ZAŠTITA OD JONIZIRAJUĆEG ZRAČENJA KOD MEDICINSKE EKSPOZICIJE

ZAŠTITA OD JONIZIRAJUĆEG ZRAČENJA KOD MEDICINSKE EKSPOZICIJE
IONIZING RADIATION PROTECTION DURING MEDICAL EXPOSURE

Contributor(s): Lidija Lincender-Cvijetić (Editor)
Subject(s): Health and medicine and law
Published by: Akademija Nauka i Umjetnosti Bosne i Hercegovine
Keywords: Radiation protection; radiodiagnostics; nuclear medicine; radiotheraphy; Ionizing radiation; Use of CT; Medicine in Bosnia and Herzegovina;
Summary/Abstract: Na naučnom simpoziju „Zaštita od jonizirajućeg zračenja kod medicionske ekspozicije“ koji je organizovao Odbor za maligna oboljenja Odjeljenja medicinskih nauka ANUBiH, održano je 13 predavanja. Nakon izlaganja eminentnih stručnjaka iz ove oblasti iz Bosne i Hercegovine, kao i na osnovu diskusija, doneseni su sljedeći zaključci: - Jačanje kapaciteta učesnika u provođenju medicinske ekspozicije, kao i Državne regulatorne agencije za radijacijsku i nuklearnu sigurnost, kako bi se u potpunosti mogli implementirati međunarodni standardi iz oblasti zaštite od zračenja pacijenata; - Uvođenje kursa zaštite od jonizirajućeg zračenja u osnovni plan i program medicinskih i stomatoloških fakulteta; - Usklađivanje kursa iz zaštite od jonizirajućeg zračenja na fakultetima zdravstvenih studija sa međunarodnim standardima; - Uspostavljanje specijalizacije iz oblasti medicinske fizike na cijeloj teritoriji države Bosne i Hercegovine u skladu sa međunarodnim standardima; - Promocija zaštite od zračenja pacijenata kod ljekara koji upućuju na radiodijagnostičke i nuklearnomedicinske preglede. Simpozij je pobudio interes kako medicinskih radnika, tako i ostalih, jer se radi o savremenoj temi koja predstavlja problem zbog široke primjene jonizirajućeg zračenja u medicinske svrhe. Potrebni su strogi kriteriji za upućivanje na radiološke pretrage, kao i obavezna primjena zaštite od jonizirajućeg zračenja.

Series: Posebna izdanja ANUBiH

E-ISBN-13: 978-9926-410-30-8
Page Count: 128
Publication Year: 2018
Language: Bosnian, English, Croatian, Serbian

OPRAVDANOST MEDICINSKE EKSPOZICIJE I KRITERIJA ZA UPUĆIVANJE NA RADIOLOŠKE PRETRAGE

OPRAVDANOST MEDICINSKE EKSPOZICIJE I KRITERIJA ZA UPUĆIVANJE NA RADIOLOŠKE PRETRAGE
(JUSTIFICATION OF MEDICAL EXPOSURE AND CRITERIA FOR REFERRAL TO DIAGNOSTIC IMAGING)

Author(s):Lidija Lincender-Cvijetić
Contributor(s):Svjetlana Baroševčić (Translator)
Language:Bosnian, Croatian, Serbian
Subject(s):Health and medicine and law
Page Range:7-12
No. of Pages:6
Keywords:ionizing radiation; radiology; radiation protection;
Summary/Abstract:Aim of the article: To draw attention to justification of medical exposure in the application of ionizing radiation, as well as to the necessity of ionized radiation protection through the application of existing regulations. This study refers to the application of ionizing radiation for medical purposes, justification of medical exposure, criteria for referral to diagnostic imaging, and ionizing radiation protection. The protection is based on the opinion that diagnostic imaging is justified and useful for patients. Balance between digital techniques and radiation dose the patient receives is very important in digital techniques. Nowadays, diagnostic imaging procedures present one of the largest artificial sources of ionizing radiation of the population in medicine. Proper selection of diagnostic imaging procedures and monitoring of the disease can influence setting the final diagnosis and application of adequate treatment. It is necessary to avoid duplication and repetition of diagnostic imaging procedures using ionizing radiation. Special importance in diagnostic imaging procedures applied to both adults and children requires knowledge of imaging procedure possibilities, their adequate application and education of radiology engineers. The most important is the safety of the patient in the application of necessary radiology procedures (imaging techniques and exposures) which is achieved by adequate protection and immobilization. Professional staff must adhere to ionizing radiation protection measures in the field of imaging diagnostics, nuclear medicine and radiotherapy. Compliance with ALARA (As Low as Reasonably Achievable) principles issued by European Agency for Protection against Ionizing Radiation and application of regulations of the State Regulatory Agency for Radiation and Nuclear Safety can significantly reduce the radiation dose without losing diagnostic information. Application of the specific levels of radiation doze for each particular imaging as an “accepted level” along with regular quality control of diagnostic and therapeutic procedures can assist in the protection against radiation in radiology, in justified application of diagnostic imaging and therapeutic procedures. Conclusion: By the adequate application of diagnostic imaging procedures based on strict clinical indications, by modifying the existing regulations and protection means, as well as by continuously educating radiologists, general practitioners, specialists and medical radiology engineers, we can contribute to decreasing the risk when it comes to changes in ionizing radiation in medicine.

