Image quality and dose in mammography in 17 countries in Africa, Asia and Eastern Europe: results from IAEA projects.

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.

Some aspects on radiation protection in conventional and digital radiology in Romania.

Since 1965, medical radiation exposure in the population of Romania has been evaluated by the Network of Radiation Hygiene Laboratories of the Ministry of Public Health, including 23 laboratories throughout the whole country; the network is co-ordinated by the Institute of Public Health Bucharest. In Romania, for a population of 22.5 million inhabitants, 465 X-ray examinations were reported during the last survey, the most frequent being chest examination. There was no specific reference to digital radiology. Digital radiology has been introduced only recently in Romania, and only some rough data on the situation can be presented. Siemens AG is now present in Romania with 23 installations, type SIEREGRAPH CF and AXIOM ICONOS. A digital image intensifier technique is used only for fluoroscopy, and radiography is performed using a conventional film/screen combination. The company Philips has nine installations for angiography, model INTEGRIS, and uses a computed radiography technique. Several direct digital radiography MULTISYSTEM SWISSRAY installations (about 40 units) are also available for adult and paediatric examinations. The Council Directive 97/43/EURATOM on health protection of individuals against dangers of ionising radiation in relation to medical exposure was fully transformed into Romanian legislation in 2002.

Ionizing radiation--understanding and acceptance.

A written survey about perceived radiation risks was conducted among three groups of a total of 400 individuals. Seventy-seven (26%) of the respondents were radiation workers, 35 (12%) were medical doctors without professional exposure, and 177 (68%) belonged to the general population. Even if the sample is not representative of the Romanian population as a whole, some interesting conclusions can be made. The level of anxiety toward radiation, expressed as a hazard perception index, is significantly lower in radiation workers when compared to medical doctors and the general population (0.81 +/- 0.94, 1.42 +/- 1.21, and 1.72 +/- 1.34, respectively, p < 0.001). Hazard perception index values also varied with the education status, with lowest values among medical university graduates and highest among public school graduates (p < 0.001). Both university-graduated groups significantly differ from the non-university groups (p < 0.05). Knowledge about radiation and emergency plans for nuclear accidents/incidents was also correlated with hazard perception, with the results confirming the hypothesis that better knowledge is associated with lower radiation hazard perception. The extent to which people accept civilian nuclear power is also related to hazard perception and knowledge. The way people perceive the radiation risk differed among the three groups. Different levels of risk perception were associated with radiation from nuclear energy and diagnostic x rays. It is important that radiological protection authorities develop new plans and materials for communicating with the general public in order to improve knowledge of ionizing radiation, radiation risks, and the safety of civilian nuclear energy employment.