Statistical analysis of the periodic intermediate checks results on the standards used for calibrations of ionizing radiation dosimeters in a 60Co gamma ray beam.

Periodic intermediate checks on the equipment used for calibration activity accredited for the conformity with the international norm ISO/IEC 17025 are an essential issue for monitoring the validity of calibration laboratory's results. These checks should be carried out according to a procedure defined by each accredited laboratory. The results of these checks should not exceed the acceptance criteria established in the laboratory and statistical techniques shall be applied to the reviewing of the results. In this work, a simple method of carrying out intermediate checks on working standards used for calibrations of ionizing radiation dosimeters in a 60Co gamma ray beam was presented. Moreover, the statistical analysis of obtained results was presented. This analysis allowed for a reliable inference regarding the operation of the working standards used to calibrate the customer's devices. The presented methods can be used as a guidance in order to conform to the ISO/IEC 17025 requirements for carrying out and reviewing of periodic intermediate checks results in the area of calibrations of ionizing radiation dosimeters for external beam radiotherapy.

Perfusion-Diffusion Ratio: A New IVIM Approach in Differentiating Solid Benign and Malignant Primary Lesions of the Liver.

INTRODUCTION: In order to improve the efficacy of intravoxel incoherent motion (IVIM) parameters in characterising specific tissues, a new concept is introduced: the perfusion-diffusion ratio (PDR), which expresses the relationship between the signal S(b) decline rate as a result of IVIM and the rate of signal S(b) decline due to diffusion. The aim of this study was to investigate this novel approach in the differentiation of solid primary liver lesions. Material and Methods. Eighty-three patients referred for liver MRI between August 2017 and January 2020 with a suspected liver tumour were prospectively examined with the standard liver MRI protocol extended by DWI-IVIM sequence. Patients with no liver lesions, haemangiomas, or metastases were excluded. The final study population consisted of 34 patients with primary solid liver masses, 9 with FNH, 4 with regenerative nodules, 10 with HCC, and 11 with CCC. The PDR coefficient was introduced, defined as the ratio of the rate of signal S(b) decrease due to the IVIM effect to the rate of signal S(b) decrease due to the diffusion process, for b = 0. RESULTS: No significant differences were found between benign and malignant lesions in the case of IVIM parameters (f, D, or D ∗) and ADC. Significant differences were observed only for PDR, with lower values for malignant lesions (p = 0.03). The ROC analysis yielded an AUC value for PDR equal to 0.74, with a cut-off value of 5.06, sensitivity of 81%, specificity of 77%, and accuracy of 79%. CONCLUSION: PDR proved to be more effective than IVIM parameters and ADC in the differentiation of solid benign and malignant primary liver lesions.

The role of SSDL in quality assurance in radiotherapy.

This paper describes the role of the Polish Secondary Standard Dosimetry Laboratory (SSDL) in quality assurance in radiotherapy by means of providing calibration of ionisation chambers, TLD postal dosimetry audits and end-to-end audits for radiation therapy. A historical review of the methods and results are presented. The influence of the SSDL in Warsaw on radiation protection of patients in Poland is discussed. The International Atomic Energy Agency together with World Health Organisation (IAEA/WHO), through its network of SSDLs around the world, propagates newly developed methods for calibration and auditing. Suitable high quality equipment was provided by the IAEA, as well as special materials and technical support to the SSDL in Warsaw. The activity of the SSDL and the services provided for Polish radiotherapy centres have resulted in a reduction of discrepancies between planned doses and doses delivered to patients. The newly tested IAEA methods of end-to-end on-site dosimetry audits allow for monitoring and improving the quality of IMRT in Poland. The traceability of standards used for the calibration of therapy level dosimeters from Polish radiotherapy centres is assured by the IAEA dosimetry laboratory. The consistency of methods performed in the Polish SSDL with the ISO:17025 norm is supervised by the Polish Centre for Accreditation - a member of International Laboratory Accreditation Cooperation (ILAC), for calibration and testing. Due to the rapid technological development of radiotherapy, special attention has to be paid to newly developed methods for dosimetry auditing and institutions which provide services for assuring radiation safety of patients.

