Kultura sigurnosti je set vrijednosti, znanja, vještina, stavova i prakse na individualnom i institucionalnom nivou organizacije radioterapijskog procesa koji uspostavlja način rada u kojem sigurnost i zaštita zdravlja predstavljaju prioritet prilikom obavljanja radnih zadataka. Razvoj kulture sigurnosti na individualnom i institucionalnom nivou postalo je jedno od ključnih sigurnosnih pitanja u savremenoj radioterapiji. Cilj ovog istraživanja je procijeniti mogućnost upotrebe elektronskog sistema za prijavljivanje incidenata u razvoju kulture sigurnosti kod zdravstvenih profesionalaca u radioterapiji i mogućnost izgradnje sistemske primjene seta vrijednosti koji omogućava obavljanje svih radnih zadataka u radioterapiji uz davanje maksimalnog priorieta sigurnosti. Kao instrument istraživanja korišten je elektronski sistem za prijavljivanje incidentata u formi strukturiranog kompjuterskog intervjua prema ROSEIS metodologiji. Na osnovu informacija prikupljenih pomoću sistema napravljena je procjena razvijenosti različitih segmenata kulture sigurnosti, predložene mjere na njenom razvoju i poboljšanju, te data pocjena njihove efikasnosti u unaprijeđenju sigurnosti u radioteapiji. Razvijena kultura sigurnosti u radioterapijskom radnom okruženju može značajno unaprijediti kvalitet radioterapijskog tretmana, reducirati pojavu incidenata, poboljšati efikasnost i efektivnost radioterapijskog tretmana. Razvoj kulture sigurnosti ne podrazumijeva samo uspostavu standardnog seta pravila, nego i promjenu stavova, ponašanja i profesionalne prakse na individualnom i institucionalnom nivou.

Background: Radiotherapy is one of the primary treatment options in cancer management, together with surgery and chemotherapy. Radiation therapy is technologically complex discipline involving professionals with various specialties, and using high energy radiation in treatment of wide range of different cancer types. Technical complexity, increasing number of patients, large workload, and delivery of radiation therapy treatment with lack of human, technical and financial resources in low and middle income countries creates environment with great potential to develop incidents. Emerging need of modern radiation therapy is to develop preventive approach to risk management i to improve the patient safety. Objective: The objective of this research is to identify and assess risk associated with radiation therapy practice in Bosnia and Herzegovina. Methods: An anonymous, voluntary electronic on-line radiation therapy incident reporting system (IRS) was created. IRS consists of four sections containing questions about working environment, incident occurrence, root causes and contributing factors, and incident severity assessment. Data collected using IRS were used to create taxonomy of incidents in radiation therapy. Risk assessment was made using Risk Matrix method. Research was made using the data collected from first 60 incidents reported to IRS. Results: Based on probability and frequency of incident occurrence and severity of consequences, it was assessed that 41.7% of incidents had low risk level (L), 50% of incidents had moderate risk level (M), and 8.3% of incidents had high risk level (H). Radiation therapy risk profile based on risk assessment results clearly shows that incidents with low frequency, low occurrence probability, but high consequences severity level have highest level of risk. Conclusion: The results of this research confirm that the electronic on-line radiation therapy IRS allows the identification and classification of the most significant risk factors in radiotherapy and prevention of serious incidents occurrence.

Contouring, planning and dose calculation in treatment planning systems (TPS) are based on computedtomography (CT) images. Therefore, it is important to have developed, optimized and adapted scanning protocolsfor specific anatomic regions and special radiotherapy modalities such as stereotactic radiosurgery (SRS). The aimof this study was to determine influence of tube voltage, field of view size (FOV) and reconstruction kernels on CTnumbers and the resulting radiotherapy (RT) dose calculation.This study was performed at Clinic of Oncology, Clinical Center University of Sarajevo. Verification electrondensity and CT number values was performed using CIRS Thorax 002LFC phantom, while anthropomorphic CIRS038 phantom for stereotactic end-to-end verification was used for the purpose of dose plan calculation analysis withlarge bore CT simulator Canon Aquillion LB.The significant correlation between the tube voltage and the measuredvalues of CT numbers is significant for all materials (p < 0.05), except for water (p = 0.310). No significantcorrelation between FOV and obtained values of CT numbers was found in any of the evaluated tissue equivalentmaterials. Evaluating the impact of reconstruction kernels on Hounsfield units (HU), significant deviations werefound for the FC62, FC68 and FC07 reconstruction kernels. Also, analyzing the influence of reconstruction kernelson the RT dose calculation, the extreme values are associated with Dmin/D in PTV for kernels FC41 and FC68, wheredeviations from the values obtained using the baseline scanning parameters were -1.3% and -1.9%. For deviation of1 HU in muscle tissue of CIRS 002LFC, the calculated Dmin/D in PTV of CIRS STEEV phantom will reduce by0.79%. Similarly, the reduction of D₉₈ and D₂ would be 6.8 cGy and 3.03 cGy for 1 HU, respectively. Change of thereconstruction kernels caused differences of 0.4% in Dmin/D calculation in clinical target volume (CTV).CT scanning and reconstruction parameters may affect Hounsfield units, which could have an impact on dosecalculations in RT plan. Hence, it is recommended to standardize the scanning protocol used in calibration curvegeneration for TPS. One should avoid use of different tube voltages and kernels, while according to this study, thechange of FOV will have no impact on dose calculations

