Sá Dos Reis Cláudia, Pascoal Ana, Radu Lucian, de Oliveira Mário Fartaria, Alves João
Department of Medical Radiation Sciences, Curtin University, Perth, Western, Australia.
Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa (ESTeSL/IPL), Lisboa, Portugal.
Insights Imaging. 2017 Jun;8(3):345-355. doi: 10.1007/s13244-017-0550-9. Epub 2017 Mar 16.
To assess current practices in digital mammography (DM) in Portuguese healthcare providers using digital systems. To investigate compliance with European standards regarding mean glandular dose and quality control practice and to identify optimisation needs.
Two questionnaires, targeted at breast radiographers and chief radiographers, were designed and applied in 65 imaging departments offering DM. Questions fielded were focused on the staff profile and technical/clinical practice.
Prior to starting their activity in DM, 70% (82 out of 118) of the respondents received training in DM. The practice in 29 out of 59 providers was established by the manufacturers' recommendations for image acquisition. Variations were observed between radiographers who belong to the same provider namely the selection of exposure parameters such as the target-filter combination and automatic mode. The use of the manual exposure mode was reported for imaging breast implants (44%) and surgical specimens (22%). The main causes of repeat examinations were skin folding (21%) and absence of pectoral muscle (PM) (20%).
The study revealed opportunities to optimise radiographers' practice in DM regarding the selection of exposure parameters. A robust and consistent training programme in DM and established local protocols can help to reduce the variations observed and improve clinical practice.
• Radiographers adopted different practices selecting AEC modes and T/F combinations. • Radiographer practice is more consistent using DR than using CR systems. • The main causes for rejecting images were the visibility of skin folding and PM absence. • Radiographers were partly unaware of the dose indicator. • Radiographers' training needs: QC, interventional procedures and breast dose optimisation.
评估葡萄牙医疗服务提供者使用数字系统进行数字化乳腺摄影(DM)的当前实践情况。调查在平均腺体剂量和质量控制实践方面对欧洲标准的遵守情况,并确定优化需求。
设计了两份针对乳腺放射技师和主任放射技师的问卷,并应用于65个提供DM服务的影像科室。所提问题集中在工作人员概况以及技术/临床实践方面。
在开始从事DM工作之前,70%(118人中的82人)的受访者接受了DM方面的培训。59家医疗服务提供者中有29家的实践是按照制造商的图像采集建议确立的。在属于同一医疗服务提供者的放射技师之间观察到了差异,即曝光参数的选择,如靶-滤过组合和自动模式。据报告,在对乳腺植入物(44%)和手术标本(22%)进行成像时使用手动曝光模式。重复检查的主要原因是皮肤褶皱(21%)和胸肌缺失(20%)。
该研究揭示了在DM中优化放射技师曝光参数选择实践的机会。开展强有力且一致的DM培训计划以及制定当地协议有助于减少观察到的差异并改善临床实践。
• 放射技师在选择自动曝光控制(AEC)模式和靶/滤过(T/F)组合时采用了不同的做法。• 使用直接数字化X线摄影(DR)系统时放射技师的实践比使用计算机X线摄影(CR)系统时更一致。• 拒绝图像的主要原因是皮肤褶皱可见和胸肌缺失。• 放射技师部分未意识到剂量指标。• 放射技师的培训需求:质量控制、介入程序和乳腺剂量优化。