Optimal b-values for diffusion kurtosis imaging of the liver and pancreas in MR examinations.

PURPOSE: The objective was to optimise the number of b-values for diffusion kurtosis imaging (DKI) of the liver and pancreas in MR examinations to ensure reliable results with the shortest possible acquisition time. METHODS: Twenty healthy volunteers underwent DKI at 3.0 T Siemens Magnetom Skyra using 7 b-values (b = 0, 200, 500, 750, 1000, 1500, 2000 s/mm2). The regions of interest (ROIs) were placed in the liver (right lobe, left lobe) and pancreas (head, tail). DKI parameters (Dapp, Kapp) for ROIs were calculated for 7 b-values utilising the nonlinear least-squares (NLLS) Marquardt-Levenberg algorithm. All calculations were repeated for ten subsets of data, with the number of b-values reduced to 4. DKI parameters calculated for subsets were compared with parameters calculated for all 7 b-values. RESULTS: The correlation coefficient between DKI parameters calculated for 7 b-values and subsets ranged from 0.65 to 1.00. The coefficient of variation (CoV) of DKI parameters calculated for a group of volunteers varied from 8% to 42% and was not affected by the reduction of the b-values number. Only one subset of data (b = 0, 500, 1500 and 2000 s/mm2) simultaneously met two criteria: no statistical difference (p < 0.05) from results obtained for 7 b-values and very good correlation with them. CONCLUSIONS: DKI acquisition with 4 b-values (b = 0, 500, 1500 and 2000 s/mm2), compared to DKI acquisition utilising 7 b-values, allowed for the reduction of acquisition time by 36%, without affecting the calculated DKI parameters.

Reproducibility of intravoxel incoherent motion of liver on a 3.0T scanner: free-breathing and respiratory-triggered sequences acquired with different numbers of excitations.

PURPOSE: To optimise the intravoxel incoherent motion (IVIM) imaging of the liver on a 3.0T scanner by assessing parameter reproducibility on free-breathing (FB) and respiratory-triggered (RT) sequences acquired with different numbers of signal averages (NSA). MATERIAL AND METHODS: In this prospective study 20 subjects (M/F: 10/10; age: 25-62 years, mean: 39 years) underwent IVIM magnetic resonance imaging (MRI) on a 3.0T scanner using an 18-channel phase-arrayed coil and four different echo-planar sequences, each with 10 b values: 0, 10, 30, 50, 75, 100, 150, 200, 500, and 900 s/mm2. Images were acquired with FB and RT with NSA = 1-4 (FBNSA1-4, RTNSA1-4) and with NSA = 3-6 (FBNSA3-6, RTNSA3-6). Subsequently, for the assessment of reproducibility of IVIM-derived parameters (f, D, D*), each subject was scanned again with an identical protocol during the same session. IVIM parameters were calculated. The distribution of IVIM-parameters for each DWI sequence were given as the median value with first and third quartile. Inter-scan reproducibility for each IVIM parameter was evaluated using coefficient of variance and Bland-Altman difference. Differences between FB sequence and RT sequence were tested using non-parametric Wilcoxon signed-rank test. RESULTS: Mean coefficient of variance (%) for f, D, and D* ranged from 60 to 64, from 58 to 84, and from 82 to 99 for FBNSA1-4 sequence; from 50 to 69, from 41 to 97, and from 80 to 82 for RTNSA1-4 sequence; from 22 to 27, 15, and from 70 to 80 for FBNSA3-6 sequence; and from 21 to 32, from 12 to, and from 50 to 80 for RTNSA3-6 sequence, respectively. CONCLUSIONS: Increasing the number of signal averages for IVIM acquisitions allows us to improve the reproducibility of IVIM-derived parameters. The sequence acquired during free-breathing with NSA = 3-6 was optimal in terms of reproducibility and acquisition time.

