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.

Moždani udar ili cerebrovaskularni inzult (CVI) je u današnje vrijeme jedan od glavnih uzroka smrtnosti i invaliditeta u svijetu. Veoma značajnu ulogu u dijagnostici CVI-a zauzima magnetna rezonanca (MR), koja se ogleda u mogućnosti klasifikacije i otkrivanju patofiziologije kako bi se pravovremeno i brzo postupilo sa terapijskim tretmanom ukoliko je došlo do pojave CVI-a. Ciljevi: Uporediti kvalitet prikaza CVI-a  između T2 FLAIR i T2 sekvence, utvrditi utjecaj lokalizacije CVI-a na intenzitet signala, utvrditi utjecaj vremena  pojave CVI-a na intenzitet signala. Utvrditi smo kategorije pacijenata kod kojih najčešće nastaje CVI, kao i korelaciju između uputne i definitivne dijagnoze. Metode istraživanja: Istraživanje je dizajnirano kao retrospektivna deskriptivna studija. Rad je realiziran u Kliničkom centru Univerziteta u Sarajevu, na Klinici za radiologiju. U studiju je uključeno 50 pacijenata kod kojih MR nalaz ukazuje na prisustvo CVI-a. Ispitivanje je obavljeno na MRI jedinicama jačine 1.5 i 3.0 T. Rezultati: Od ukupnog broja pacijenata 50 (100%), 32 su muškog pola (64%), a 18 (36%) ženskog pola. CVI je najčešće bio prisutan kod pacijenata muškog pola u grupi od 61-70 godine, dok je kod pacijenata ženskog pola najčešće bio prisutan u grupi od 71-80 godine. 52% pacijenata je imalo jedan od faktora rizika za nastanka CVI-a, HTA je bila prisutna kod 28% pacijenata a DM kod 22% pacijenata. T2 FLAIR sekvenca je imala veće vrijednosti intenziteta signala na lateralnom rubu CVI-a, dok je T2 sekvenca imala veće vrijednosti u centru i prednjem rubu CVI-a.  T2 FLAIR sekvenca je imala veći intenzitet signala na lokacijama: thalamus, mesencephalon, okcipitalno kortikalno subkortikalno i  područje kapsule interne. T2 sekvenca je imala veći intenzitet signala lokacijama: medula oblongata, parieto okcipitalno kortikalno subkortikalno, frontoparietalno paraventrikularno, parietalno kortikalno subkortikalno, frontoparietalno kortikalno subkortikalno, cerebelum i pons. Najčešća uputna  dijagnoza je bila CVI. Zaključak: T2 FLAIR sekvenca je senzitivnija kod prikaza akutnog i subakutnog CVI-a. T2 sekvenca je senzitivnija kod prikaza hroničnog CVI-a, čime radna hipoteza u ovom slučaju nije u potpunosti dokazana.

ABSTRACT Uvod: Karcinom glave i vrata čini 3-5 % svih malignih oboljenja, koji je većinom zastupljen kod muškaraca. Napretkom radioterapije omogućen je optimalniji pristup u liječenju karcinoma glave i vrata, sa poboljšanim ishodom liječenja. Primjena savremenih imidžing tehnika u verifikaciji preciznosti tretmana znatno je promijenila tok radioterapije u liječenju malignih bolesti u smislu eskalacije doze na ciljni volumen uz veću poštedu zdravih struktura. Svrha rada je dokazati značaj i ulogu slikovne verifikacije CBCT imidžing metodom u preciznosti liječenja i kontroli tumora tokom tretmana. Materijal i metode: Istraživanje je provedeno prospektivno u trajanju od 6 mjeseci, na Klinici za onkologiju, Kliničkog centra Univerziteta u Sarajevu. U studiju je uključeno 30 pacijenata sa karcinomom glave i vrata, kod kojih je primjenom slikovne verifikacije CBCT-om uočen gubitak tjelesne težine ili promjena ciljnog volumena. Pacijenti su zračeni VMAT tehnikom na linearnom akceleratoru TrueBeam. Rezultati: Rezultati istraživanja su pokazali da je većina pacijenata bila muškog spola (19), starije životne dobi, sa karcinom larinksa koji je bio prisutan u čak 11 ispitanika. Jači nusefekti bili su prisutni samo kod 3,33% pacijenata, a najzastupljenije neželjene reakcije bile su blaga promuklost, suhoća usta, zamor, otežano gutanje. Od ukupnog broja pacijenata, kod 16 pacijenata uočeno je smanjenje volumena targeta koji je inicijalno prosječno iznosio 80,16 cm3, dok je nakon prosječno 18 frakcija zračenja iznosio 77,58 cm3, što je sigifikanto statistički dokazano (p= 0,007). Utvrđeno je smanjenje volumena lijeve parotidne žlijezde nakon reskeniranja u odnosu na inicijalnu vrijednost (17.37±7.55/16.93±7.06 cm3). Kod svih pacijenata na CBCT volumetrijskim slikama uočen je gubitak tjelesne težine. Zaključak: Radioterapija karcinoma glave i vrata jedan je od učinkovitih modaliteta liječenja, koji moće biti praćen određenim neželjenim reakcijama. Primjena IGRT-a na osnovu kompjuterizirane tomografije konusnog snopa (CBCT), uveliko doprinosi peciznoj isporuci propisane doze zračenja, uz smanjenu toksičnost tretmana. Volumetrijski prikaz anatomskih struktura CBCT metodom, omogućio je da se promijeni tok kursa radioterapije u smislu prilagođavanja PTV margina u toku tretmana, odnosno primjenu adaptivne radioterapije.  