Uvod: Radioterapija je kompleksna disciplina koja uključuje širok spektarstanja izazvanih malignim oboljenjima, organizacionu kompleksnost i upotrebu naprednih tehnoloških rješenja u terapiji, te ima veliki potencijal za razvoj incidenata.Incidenti, u zavisnosti od stepena ozbiljnosti, mogu kompromitirati efekat radioterapije, dovesti do izostanka kontrole bolesti i njenog recidiva ili pojave ranih i kasnih komplikacija na zdravim organima u smislu radiotoksičnosti. Ozbiljni incidenti u radioterapiji su rijetki, ali kada se dese, njihove posljedice mogu biti značajno oštećenje zdravlja ili smrt. Incidenti nisu posljedica slučajnog toka događaja, niti koincidencije koja će se teško ponoviti. Pojava incidenata ima svoje zakonitosi i posljedica je sistemskih postavki, uslova i procesa. Cilj ovog istraživanja je procijeniti mogućnost upotrebe elektronskog sistema za prijavljivanje incidenata u upravljanju rizikom u radioterapiji. Metode: Za potrebe istraživanja razvijen je elektronski sistem za prijavljivanje incidentata u formi strukturiranog kompjuterskog intervjua prema ROSEIS metodologiji. Na osnovu informacija prikupljenih pomoću sistema napravljena je taksonomija incidenata prema: vrsti, mjestu i načinu nastanka, načinu detekcije, uzroku nastanka i faktorima doprinosa, dozimetrijskom i kliničkom značaju, te ozbiljnosti posljedica. Procjena rizika je napravljena upotrebom Risk Matrix metode. Rezultati: U rezultatima su prikazani najčešći uzroci nastanka i faktori promocije incidenata u radioterapiji, kao i njihova povezanost sa faktorima radnog okruženja, organizacije i upravljanja, finanasijskim i ljudskim resursima, radnim opterećenjem, radioterapijskim uređajima, softverom i tehnološkom kompleksnošću tretmana.Predložene su korektivne i preventivne mjere, te data procjena njihove efektivnosti na poboljšanje detekcije, redukciju vjerovatnoće pojave incidenata i redukciju njihove magnitude. Zaključci: Rezultati istraživanja pokazuju da su informacije prikupljene pomoću elektronskog sistema za prijavljivanje incidenata dobar prerekvizit za razvoj sistema upravljanja rizikom koji omogućava identifikaciju i klasifikaciju najznačajnijih faktora rizika u radioterapiji, kao i utvrđivanje specifičnih preventivnih i korektivnih akcija s ciljem prevencije pojave incidenata i redukciju ozbiljnosti njihovih neželjenih efekata.

The presence of a high-density material object such as the vascular access port made of titanium, can affect the homogeneity of dose distribution in underlying tissues. This influence depends on numerous factors but in the first place on the composition material of such an object and its geometry. In this work an influence of the various titanium-made vascular ports, placed in the 6 MV photon field, have been analyzed. The vascular ports of various sizes were placed on the top of thepolymethyl-methacrylate (PMMA) phantom which is then scanned on a computed tomography (CT) simulator to generate the digitized 3-dimensional images for the purpose of treatment planning. The treatment plans were prepared in matRad treatment planning toolkit. The beam profiles and the percentage depth doses have been analyzed. The observed maximum dose values, for ports A, B, C and D, relatively to the maximum dose value in PMMA phantom alone, were 102.25%, 100.62%, 101.78% and 102.48%, respectively. The titanium edges of the ports reduce the dose below them in amount of 8.52%, 8.64%, 10.01% and 10.04% observed for ports A, B, C and D, respectively, in comparison to the central axis dose value obtained in PMMA phantom for the port-free case. The established changes in PDD curves and beam profiles depend on the vascular access port dimensions, reservoir volumes as well as of the amount of titanium content.

Introduction: The engineers of the medical radiology in radiotherapy are key professional group directly responsible for reliable delivery of radiation therapy treatment and the implementation of radiation protection measures in practice. Therefore, their knowledge and skills in this area need to be adequate and up to date. The aim of this research is the assessment of knowledge, attitudes and practice in the field of radiation protection among the engineers of medical radiology employed in radiotherapy centers within the public healthcare system in Bosnia and Herzegovina. Material and methods: The research was conducted on a sample of 30 engineers of medical radiology using a structured questionnaire which contains demographic data and sets of 10 questions related to radiotherapy devices, radiation protection in radiotherapy, risks and incidents related to use of ionizing radiation and the role of medical radiology engineers in radiation protection system. Results: The results of the research show optimal level of knowledge in the field of radiation protection (74.66%) and optimal level of awareness of the risks associated with the use of ionizing radiation (72%). The level of knowledge and awareness is significantly higher among respondents with longer working experience and those who have completed master’s degree and postgraduate education in the field of radiation protection. The application of ionizing radiation protection measures in practice has been assessed as satisfactory (2,3). Respondents are not sufficiently involved in the work of regulatory bodies (26.7%), decisionmaking (23.3%), development of procedures (23.3%) and education of other employees in the field of radiation protection (2.7%). Conclusion: Engineers of medical radiology are not fully involved in the radiation protection system as educated and trained professionals. One of the most important professional interests of engineers of medical radiology is adequate influence on the processes in the field of radiation protection.