It has been shown that fractal analysis is useful in image processing, texture analyses and texture image segmentation. It is important to clearly detect edges of breast masses, and precisely locate individual microcalcification in mammograms. We present practical help in that area by fractal analysis, using the concept of fractional Brownian motion. It can be shown that there is a correlation between specific quantitative result of such analysis (Hurst coefficient) and the type of breast mass or tumor. Keywords: digital mammograms, image segmentation, fractals, fractional Brownian motion, Hurst coefficient.

Many new computed tomography (CT) techniques have been introduced during the recent years, one of them being CT-assisted dynamic perfusion imaging (perfusion CT, PCT). Many concerns were raised when first cases of deterministic radiation effects were reported. This paper shows how radiochromic films can be utilised as passive dosemeters for use in PCT. Radiochromic dosemeters undergo a colour change directly and do not require chemical processing. Prior to their use, they need to be calibrated. Films are placed on top and on the right side of the patient and exposed during the procedure. Readout is performed using a densitometer. Results show that average local skin doses are 0.51±0.07 and 0.42±0.04 Gy on top and on the lateral side of the patient, respectively. Results of the patient dosimetry (local skin doses) are consistent. This is due to the fact that each patient had the same CT protocol used for imaging (120 kV, 60 mA and C(vol) of 247.75 mGy). Radiochromic films designed for interventional radiology can be effectively used for local skin dose measurements in perfusion CT. Dose values obtained are below the threshold needed for deterministic effects (erythema, hair loss, etc.). These effects might happen if inappropriate CT protocol is used; one that is usually used for routine imaging.

OBJECTIVE The purpose of this study was to assess the frequency of pediatric CT in 40 less-resourced countries and to determine the level of appropriateness in CT use. MATERIALS AND METHODS Data on the increase in the number of CT examinations during 2007 and 2009 and appropriate use of CT examinations were collected, using standard forms, from 146 CT facilities at 126 hospitals. RESULTS The lowest frequency of pediatric CT examinations in 2009 was in European facilities (4.3%), and frequencies in Asia (12.2%) and Africa (7.8%) were twice as high. Head CT is the most common CT examination in children, amounting to nearly 75% of all pediatric CT examinations. Although regulations in many countries assign radiologists with the main responsibility of deciding whether a radiologic examination should be performed, in fact, radiologists alone were responsible for only 6.3% of situations. Written referral guidelines for imaging were not available in almost one half of the CT facilities. Appropriateness criteria for CT examinations in children did not always follow guidelines set by agencies, in particular, for patients with accidental head trauma, infants with congenital torticollis, children with possible ventriculoperitoneal shunt malfunction, and young children (< 5 years old) with acute sinusitis. In about one third of situations, nonavailability of previous images and records on previously received patient doses have the potential to lead to unnecessary examinations and radiation doses. CONCLUSION With increasing use of CT in children and a lack of use of appropriateness criteria, there is a strong need to implement guidelines to avoid unnecessary radiation doses to children.

Monitoring of professionally exposed workers in Bosnia and Herzegovina started in 1960s. Doses received by patients and professionals in interventional cardiology are high in comparison with other practices in medicine. The purpose of this study is to present personal and patient dosimetry data. Results show increase in doses of personnel in interventional cardiology. Total collective dose for four cardiology centres in Bosnia and Herzegovina increased from 15 person mSv in 2007 to 52 person mSv in 2010. This increase mainly corresponds to higher number of personnel and increase in the number of procedures. Average monthly dose has increased from 0.40 to 0.72 mSv in the same period. The results of occupational and patient doses in interventional cardiology are similar to results reported in the literature. It is of great importance for professionals working in this field to be educated in radiation protection and proper use of X-ray equipment.

Monitoring of occupationally exposed workers in Bosnia and Herzegovina started in 1960s and it was interrupted in 1992. Dosimetry service resumed in 1999 when the International Atomic Energy Agency provided Radiation Protection Centre with Harshaw 4500 Thermoluminescence dosemeter (TLD)-reader and the first set of TLDs. The highest doses are received by professionals working in interventional procedures (radiology, cardiology, gastroenterohepatology etc.). Number of these procedures is increasing each year (just in cardiology this increase is 24 % per year). Results from two TLDs are used to estimate effective dose. One is worn under the apron (chest level), and the other above (neck level). Calculation is performed using Niklason's methodology. Total number of occupationally exposed persons in interventional radiology is 90. The collective dose they receive is 67 person mSv, while the mean dose is 0.77 mSv (based on 12-month period). Highest doses are received by physicians (3.7 mSv), while radiographers and nurses receive 2.1 and 1.9 mSv respectively. This occurs due to the fact that physicians stand closer to the source (patient). The lead apron is proven to be the most efficient radiation protection equipment, but, also, lead thyroid shield and glasses can significantly lower doses received by professionals. The use of this equipment is highly recommended.

