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Radiation Protection Dosimetry Advance Access published online on October 21, 2008
Radiation Protection Dosimetry, doi:10.1093/rpd/ncn283
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© The Author 2008. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

SURVEY OF MAMMOGRAPHY PRACTICE IN CROATIA: EQUIPMENT PERFORMANCE, IMAGE QUALITY AND DOSE

Dario Faj1,*, Dario Posedel2, Damir Stimac1, Zdravko Ivezic1, Mladen Kasabasic1, Ana Ivkovic1, Dragan Kubelka3, Vesna Ilakovac4, Zoran Brnic5 and Olivera Ciraj Bjelac6

1 University Hospital of Osijek, J. Huttlera 4, 31000 Osijek, Croatia
2 Ekoteh Ltd., Zagreb, Croatia
3 State Office for Radiation Protection, Frankopanska 11, 10000 Zagreb, Croatia
4 Faculty of Medicine, University of Osijek, Osijek, Croatia
5 University Hospital Merkur, 10000 Zagreb, Croatia
6 Vinca Institute of Nuclear Sciences, M.P. Alasa 12–14, Vinca, 11000 Belgrade, Serbia

* Corresponding author: dariofaj{at}mefos.hr

Received July 2, 2008, amended September 14, 2008, accepted September 24, 2008

A national audit of mammography equipment performance, image quality and dose has been conducted in Croatia. Film-processing parameters, optical density (OD), average glandular dose (AGD) to the standard breast, viewing conditions and image quality were examined using TOR(MAM) test object. Average film gradient ranged from 2.6 to 3.7, with a mean of 3.1. Tube voltage used for imaging of the standard 45 mm polymethylmethacrylate phantom ranged from 24 to 34 kV, and OD ranged from 0.75 to 1.94 with a mean of 1.26. AGD to the standard breast ranged from 0.4 to 2.3 mGy with a mean of 1.1 mGy. Besides clinical conditions, the authors have imaged the standard phantom in the referent conditions with 28 kV and OD as close as possible to 1.5. Then, AGD ranged from 0.5 to 2.6 mGy with a mean of 1.3 mGy. Image viewing conditions were generally unsatisfying with ambient light up to 500 lx and most of the viewing boxes with luminance between 1000 and 2000 cd per m2. TOR(MAM) scoring of images taken in clinical and referent conditions was done by local radiologists in local image viewing conditions and by the referent radiologist in good image viewing conditions. Importance of OD and image viewing conditions for diagnostic information were analysed. The survey showed that the main problem in Croatia is the lack of written quality assurance/quality control (QA/QC) procedures. Consequently, equipment performance, image quality and dose are unstable and activities to improve image quality or to reduce the dose are not evidence-based. This survey also had an educational purpose, introducing in Croatia the QC based on European Commission Guidelines.


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Z. Brnic, T. Krpan, D. Faj, D. Kubelka, J. P. Ramac, D. Posedel, R. Steiner, V. Vidjak, V. Brnic, K. Viskovic, et al.
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