OPTIMIZACIJA ZAŠTITE OD ZRAČENJA U RADIODIJAGNOSTICI

OPTIMIZACIJA ZAŠTITE OD ZRAČENJA U RADIODIJAGNOSTICI
(OPTIMIZATION OF RADIATION PROTECTION IN DIAGNOSTIC RADIOLOGY)

Author(s):Adnan Beganović
Contributor(s):Adnan Arnautlija (Translator)
Language:Bosnian, Croatian, Serbian
Subject(s):Health and medicine and law
Page Range:13-20
No. of Pages:8
Keywords:radiology; radiodiagnostics; optimization; radiation protection;
Summary/Abstract:The International Commission on Radiological Protection (ICRP) has published a number of reports dealing with various topics in the field of radiation protection of patients, professionally exposed persons and the population. “ICRP Recommendations of 2007” deal with general principles of radiation protection, such as: justification, optimization and limitation of individual doses and risk. These principles have become part of domestic regulations, among which is the Ordinance on the Protection against Ionizing Radiation in Medical Exposure, where special attention is given to the principle of optimization. The methods of optimization are described for the four most important techniques in diagnostic radiology: radiography, mammography, fluoroscopy and computed tomography. Furthermore, the dosimetric quantities used as dose indicators for the patient are also given. The optimization process should be planned, implemented and monitored by a working group with sufficient authority to modify the method of operation in the radioiodiagnostics department. The precondition for initiating optimization is to determine the doses in the most common procedures in diagnostic radiology. The results obtained should be published and transparent, so they can be used in the education and training of staff.

OPTIMIZACIJA U NUKLEARNOJ MEDICINI

OPTIMIZACIJA U NUKLEARNOJ MEDICINI
(OPTIMIZATION IN NUCLEAR MEDICINE)

Author(s):Elma Kučukalić - Selimović, Amra Skopljak-Beganović
Contributor(s):Adnan Arnautlija (Translator)
Language:Bosnian, Croatian, Serbian
Subject(s):Health and medicine and law
Page Range:21-27
No. of Pages:7
Keywords:nuclear medicine; optimization; radiation protection;
Summary/Abstract:Optimizing the use of ionizing radiation sources is one of the basic principles promoted by the International Commission on Radiological Protection (ICRP), and as such it has become a part of domestic and international regulations. The Ordinance on the Protection from Ionizing Radiation in Medical Exposure, which is a transposition of the European Directive 2013/59/Euratom, requires the users to apply this principle in nuclear medicine. Optimization methods are used in nuclear medicine in order to obtain an interpretive finding with minimal exposure of the patient to ionizing radiation. Optimization methods for nuclear medicine examinations include selecting appropriate radiopharmaceuticals, selecting the appropriate radioactive isotope activity and analyzing image quality, extending the acquisition time, selecting the appropriate collimator, etc. The optimization process is a team effort, involving a specialist in nuclear medicine, a medical physicist and a medical radiology engineer. An optimized protocol for any examination should be available to staff involved in nuclear medicine work tasks.

ZAŠTITA OD ZRAČENJA U RADIOTERAPIJI

ZAŠTITA OD ZRAČENJA U RADIOTERAPIJI
(RADIATION PROTECTION IN RADIOTHERAPY)

Author(s):Nermina Kantardžić
Contributor(s):Dino Kantardžić (Translator)
Language:Bosnian, Croatian, Serbian
Subject(s):Health and medicine and law
Page Range:28-38
No. of Pages:11
Keywords:radiotherapy; radiation protection; quality assurance;
Summary/Abstract:Aim: To present the basic principles in radiation protection in radiotherapy. Protection for public, professionals and patients are discussed in the paper. Background: Radiotherapy is the one of main methods of treatment modalities of malignant tumors, which uses high energy ionization. It is sophisticated process consisting of several phases of work. Because of its complexities and usage of high energy radiation, need specific protection against unnecessary radiation for every phase. Methods and materials: We researched literature of radiation protection in radiotherapy, used experiences of work in department of radiotherapy of Clinic of Oncology Clinical Center of Sarajevo University. In this work we presented proposals and standards of International Agency of Atomic Energy (IAEA). Discussion: Radiation protection in radiotherapy should encompass all aspects of work. Conclusion: Optimal radiotherapy includes: high and potentially lethal absorbed dose is required to cure cancer, individualized treatment approach, sophisticated technology environment, complex treatment set-up, quality assurance, and treatment verification and radiation protection.

