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Uvod: Rak dojke je najpogostejši rak pri ženskah v Sloveniji. Mamografija se kot začetna preiskava uporablja tudi za rutinski pregled pri ženskah s prsnimi vsadki. Pri slikanju žensk s prsnimi vsadki uporabljamo tehniko po Eklundu, kar pomeni, da po opravljenih standardnih projekcijah, vsadek potisnemo ob steno prsnega koša. Namen: Namen magistrskega dela je oceniti AGD pri presejani mamografiji za ženske s prsnimi vsadki in preučiti obstoj razlik v AGD glede na način nastavitve ekspozicijskih pogojev. Zanimalo nas je, za koliko se razlikuje AGD med standardno in Eklund tehniko ter vpliv nastavitev ekspozicijskih pogojev na kakovost mamografskih posnetkov. Metode dela: Izvedli smo retrospektivno neintervencijsko študijo s sekundarno analizo. V raziskavi smo zajeli 536 žensk s prsnimi vsadki, ki so v programu DORA opravile mamografski pregled na aparatu Hologic od začetka izvajanja programa (21. 4. 2008) do 31. 12. 2021. Ocenili smo vrednosti AGD žensk s prsnimi vsadki glede na projekcijo, debelino dojke ob kompresiji in načinu nastavitve ekspozicijskih pogojev. Primerjali smo AGD med posnetki s standardno tehniko in posnetki z Eklund tehniko. V zadnjem delu raziskave so trije radiologi ocenili kakovost posnetkov. Rezultati: Pri standardnih posnetkih z ročno nastavitvijo je povprečna vrednost AGD statistično značilno nižja pri debelini dojke 6 < 8 cm, 8 < 10 cm in > 10 cm. Pri dodatnih posnetkih z avtomatskim načinom je povprečna vrednost AGD statistično značilno nižja pri debelini dojke < 4 cm in 4 < 6 cm. Pri dodatnih posnetkih debeline dojk 6 < 8 cm je AGD statistično značilno nižja pri posnetkih z ročnim načinom. Med posnetki s standardno tehniko in posnetki po Eklund tehniki obstajajo statistično značilne razlike v povprečni vrednosti AGD za oba načina nastavitev. Skupna ocena vseh kriterijev kakovosti CC, MLO in MLOID posnetkov je bila statistično značilno višja pri ročni nastavitvi. Razprava in zaključek: Rezultati kažejo, da imajo standardni posnetki z ročnim načinom nižje vrednosti AGD in višjo kakovost. Zaključimo lahko, da je pri dodatnih posnetkih debeline dojk < 4 cm in 4 < 6 cm zaradi nižjih vrednosti AGD ustreznejši avtomatski način nastavitve in pri debelini dojk 6 > 8 cm ročni način. Smiselno bi bilo uvesti standardiziran protokol za slikanje prsnih vsadkov na aparatih Hologic. Introduction: Breast cancer is the most common cancer among women in Slovenia. Mammography is used as an initial examination for routine screening in patients with breast implants. Mammography in patients with breast implants is performed in four projections two standard projections and two additional projections using the Eklund technique. Purpose: The purpose of this master's thesis is to evaluate the average glandular dose (AGD) in screening mammography for patients with breast implants and to examine the differences in AGD based on the method of exposure setting. We were interested in how much the AGD differs between the standard and Eklund techniques and whether the method of exposure settings affects the quality of mammograms. Methods: We conducted a retrospective non-interventional study with secondary analysis. The study included 536 patients with breast implants who completed mammography imaging in the screening program DORA between April 21st 2008 and December 31st 2021. We evaluated the AGD values of patients with breast implants based on the projection, breast thickness, and exposure setting method. We compared the AGD between images using the standard technique and those using the Eklund technique. In the last part of the study, three radiologists assessed the quality of the images. Results: In standard images with manual settings, the mean AGD value is statistically significantly lower for breast thicknesses of 6 < 8 cm, 8 < 10 cm, and > 10 cm. In additional images with automatic mode, the mean AGD value is statistically significantly lower for breast thicknesses < 4 cm and 4 < 6 cm. In additional images with breast thickness of 6 < 8 cm, the AGD is statistically significantly lower in manual mode images. There are statistically significant differences in the mean AGD value between images using the standard technique and those using the Eklund technique for both exposure setting methods. The overall assessment of all quality criteria for CC, MLO, and MLOID images was statistically significantly higher with manual settings. Discussion and conclusion: The results indicate that standard images with manual settings have lower AGD values and higher quality ratings. We can conclude that for additional images with breast thickness < 4 cm and 4 < 6 cm, the automatic mode of exposure setting is more appropriate due to lower AGD values. The manual mode is more suitable for breast thicknesses of 6 > 8 cm. Introducing a standardized protocol for imaging breast implants using Hologic machines would be reasonable.

