The critical nature of health care demands high performance levels from medical equipment. To ensure these performance levels are maintained, medical physicists and biomedical engineers conduct a range of measurements on equipment during acceptance testing and on-going quality assurance programs. Wherever there are measurements, there are measurement uncertainties with potential conflicts between the measurements made by installers, owners and occasionally regulators. Prior to 1993, various methods were used to calculate and report measurement uncertainties. In 1993, the International Organization for Standardization published the Guide to the Expression of Uncertainty in Measurement (GUM). The document was jointly published with six international organizations principally involved in measurements and standards. The GUM is regarded as an international benchmark on how measurement uncertainty should be calculated and reported. Despite the critical nature of these measurements, there has not been widespread use of the GUM by medical physicists and biomedical engineers. This may be due to the complexity of the GUM. Some organisations have published guidance on the GUM tailored to specific measurement disciplines. This paper presents the philosophy behind the GUM, and demonstrates, with a medical physics measurement example, how the GUM recommends uncertainties be calculated and reported.

The minimal dose covering 90 % of the prostate volume--D 90--is arguably the most important dosimetric parameter in low-dose-rate prostate seed brachytherapy. In this study an analysis of the measurement uncertainties in D 90 from low-dose-rate prostate seed brachytherapy was conducted for two common treatment procedures with two different post-implant dosimetry methods. The analysis was undertaken in order to determine the magnitude of D 90 uncertainty, how the magnitude of the uncertainty varied when D 90 was calculated using different dosimetry methods, and which factors were the major contributors to the uncertainty. The analysis considered the prostate as being homogeneous and tissue equivalent and made use of published data, as well as original data collected specifically for this analysis, and was performed according to the Guide to the expression of uncertainty in measurement (GUM). It was found that when prostate imaging and seed implantation were conducted in two separate sessions using only CT images for post-implant analysis, the expanded uncertainty in D 90 values were about 25 % at the 95 % confidence interval. When prostate imaging and seed implantation were conducted during a single session using CT and ultrasound images for post-implant analysis, the expanded uncertainty in D 90 values were about 33 %. Methods for reducing these uncertainty levels are discussed. It was found that variations in contouring the target tissue made the largest contribution to D 90 uncertainty, while the uncertainty in seed source strength made only a small contribution. It is important that clinicians appreciate the overall magnitude of D 90 uncertainty and understand the factors that affect it so that clinical decisions are soundly based, and resources are appropriately allocated.

Breast screening programs operate in many countries with mammographic x-ray units subject to stringent quality control tests. These tests include the evaluation of quantities based on exposure measurements, such as half value layer, automatic exposure control reproducibility, average glandular dose, and radiation output rate. There are numerous error sources that contribute to the uncertainty of these exposure-related quantities, some of which are unique to the low energy x-ray spectrum produced by mammographic x-ray units. For each of these exposure-related quantities, the applicable error sources and their magnitudes vary, depending on the test equipment used to make the measurement, and whether or not relevant corrections have been applied. This study has identified and quantified a range of error sources that may be used to estimate the combined uncertainty of these exposure-related quantities, given the test equipment used and corrections applied. The uncertainty analysis uses methods described by the International Standards Organization's Guide to the Expression of Uncertainty in Measurement. Examples of how these error sources combine to give the uncertainty of the exposure-related quantities are presented. Using the best test equipment evaluated in this study, uncertainties of the four exposure-related quantities at the 95% confidence interval were found to be +/-1.6% (half value layer), +/-0.0008 (automatic exposure control reproducibility), +/-2.3% (average glandular dose), and +/-2.1% (radiation output rate). In some cases, using less precise test equipment or failing to apply corrections, resulted in uncertainties more than double in magnitude.

Estimates of the effective dose to adult patients from computed tomography (CT) head scanning can be calculated using a number of different methods. These estimates can be used for a variety of purposes, such as improving scanning protocols, comparing different CT imaging centers, and weighing the benefits of the scan against the risk of radiation-induced cancer. The question arises: What is the uncertainty in these effective dose estimates? This study calculates the uncertainty of effective dose estimates produced by three computer programs (CT-EXPO, CTDosimetry, and ImpactDose) and one method that makes use of dose-length product (DLP) values. Uncertainties were calculated in accordance with an internationally recognized uncertainty analysis guide. For each of the four methods, the smallest and largest overall uncertainties (stated at the 95% confidence interval) were: 20%-31% (CT-EXPO), 15%-28% (CTDosimetry), 20%-36% (ImpactDose), and 22%-32% (DLP), respectively. The overall uncertainties for each method vary due to differences in the uncertainties of factors used in each method. The smallest uncertainties apply when the CT dose index for the scanner has been measured using a calibrated pencil ionization chamber.