Patsiendidoosi hindamine ja kvaliteedimııtmised radioloogia kvaliteedis steemi osana. I Patsiendidoosi hindamine
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1 Patsiendidoosi hindamine ja kvaliteedimııtmised radioloogia kvaliteedis steemi osana I Patsiendidoosi hindamine Kalle Kepler Tartu likool, BMTK Kalle.Kepler@ut.ee Kvaliteedis steemi rakendamine meditsiiniradioloogias Tallinn,.-. okt. Patsiendidoosi hindamise vajadus EN kvaliteedijuhendeid lesvıttetehnikale Kiirgusdoosi ja pildikvaliteedi optimeerimine Kiirgusriski arvutamine Patsiendi, avalikkuse teavitamine Hea tava j rgimine ja vırdlemine Referentsdooside m ramine igusaktide nıuete t itmine ftp://ftp.cordis.lu/pub/fp-euratom/docs/eur66.pdf (olemas tılge eesti keelde) ftp://ftp.cordis.lu/pub/fp-euratom/docs/eur66.pdf EN referentsdoosid Patsiendidosimeetria meetodid Uuring Referentsdoos: ESD (mgy) -aastase patsiendi jaoks Rindkere PA..3 Rindkere Lat.. Kolju PA. Kolju Lat. 3 t iskasvanu jaoks TLD-meetod termoluminestsentsdosimeeter DAP-meetod doos-pindalamııtur Kaudne meetod kiirgusv lja geomeetria ja etalondosimeetriga mııdetud r ntgentoru saagise pıhjal Vaagen AP.9
2 Meetodi valik Mııtem ramatused Iga meetodi puhul tuleks kaaluda: meetodi kasutusmugavust meetodi t psust (mııtem ramatust) mııteseadme hinda personali valmisolekut TLD-meetod ESD: -% (doosidel.-. mgy)* DAP-meetod DAP : -7% (sıltuvalt kvp ja DAP v ESD : 7-3% Kaudne meetod ESD: % rtusest) *hinnang kirjanduse pıhjal Patsiendidosimeetria kirjeldus R ntgentoru saagis Y sıltuvalt pingest lesvıtteparameetrid (kv, mas, mm Al) r ntgentoru doos-pindala (DAP) Y, ìgy/mas 8 6 ıhu kerma naha sisenddoos (tagasihajumine kaasa arvatud vıi mitte) s vadoos elundidoos v ljunddoos film KVp, kv lisafiltriga lisafiltrita Saagis on mııdetud cm kaugusel fookusest, punktid on antud koos laiendm ramatusega (k = ); leitud sıltuvusi kasutati patsiendidoosi m ramiseks kaudsel meetodil Viited j rgnevatel graafikutel: Cook J V, Shah K, Pablot S, et al. Guidelines on best practice in the x-ray imaging of children. Surrey, UK (998) Servomaa A, Komppa T, Parviainen T. Potilasannokset lasten r ntgenkuvauksissa. STUK-A7. Helsinki, Finland () European Commission, European guidelines on quality criteria for diagnostic radiographic images in paediatrics. EUR 66 EN (996)
3 Vaagen AP ESD, mgy < 9 6 Vanus, a H [] [] [3] DAP, mgy cm 6 8 Rindkere AP/PA < 9 6 Vanus, a H H H3 [] [] [] Cook et al, [] Servomaa et al, [3] CEC [] Cook et al, [] Servomaa et al Tartu likooli BMTK II Radioloogiaseadmete kvaliteedimııtmised Teostanud radioloogiaseadmete kvaliteedimııtmisi alates aastast 997, kokku le 6 tervishoiuasutuses Tuginedes rahvusvahelistele (s.h IEC ja CEC) standarditele ja hea tava juhenditele on v lja t tatud oma testmetoodika Testmetoodikat on auditeerinud mitmed rahvusvaheliselt tunnustatud eksperdid Andmebaasis sisalduvad kvaliteediandmed ligi seadme kohta, neist statsionaarseid V/LVseadmeid Valik standardeid Radioloogiaseadmete EN aktseptkriteeriumid International Electrotechnical Commission. Medical electrical equipment - Part : General requirements for safety - Collateral standard: General requirements for radiation protection in diagnostic x-ray equipment, IEC 66--3, 99. (olemas eestikeelne tılge) International Electrotechnical Commission. Evaluation and routine testing in medical imaging departments - Part 3-: Acceptance tests - Imaging performance of X-ray equipment for radiographic and radioscopic systems, IEC [3] International Electrotechnical Commission. Medical electrical equipment - Part -7: Particular requirements for the safety of highvoltage generators of diagnostic x-ray generators, IEC 66--7, 998. European Commission. Criteria for acceptability of radiological (including radiotherapy) and nuclear medicine installations. Radiation Protection No 9,
4 R ntgenseadmete jaotus vanuse j rgi Testprotseduuride r hmad % % 3% uus kasutatud vana Uus soetatud p rast 99. a (k.a), vana soetatud enne 99. a, kasutatud soetatud kasutatud peast (Diagramm hılmab ainult seadmeid, mille kohta on andmed T BMTK andmebaasis) Vırgutoite testid Elektriohutustestid Kırgepingegeneraatori testid lesvıtter ntgentoru testid Vertikaalstatiivi testid L bivalgustusr ntgentoru testid L bivalgustuslaua testid Patsiendi sisenddoosikiirus Kujutisvıimendi sisenddoosikiirus Kujutisvıimendi testid N ide: kırgepinge lainekuju kv 8 6 -m m m m 6m 8m m m Time (s) Mııdetud mitteinvasiivselt kvp-meetriga, lisafiltratsioon mm Al, v ike fookus, r ntgentoru vool 6 ma, ekspositsiooniaeg, s Kvaliteedikontrolli tulemused: kvp t psus > kvp täpsus, %
5 Poolnırgestuspaksus (HVL) ma t psus % 8% HVL, mm Al keskm. = 3.7 mm Al st.hälve =.73 mm Al >. 6% % % % >8 ma täpsus, % Maksimaalne patsiendi sisenddoosikiirus automaatre iimis Maksimaalne patsiendi sisenddoosikiirus k sitsire iimis 8 6 AERC mode >6 Maksimaalne patsiendi sisenddoosikiirus, mgy/min manual mode >7 Maksimaalne patsiendi sisenddoosikiirus, mgy/min KVALITEET ALGAB M TMISEST
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