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

Background: The use of resolution recovery (RR) in bone and myocardial perfusion imaging is becoming increasingly popular in nuclear medicine departments. RR produces reconstructed images that show improved spatial resolution and signal-to-noise ratio compared with conventional single-photon emission computed tomography (SPECT) images. Objective: To evaluate the impact of the ordered subset expectation maximization (OSEM) RR modality on preserving noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) for short SPECT acquisition. Methods: This prospective study was conducted on 80 patients. Full SPECT acquisition was performed as a standardized protocol, while reduced acquisition was achieved with the Poisson resampling method. Noise, SNR, and CNR were measured for different reconstruction parameters for the same image levels. The impact of surface area and body mass index was also measured for the same reconstruction parameters. Results: The results show significantly higher SNR and CNR for the Evolution for Bone protocol compared to the other two reconstruction protocols for full and reduced SPECT acquisition. With the shortening of the SPECT acquisition, an increase in the value of noise was recorded. SNR and CNR decreased with the reduction in SPECT acquisition. Conclusion: The Evolution for Bone protocol for all three analyzed acquisition protocols had the lowest noise values. The highest SNR and CNR were recorded in the Evolution for Bone protocol for the three acquisition protocols and SPECT acquisition time can be reduced from 20 to 10 min for bone SPECT.

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.

Već nekoliko decenija, rak pluća najčešći je uzrok oboljevanja i umiranja od malignih tumora širom svijeta. Kako u svijetu tako i u BiH maligne neoplazme danas su visoko rangirane na listi vodećih uzroka smrti u gdje najveći udio u ukupnom broju čine maligne neoplazme bronha i pluća. Karcinom pluća, histološki gledano može se opisati kao bolest, koja ima mnogo podvrsta, te svaka od njih zahtjeva specifičan oblik terapije. Jedna od najprovjerenijih metoda u liječenju raka pluća je radioterapija. Razvoj informatičkih tehnologija doprinio je napretku medicine kao znanstvene grane, posebno u području radioterapije gdje je tehnološki napredak omogućio poboljšanje preciznosti prilikom zračenja malignih tkiva uz bolju kontrolu okolnog zdravog tkiva. Prilagodba radioterapije respiratornim pokretima oduvijek je bila glavna briga u radioterapiji karcinoma grudnog koša. Pokreti prilikom disanja ne utiču samo na pozicioniranje pacijenta tijekom provođenja terapije, već i na pogreške u procesu planiranja liječenja. Kako bi se riješio ovaj problem i reducirala pojava grešaka, već 1990.–ih godina predlaže se upotreba tehnike respiratornog gatinga. 4D – CT kao opcija je poželjan za procjenu tumorske kretnje i individualiziranje ciljnog volumena i njegovih margina. Dimenzija vremena zajedno sa CT-om čini savršenu 4D tehniku koja minimizira utjecaj respiracijskog kretanja tumora i omogućuje lakše ocrtavanje istog. Korist i rasprostranjenost primjene respiratornog gatinga predstavlja prioritet za poboljšanje kvalitete i rezultata radioterapije. Postizanje lokalne kontrole tumora zahtijeva razumijevanje i uključivanje pokreta tumora u simulaciji, planiranju i isporuci tretmana, što dovodi do višestrukih mogućnosti praćenja kretnji targeta. Tehnike respiratornog gajtinga koriste vanjske uređaje za predviđanje faze ciklusa disanja dok pacijent slobodno diše i omogućava isporuku doze samo u određenim fazama disanja. Isporuka snopa zračenja tehnikom respiratornog gatinga namijenjena je kako bi se ograničila ozračenost tumora koji se kreće tokom disanja, na odabrane dijelove respiratornog ciklusa i na taj način omogućava eskalaciju doze i smanjenje doze na rizične organe. Praćenje respiratornog ciklusa zajedno sa četverodimenzionalnim planiranjem pruža opcije kao što su ozračivanje integrisanog tumorskog volumena uz mogućnost aplikovanja zračenja u trenucima udisaja ili izdisaja. Brojna istraživanja predstavljaju tehniku respiratornog gatinga značajnim izazovom, ali i optimalnom tehnikom za liječenje karcinoma pluća uz znatno smanjenje nuspojava i komplikacija radioterapijskog tretmana.

