No 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.

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.