Evaluation of Imaging Parameters of Ultrasound Scanners: Baseline for Future Testing.

BACKGROUND: Regular quality control is required in Poland only for those methods of medical imaging which involve the use of ionizing radiation but not for ultrasonography. It is known that the quality of ultrasound images may be affected by the wearing down or malfunctioning of equipment. MATERIAL/METHODS: An evaluation of image quality was carried out for 22 ultrasound scanners equipped with 46 transducers. The CIRS Phantom model 040GSE was used. A set of tests was established which could be carried out with the phantom, including: depth of penetration, dead zone, distance measurement accuracy, resolution, uniformity, and visibility of structures. RESULTS: While the dead zone was 0 mm for 89% of transducers, it was 3 mm for the oldest transducer. The distances measured agreed with the actual distances by 1 mm or less in most cases, with the largest difference of 2.6 mm. The resolution in the axial direction for linear transducers did not exceed 1 mm, but it reached even 5 mm for some of the convex and sector transducers, especially at higher depths and in the lateral direction. For 29% of transducers, some distortions of anechoic structures were observed. Artifacts were detected for several transducers. CONCLUSIONS: The results will serve as a baseline for future testing. Several cases of suboptimal image quality were identified along with differences in performance between similar transducers. The results could be used to decide on the applicability of a given scanner or transducer for a particular kind of examination.

Mean glandular doses in mammography: a comparison of values displayed by a mammography unit with in-house values, both using the method proposed by Dance.

The purpose of this work is to compare the mean glandular dose (MGD) displayed by the mammography system and the MGD calculated according to the method proposed by Dance for women. This study also attempts to analyse whether the relationship between the calculated and the displayed values is constant and what factors influence this relationship. Material for this study included data from 1200 exposures (i.e. six series; each series consisting of 200 exposures) performed with one full-field digital mammography unit. Based on collected parameters of exposures, values of the MGD for individual mammography examinations were calculated according to the methods proposed by Dance. Obtained values of the MGD were compared with the values displayed by the mammography system. The MGD displayed by the mammography system and the MGD calculated according to the method proposed by Dance for women are significantly different. This result emphasises the importance of verifying MGD values for patient radiation protection, particularly after machine servicing.

Individual doses for women undergoing screening mammography examinations in Poland in 2007.

Exposure doses to women undergoing screening mammography examinations should be kept as low as reasonably achievable, but they should ensure high enough image quality for adequate diagnosis. The aim of this study was to estimate the radiation risk according to the 'European guidelines for quality assurance in breast cancer screening and diagnosis', fourth edition (European Commission 2006). Materials for this study were obtained from data from 250 screening mammography facilities in Poland. For every mammography facility, a standard average glandular dose for routine exposure was calculated. Furthermore, average glandular doses for individual mammography examinations obtained according to the methods proposed by Dance et al (2000 Phys. Med. Biol. 45 3225-40) were calculated. The average glandular doses determined for 250 mammography facilities ranged from 0.12 to 14.56 mGy (the mean values ranged from 0.62 to 4.53 mGy). Only for 39 mammography facilities were all exposures found to be below the acceptable level for an average glandular dose, and for only 18 mammography facilities did no exposures exceed the achievable levels for an average glandular dose. Average glandular doses to women undergoing mammography screening attained unnecessary high values, and they were found to depend on the technical parameters of the mammography equipment and maintenance of mammography units by personnel in various mammography facilities.

[The reasons for the false positive diagnosis of glaucoma]. / Przyczyny falszywie dodatniego rozpoznania jaskry.

Glaucoma, if left untreated, leads to blindness, but if detected early, disease progression can be stopped or slowed with drugs or surgical treatment. The development of existing and new diagnostic methods has allowed substantial improvement in the clinical detection of possible glaucoma. But in some cases false positive diagnoses can be undertaken. In this paper we discussed reasons for the wrong evaluation of factors suggesting the diagnosis of glaucoma, with special interest for mistakes in applanation tonometry results caused by thick cornea.