Background: The study aimed to explore effects of dispersed radiation on radiosensitive organs during mammography. The thyroid and the gonads are determined as key organs for exploration of dispersed radiation: the first one due to its vicinity to the dispersion zone and the second ones due to their symmetrical position in regard to the thyroid, which enables an assessment of distribution of dispersed radiation in regard to a compression plate. Materials and Methods: Entrance skin doses were defined during diagnostic procedures, using thermoluminescent dosimeters attached to the skin surface above the thyroid and the gonads for the purpose of exploration of dispersed radiation effects. Results: Results obtained indicate that medium entrance skin doses on skin around the thyroid were 0, 211 ± 0, 107 mGy per woman and 0, 017 ± 0, 012 mGy per woman on skin around the gonads. Measuring confirms that there is a significant correlation between entrance skin doses for the thyroid and total applied mAs during mammography (r = 0, 802, p<0, 01). Conclusion: Measuring defined that most of dispersed radiation was directed towards the area above breasts and the thyroid and only a small amount covered the area under the breasts and went towards the gonads. Entering skin doses for the thyroid ranged from 0.10 to 0, 51 mGy while the dose received by the thyroid varied from 0, 7 % to 1, 6 % of the MGD dose. Entrance skin doses for the gonads can be 13 times less than the thyroid dose and cannot be concerned dangerous for the gonads.

The aims of this study were to investigate the frequency of computed tomography (CT) examinations for paediatric patients below 15 y of age in 128 CT facilities in 28 developing countries of Africa, Asia and Eastern Europe and to assess the magnitude of CT doses. Radiation dose data were available from 101 CT facilities in 19 countries. The dose assessment was performed in terms of weighted CT dose index (CTDI(w)), volume CT index and dose length product (DLP) for chest, chest (high resolution), lumbar spine, abdomen and pelvis CT examinations using standard methods. The results show that on average the frequency of paediatric CT examinations was 20, 16 and 5 % of all CT examinations in participating centres in Africa, Asia and Eastern Europe, respectively. Eleven CT facilities in six countries were found to use adult CT exposure parameters for paediatric patients, thus indicating limited awareness and the need for optimisation. CT images were of adequate quality for diagnosis. The CTDI(w) variations ranged up to a factor of 55 (Africa), 16.3 (Asia) and 6.6 (Eastern Europe). The corresponding DLP variations ranged by a factor of 10, 20 and 8, respectively. Generally, the CTDI(w) and DLP values in Japan are lower than the corresponding values in the three regions in this study. The study has indicated a stronger need in many developing countries to justify CT examinations in children and their optimisation. Awareness, training and monitoring of radiation doses is needed as a way forwards.

Cardiologists at the Cardiac Centre of the Clinical Centre of Sarajevo University performed invasive cardiology procedures in one room equipped with a Siemens Coroskop (Siemens Healthcare, Erlangen, Germany) unit with the possibility of digital cine imaging. The number of procedures performed with this unit is 1126 per year. The number of adults performing only diagnostic procedures is 816, therapeutic procedures 62 and both diagnostic and therapeutic 228. Twenty diagnostic examinations but no therapeutic procedure are performed on children per year. The workload is increasing year by year, with an average increase of 26 % per year. The X-ray system does not have a kerma area product (KAP) meter installed; therefore an external KAP meter was mounted on the X-ray tube. Gafchromic dosimetry films (International Specialty Products, Wayne, USA) were placed under the patient to record the skin dose distribution. The peak skin dose (PSD) was calculated from the maximum optical density of the dosimetry films. Dose measurements were performed on 51 patients undergoing therapeutic procedures (percutaneous transluminal coronary angioplasty and stent placement). Two patients received doses (KAP) larger than 100 Gycm(2). The PSD was higher than 1 Gy in 3 out of 16 evaluations, and one of these patients received a skin dose >2 Gy. No deterministic skin effects were recorded. The dosimetry results are similar to results reported in other countries. Invasive cardiac procedures deliver high doses to the skin that could cause deterministic effects (erythema). Physicians performing these procedures should be aware of these risks. More efforts should be put into the training of cardiologists in radiation protection.

