; 64:1244-5. [PMID: 15823732 DOI: 10.1016/j.mehy.2005.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Accepted: 01/01/2005] [Indexed: 10/25/2022]
|
47
|
Faj D, Vrtar M, Krajina Z, Jurković S, Margaretić D. Model of total skin electron treatment using the 'six-dual-field' technique. Coll Antropol 2003; 27:713-21. [PMID: 14746163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
During implementation of the total skin electron treatment, using six-dual-field technique, at radiotherapy department a large number of measurements are needed. To assess depth dose curve required by clinicians and dose uniformity over a whole treatment plane, combinations of different irradiation parameters are used (electron energy, beam angle, scatterers). Measurements for each combination must be performed. One possible way to reduce number of measurements is to model the treatment using the Monte Carlo simulation of electron transport. We made a simplified multiple-source Monte Carlo model of electron beam and tested it by comparing calculations and experimental results. Calculated data differs less than 5 percent from measurements in the treatment plane. During the treatment patient can be approximated using cylinders with different diameters and orientations. We tried to model the depth dose variations in the total skin electron treatment not just around the body cross-section (simplified to cylinders of different diameters), but also along the body to account for the variations in body curvature longitudinally. This effect comes down to the problem of modeling distribution in different cylinders, but varying the longitudinal orientation of those cylinders. We compared Monte Carlo calculations and film measurements of depth dose curves for two orientations of the cylindrical phantom, which were the simplest for experimental arrangement. Comparison of the results proved accuracy of the model and we used it to calculate depth dose curves for a number of other cylinder orientations.
Collapse
Affiliation(s)
- Dario Faj
- University Hospital Osijek, Osijek, Croatia
| | | | | | | | | |
Collapse
|
48
|
Margaretić D, Faj D, Tomas I, Dmitrović B, Krajina Z. Total skin electron treatment of extensive cutaneous lesions in Kaposi sarcoma. Croat Med J 2002; 43:342-5. [PMID: 12035143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
We report on a 62-year-old HIV-negative male patient with Kaposi sarcoma. After 8 years of treatment of smaller localized skin lesions with surgery and local radiotherapy, the patient developed extensive lesions of the whole skin. The extent of the lesions required the administration of the total skin electron therapy (TSET). Until then, TSET had been used at our Department only for the treatment of mycosis fungoides. The dose delivered was 30 Gy higher than in a conventional radiotherapy treatment, where doses are usually between 8 and 24 Gy. Six months after the TSET therapy, the lesions completely regressed, except for two large facial lesions, which were surgically removed. Major side effects were mild erythema and hyperpigmentation of the skin. Erythema disappeared a month after the therapy.
Collapse
Affiliation(s)
- Damir Margaretić
- Radiotherapy and Oncology Department, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia.
| | | | | | | | | |
Collapse
|