Introduction: Prostate cancer has been the leading type of cancer to affect male population, and as such, it is a subject to efforts to furthermore diagnostic tools already in existence as well as development of new ones which will Aid early diagnostic, treatments as well as a follow up procedures and clinical trials. Bone scan index is a useful and objective biomarker used as a valuable tool for determination as to precise bone involvement in advanced cases, as well as a tool to predict the outcome in prostate cancer patients in clinical trials.Methods: This paper is a non-experimental (qualitative) research, that is, a scientific review of the literature.Results: The results we analyzed in this paper were collected from published academic journals.Conclusion: As a new imaging biomarker, bone scan index has potential to predict therapeutic effects and survival of patients with prostate cancer. Using measurable diagnostic image parameters, the bone scan index is important for determining metastatic bone changes in prostate cancer patients.

Introduction: Glioblastoma in children (pGBM) occurs somewhat less frequently than in adults. Pediatric pGBMs have a different molecular profile than GBM for adults. The aim of the presentation of this case is the possibility of the effectiveness of the GBM radiation method and the evaluation of magnetic resonance imaging, and the monitoring of the treatment outcome of the patient.Material and methods: The case study is of the retrospective-prospective type. Medical documentation, magnetic resonance imaging, and chronologically monitored evaluation of the findings from November 2018 to August 2021 were used to present the study. The postoperative course was analyzed, as well as the effect of concurrent chemoradiotherapy, VMAT radiotherapy and adjuvant chemotherapy with Temozolomide in a patient aged 4 years and 6 months, comparing treatment outcome with median and overall survival in glioblastoma.Results: The pediatric patient after being diagnosed with high-grade glioma in 2018 is so far in very good general condition, without signs of physical and psycho-social defects, which compared to the scientifically proven median of survival indicates a good therapeutic effect. Volumetrically modulated arc radiotherapy with the use of modern IGRT verification techniques and with the use of chemotherapy with Temozoloimod, has proven to be a still effective oncological method treatment of GBM. For the final outcome of the disease and the effect of therapeutic modalities, the patient's condition and evaluation of magnetic resonance imaging will be monitored. The result supports further research into this therapeutic regimen.Conclusion: Glioblastoma is a very aggressive tumor, which occurs somewhat less frequently in the pediatric population than in adults, but is a very fatal disease. Surgical resection followed by concurrent chemoradiotherapy, with adjuvant Temozolomide is still the method of choice in the treatment of glioblastoma.

Introduction: Radiation therapy has long played an integral role in the manage¬ment of locally advanced head and neck cancer (HNC), both for organ preservation and to improve tumor control in the postoperative setting. The aim of this research is to investigate the effects of adaptive radiotherapy on dosimetric, clinical, and toxicity outcomes for patients with head and neck cancer undergoing radiation therapy treatment. Many sources have reported volume reductions in the primary target, nodal volumes, and parotid glands over treatment, which may result in unintended dosimetric changes affecting the side effect profile and even efficacy of the treatment. Adaptive radiotherapy (ART) is an interesting treatment paradigm that has been developed to directly adjust to these changes.Material and methods: This research contains the results of 15 studies, including clinical trials, randomized prospective and retrospective studies. The researches analyze the impact of radiation therapy on changes in tumor volume and the relationship with planned radiation dose delivery, as well as the possibility of using adaptive radiotherapy in response to identified changes. Also, medical articles and abstracts that are closely related to the title of adaptive radiotherapy were researched.Results: The application of ART significantly improved the quality of life of patients with head and neck cancer, as well as two-year locoregional control of the disease. The average time to apply ART is the middle of the treatment course approximately 17 to 20 fractions of the treatment.Conclusion: Based on systematic review of the literature, evidence based changes in target volumes and dose reduction at OAR, adaptive radiotherapy is recommended treatment for most of the patients with head and neck cancer with the support of image-guided radiotherapy.

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.