Quality Assurance and Radiation Safety as Part of Diagnostic Process
The National Congress with international participation of “Radiology in Ukraine” arranged by the Association of Radiologists of Ukraine is annually conducted in Ukraine. This is one of the few places today to meet and exchange experience for medical professionals whose work involves the use of radiation sources. It has been a good tradition for many years to create within the Congress a separate section “Radiological Visualization Technologies. Quality Assurance and Radiation Safety” dedicated to new methods of visualization and justification of the need for quality control and current radiation safety issues in Ukraine. A qualitative research with minimum dose load allows both doctors and patients to be at an advantage, so engineers and practicing physicians are actively involved in the activities of this section.
The main issues of concern to experts in radiation safety and medical physics are the implementation of new research methods, lack of control over equipment wear, insufficient legislative and technical framework for quality control of diagnostic and therapeutic tools, as well as difficulties in accounting of patient doses.
For example, the diagnostic reference levels to control radiation exposure to patients during different diagnostic procedures developed by the S. P. Grigoriev Institute for Medical Radiology cannot function in full extent. The head of the Central Laboratory of Radiation Hygiene of Medical Personnel and Patients, Candidate of Biological Sciences Larysa Stadnyk described this in her report. The main cause of the lack of full control over the dose of patients is the impossibility of measuring the output dose due to the lack of appropriate equipment, legal framework, and qualified personnel whose responsibilities will include measurement, monitoring and control of dose-forming parameters of devices. A national X-ray quality control system that will include be patient dose measurement should be developed.
During the day’s work of the session, several reports were devoted to expanding the capabilities of X-rays equipment through using the tomosynthesis method. This is a method to obtain an image by taking several X-ray pictures at the set depth with the fixed distance between them. The information obtained due to this is digitized and processed to form a final image. The method has an intermediate position in terms of diagnostic capabilities between radiography and computed tomography, it is used to diagnose any pathology that can be revealed by radiography, but in some cases, its effectiveness does not exceed usual radiography.
According to employees of the Teleoptik Company who are involved in supply of such devices to the clinics in Ukraine, the information content and separative power during tomosynthesis can be compared with the computer tomography research. The head of the service and production department Serhii Balashov stated that the dose during computer tomography research is at least ten times higher than the one during a similar research using the tomosynthesis method: “dose is assessed by a calculation method based on foreign publications and methodological guidelines of the S. P. Grigoriev Institute for Medical Radiology taking into account the established modes. Unfortunately, computed tomography scanners operating in Ukraine do not pass quality control of dose-forming parameters, thus, the dose imposed on them can be very high even in the standard modes”. (Patient dose calculation by computer tomography includes the research parameters such as current, voltage, time, etc. the dose is calculated very accurately in proper maintenance of this device: author’s note.)
Candidate of Medical Sciences, radiologist in the Center for Pediatric Cardiology and Cardiac Surgery Raad Tammo skeptically commented on a series of reports on the prospects of using this method: “Still, tomosynthesis was designed for a very specific research and is not suitable for mass use in clinics. With low informativeness of this method compared with non-ionizing research such as magnetic resonance tomography and ultrasound, patient’s dose will be significantly higher than during usual radiography. The range of research allowed by computer tomography is much wider than the capabilities in using the tomosynthesis method. Installing a tomographic attachment on a paid basis in comparison with purchasing a computed tomography scanner will not solve the problem related to the absence of a computed tomography scanner. Tomosynthesis is very efficient in mammography (breast examination: author’s note), because none of the available diagnostic methods can compete with it according to the information content, but it is waste of money for normal operation of X-ray room”.
The report of the President of the Association of Medical Physicists of Ukraine Ruslan Zelinsky on the need for a common state policy in the field of radiation safety in medicine to ensure the quality of radio diagnostics and radiotherapy was final in the activity of this section. According to his opinion that has been agreed with all participants, it is necessary to adapt in detail the documents developed by the IAEA and the EU considering Ukrainian realities, as well as develop a certification system for technical personnel, clear instructions, guidelines and minutes for quality control in diagnostics and therapy, standards for measurement devices in order to allow direct impact on the quality of the procedures using radiation sources.
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