Monitoring of occupationally exposed persons in Bosnia and Herzegovina started in 1960s and it was interrupted in 1992. Dosimetry service resumed in 1999 when the International Atomic Energy Agency provided Harshaw 4500 TLD-reader and the first set of TLDs for the Radiation Protection Centre (RPC) of the Institute of Public Health of the Federation of Bosnia and Herzegovina. In January 2009, the RPC covered 1279 professionals with personal dosimetry, which is more than 70 % of all radiation workers in the country. Most of the TLD users work in medical institutions. In period 1999-2003 RPC provided 984 workers with dosemeters. In the next 5 y period (2004-2008), the number of persons covered by dosimetry increased by an average of 51 %. The mean and collective effective dose in the period 1999-2003 were 1.55 mSv and 1.54 personSv, respectively. In the period 2004-2008, the mean doses changed by 1 % on average, but the collective effective dose increased by 53 % for all practices. Mean and collective effective dose were 1.57 mSv and 2.34 personSv, respectively. The highest personal doses are associated with industrial radiography, than exposures in nuclear medicine. Radiology plays a significant role in collective dose only, whereas other exposures are low. Results correspond to results found in the literature. New practices in industry and medicine emphasise the need for more personal dosemeters, as well as specialised dosemeters for extremities monitoring, etc.

The purpose of this prospective study at 73 facilities in 18 countries in Africa, Asia and Eastern Europe was to investigate if the CT doses to adult patients in developing countries are higher than international standards. The dose assessment was performed in terms of weighted computed tomography dose index (CTDIw) and dose length product (DLP) for chest, chest (high resolution), lumbar spine, abdomen and pelvis CT examinations using standard methods. Except in one case, the mean CTDIw values were below diagnostic reference level (DRL) while for DLP, 17 % of situations were above DRLs. The resulting CT images were of adequate quality for diagnosis. The CTDIw and DLP data presented herein are largely similar to those from two recent national surveys. The study has shown a stronger need to create awareness and training of radiology personnel as well as monitoring of radiation doses in many developing countries so as to conform to the ALARA principle.

OBJECTIVE The purpose of our study was to investigate the level of radiation protection of patients and staff during interventional procedures in 20 countries of Africa, Asia, and Europe. SUBJECTS AND METHODS In a multinational prospective study, information on radiation protection tools, peak skin dose (PSD), and kerma-area product (KAP) was provided by 55 hospitals in 20 mainly developing countries (nine mostly in Eastern Europe, five in Africa, and six in Asia). RESULTS Nearly 40% of the interventional rooms had an annual workload of more than 2,000 patients. It is remarkable that the workload of pediatric interventional procedures can reach the levels of adult procedures even in developing countries. About 30% of participating countries have shown a 100% increase in workload in 3 years. Lead aprons are used in all participating rooms. Even though KAP was available in almost half of the facilities, none had experience in its use. One hundred of 505 patients monitored for PSD (20%) were above the 2-Gy threshold for deterministic effects. CONCLUSION Interventional procedures are increasing in developing countries, not only for adults but also for pediatric patients. The situation with respect to staff protection is considered generally acceptable, but this is not the case for patient protection. Many patients exceeded the dose threshold for erythema. A substantial number (62%) of percutaneous transluminal coronary angioplasty procedures performed in developing countries in this study are above the currently known dose reference level and thus could be optimized. Therefore, this study has significance in introducing the concept of patient dose estimation and dose management.

OBJECTIVE The purpose of this study was to survey image quality and the entrance surface air kerma for patients in radiographic examinations and to perform comparisons with diagnostic reference levels. SUBJECTS AND METHODS In this multinational prospective study, image quality and patient radiation doses were surveyed in 12 countries in Africa, Asia, and Eastern Europe, covering 45 hospitals. The rate of unsatisfactory images and image quality grade were noted, and causes for poor image quality were investigated. The entrance surface doses for adult patients were determined in terms of the entrance surface air kerma on the basis of X-ray tube output measurements and X-ray exposure parameters. Comparison of dose levels with diagnostic reference levels was performed. RESULTS The fraction of images rated as poor was as high as 53%. The image quality improved up to 16 percentage points in Africa, 13 in Asia, and 22 in Eastern Europe after implementation of a quality control (QC) program. Patient doses varied by a factor of up to 88, although the majority of doses were below diagnostic reference levels. The mean entrance surface air kerma values in mGy were 0.33 (chest, posteroanterior), 4.07 (lumbar spine, anteroposterior), 8.53 (lumbar spine, lateral), 3.64 (abdomen, anteroposterior), 3.68 (pelvis, anteroposterior), and 2.41 (skull, anteroposterior). Patient doses were found to be similar to doses in developed countries and patient dose reductions ranging from 1.4% to 85% were achieved. CONCLUSION Poor image quality constitutes a major source of unnecessary radiation to patients in developing countries. Comparison with other surveys indicates that patient dose levels in these countries are not higher than those in developed countries.