ZAŠTITA OD ZRAČENJA PACIJENATA U TOKU RADIOTERAPIJSKOG TRETMANA PRIMJENOM MODERNIH TEHNIKA ZRAČENJA

ZAŠTITA OD ZRAČENJA PACIJENATA U TOKU RADIOTERAPIJSKOG TRETMANA PRIMJENOM MODERNIH TEHNIKA ZRAČENJA
(PATIENT PROTECTION FROM RADIATION DURING RADIOTHERAPY TREATMENT BY USING MODERN RADIOTHERAPY TECHNIQUES)

Author(s):Danijela Trokić, Goran Marošević, Dražan Jaroš, Aleksandar Kostovski, Dejan Ćazić, Oliver Arsovski, Božica Vujošević, Slavica Marić, Pavle Banović, Goran Kolarević, Milomir Milaković
Contributor(s):Dijana Stričić (Translator)
Language:Bosnian, Croatian, Serbian
Subject(s):Health and medicine and law
Page Range:39-62
No. of Pages:24
Keywords:protection; radiation; SRT/SBRT; IMRT;
Summary/Abstract:Purpose: to present the methodology of radiotherapy practice using modern radiotherapy techniques. Background: Technological progress resulted in implementation of new radiotherapy techniques for precise high-dose delivery to target volume with maximal protection of surrounding healthy tissue. Methodology: patient preparation on 4DCT-simulator using adequate immobilization devices, fusion of simulation CT images with diagnostic CT/MRI/PET images, target volume delineation and organs at risk delineation. Treatment planning procedure uses VMAT/RapidArc: Eclipse TPS protocol for dose escalation in target volume with maximal protection of surrounding healthy tissue over steam dose gradient. That is accomplished by isocentric dose delivery from multiple narrow radiation beams with unequally weighted beam intensity (IMRT) or by Arc-technique with source of radiation rotating around the patient for 360o while the target volume is modulated by dynamic collimator leaf movement (VMAT, SRS/SRT, SBRT). Accuracy of dose delivery by checking the target position is provided by image guided radiotherapy during the treatment using OBI CBCT. Discussion: Implementation of modern radiotherapy techniques requires highly sophisticated facilities so the delivery of high doses to tumor is feasible. Sparing surrounding tissue is significant comparing to previous techniques but for the cost of irradiating greater volume of healthy tissue with lower doses of radiation. Conclusion: High-dose delivery to tumor tissue is in direct correlation with better tumor control with keeping the dose to healthy tissue below the limit that can cause significant organ dysfunction (less than 5% of complications). Completion of QA measures for assurance of high doses delivered to target and low doses to healthy tissue due to acute and late toxicity effects.

IZLAGANJE POPULACIJE IONIZIRAJUĆEM ZRAČENJU U MEDICINSKE SVRHE: PROCJENA RIZIKA, PRAĆENJE, UPRAVLJANJE I IZVJEŠTAVANJE O DOZAMA ZRAČENJA

IZLAGANJE POPULACIJE IONIZIRAJUĆEM ZRAČENJU U MEDICINSKE SVRHE: PROCJENA RIZIKA, PRAĆENJE, UPRAVLJANJE I IZVJEŠTAVANJE O DOZAMA ZRAČENJA
(THE EXPOSURE OF POPULATION TO IONIZING RADIATION FOR MEDICAL PURPOSES: RISK ASSESSMENT, MONITORING, CONTROL AND REPORT OF RADIATION DOSES)

Author(s):Mirko Miljko, Dorijan Radančević, Vedran Markotić
Language:Bosnian, Croatian, Serbian
Subject(s):Health and medicine and law
Page Range:63-69
No. of Pages:7
Keywords:ionizing radiation; health care;
Summary/Abstract:The use of ionizing radiation for diagnostic and therapeutic purposes has been constantly increasing in the world. In order to diagnostic and therapeutic procedures that use ionizing radiation be approved for use, they must show sufficient utility of the relationship of the total potential diagnostic or therapeutic procedures, including the direct health benefits for the individual and the benefit for society as a whole, and the potential damage that could be caused to the individuals health. Some methods have shown positive impact on the final outcome of the diagnostic and therapeutic treatment of some patients. According to data from 2009, about 75% exposure to medical radiation comes from computer tomography and nuclear medicine procedures. The study “Projected Cancer Risks From computed tomographic Scans Performed in the United States in 2007” estimated that in the United States 29,000 new malignancies are developed as a result of 70 million CT examinations in 2007. (The increase in risk compared to the general population of about 0.041%). Similar studies in Bosnia and Herzegovina have shown an increased risk of projection of about 0.05%, taking into account the dose which patients are exposed to. In conclusion we can say that the reduction in the average effective dose and a consequent reduction in the risk to the patient can prevent the consequences in terms of the development of a large number of malignant diseases and achieve significant savings in the health system, which far exceeds the cost of installation dose management software.

OBUKA OSOBA PROFESIONALNO IZLOŽENIH JONIZIRAJUĆEM ZRAČENJU KOJE SU UKLJUČENE U PRIPREMU I PROVOĐENJE MEDICINSKE EKSPOZICIJE

OBUKA OSOBA PROFESIONALNO IZLOŽENIH JONIZIRAJUĆEM ZRAČENJU KOJE SU UKLJUČENE U PRIPREMU I PROVOĐENJE MEDICINSKE EKSPOZICIJE
(RADIATION PROTECTION TRAINING OF EXPOSED WORKERS INVOLVED IN PREPARING AND DELIVERING MEDICAL EXPOSURE)

Author(s):Davorin Samek, Mehidin Sirbubalo, Advan Drljević, Emir Dizdarević
Contributor(s):Rade Marković (Translator)
Language:Bosnian, Croatian, Serbian
Subject(s):Security and defense, Health and medicine and law
Page Range:70-78
No. of Pages:9
Keywords:radiation protection training; radiation protection standards; exposed workers; radiation protection regulation;
Summary/Abstract:The objective of this paper is to make an overview of the role and responsibilities of all institutions and individuals that are responsible for establishing and maintaining the radiation protection training system in B&H and to provide recommendations in order to implement the appropriate international standards. An analysis was made for the requirements of international standards in the field of radiation protection training, the current legislation, and the implementation degree of international standards in the currently applicable legislation in B&H. Within its authority, the national regulatory body has established a regulatory framework in accordance with the international standards of radiation protection training. However, the framework implementation does not take place in accordance with the specified deadlines. Radiation protection training, which is a part of the basic curriculum for the key professions in medical exposure, has not been fully implemented by the competent bodies. Based on the analysis of the current situation in radiation protection training, recommendations for the full implementation of international standards in B&H are provided here.

UPOTREBA CT-A U DJEČIJOJ DOBI U SVAKODNEVNOM RADU

UPOTREBA CT-A U DJEČIJOJ DOBI U SVAKODNEVNOM RADU
(THE USE OF CT IN CHILDREN IN DAILY WORK)

Author(s):Sandra Vegar-Zubović, Spomenka Kristić, Muris Bečirčić
Contributor(s):Deniz Bulja (Translator)
Language:Bosnian, Croatian, Serbian
Subject(s):Health and medicine and law
Page Range:79-83
No. of Pages:5
Keywords:the increasing number of CT scans; leukaemia; brain cancer; the ALARA approach;
Summary/Abstract:Goal: To determine the consequences of excessive use of CT in everyday clinical practice with special emphasis on pediatric patients. Background: Although, CT is a sovereign diagnostic method, its excessive use in clinical practice raises concerns about the possible risk for the development of malignant diseases incurred as a direct result of exposure to ionizing radiation by CT devices. The concern is even more increased in pediatric patients, due to their radiosensitivity. Methods: Review of recent literature and analysis of retrospective studies. Discussion: A study of 180,000 respondents younger than 22 years in the UK in the period between 1985 – 2002, conducted by Pearce and associates shows that the cumulative radiation dose of 50 mGy in children triples the risk of developing leukaemia, while the cumulative dose of 60 mGy nearly triples the risk of developing brain cancer. A study conducted in Australia between 1985 – 2005 within 11 million patients age 0-19, Mathews and associates observed the occurrence of malignant diseases for 10 years after completion of CT scans. They proved that the incidence of malignant diseases in children exposed to ionizing radiation is 24% higher than in unexposed children. Rice and associates13 calculated that one of 1,000 children who perform CT scan will get sick from cancer. Conclusion: The occurrence of expected number of cancer diseases created as a direct result of exposure to ionizing radiation by CT apparatus can be reduced up to 62% if the radiation dosage and all unnecessary indicated CT examinations are reduced.

ZAŠTITA OD JONIZIRAJUĆEG ZRAČENJA KOD MEDICINSKE EKSPOZICIJE (“VIZUALIZACIJA” RADIJACIJE)