Uvod: Mamografsko slikanje je najbolj razširjena metoda za zgodnje odkrivanje raka na dojkah, ki je najpogostejši rak pri ženskah v Sloveniji. Presejalni program DORA izvaja mamografsko slikanje in ocenjevanje mamografskih slik skladno s strokovnimi smernicami, s tem pa zagotavlja kakovostno mamografsko sliko, ki mora biti dobro pozicionirana, primerno osvetljena, visoko kontrastna, brez artefaktov in narejena z najnižjo dozo sevanja. Ti parametri so med seboj povezani in vplivajo drug na drugega. Z uporabo kompresije zmanjšamo debelino dojke, s tem pa povečamo kontrastno in prostorsko ločljivost, zmanjšamo tveganje za artefakte in s tem pacient prejme najnižjo dozno obremenitev. Namen: Namen je zbrati in primerjati podatke o kompresiji in debelini dojke pri pacientkah slikanih v presejalnem programu DORA med različnimi obiski, med različnimi mamografskimi aparati, med ustanovami in radiološkimi inženirji. Metode dela: V raziskavi smo uporabili retrospektivno metodo s sekundarno analizo podatkov in zajeli 2000 pacientk, ki so se udeležile mamografskega slikanja v programu DORA med leti 2013 in 2017. Zajeli in primerjali smo podatke iz treh zaporednih mamografskih slikanj treh različnih proizvajalcev mamografskih aparatov, ki so se do leta 2017 uporabljali za mamografsko slikanje v programu DORA , štirih ustanov, kjer se izvaja program DORA in 64 radioloških inženirjev, ki so med leti 2013 in 2017 izvajali mamografsko slikanje v programu DORA. Za statistično analizo smo uporabili IBM SPSS statistics verzije 26. Rezultati: Rezultati so pokazali statistične razlike med zaporednimi obiski, ustanovami slikanja, mamografskimi aparati in radiološkimi inženirji pri vseh projekcijah mamografskega slikanja. Ugotovili smo, da lahko radiološke inženirje glede na povprečno uporabljeno kompresijo razvrstimo v 3 skupine: prva skupina s povprečno kompresijo 120 N (34 %). Razprava in zaključek: Priporočili bi uvedbo standariziranega protokola mamografskega slikanja z natančnim razponom uporabljene kompresije za posamezno projekcijo pri slikanju, ob upoštevanju velikosti dojke in bolečine pacientke med samim slikanjem. To bi po našem mnenju optimiziralo mamografsko slikanje znotraj celotnega programa DORA, pripomoglo k zmanjšanju razlik v povprečni kompresiji in omogočilo pacientkam primerljivo zaporedno izkušnjo, potencialno pa tudi večjo odzivnost v preventivni program DORA. Introduction: Mammography imaging is the most widespread method for early detection of breast cancer, which is the most common cancer in women in Slovenia. DORA screening program performs mammography imaging and grading of mammography images in accordance with professional guidelines, ensuring a quality mammography image that must be well positioned, adequately lit, high contrast, no artifacts and made with the lowest radiation dose. These parameters are interrelated and affect each other. By using compression, we reduce the thickness of the breast, increasing the contrast and spatial resolution, reducing the risk of artifacts, and patient receives the lowest radiation dose.Purpose: The purpose is to collect and compare data on compression and breast thickness in patients imaged in DORA screening program during different visits, between different mammography machines, between institutions and radiological engineers. Methods: In the study, we used a retrospective method with secondary data analysis and captured 2000 patients who participated in mammography imaging in DORA program between 2013 and 2017. We captured and compared data from sequential mammography imaging, on three different mammography machines, in four institutions and 64 radiological engineers. IBM SPSS 26 statistics were used for statistical analysis. Results: The results showed statistical differences between subsequent visits, imaging institutions, mammography machines, and radiological engineers in all mammography imaging projections. We found that radiological engineers can be divided into 3 groups according to the average compression force: the first group with average compression 120 N (34 %). Discussion and conclusion: We would recommend the implementation of a standardized mammography imaging protocol with the exact range of compression used for each projection during imaging, taking into account the size of the breast and the patient's pain during the imaging itself. In our opinion, this would optimize mammography imaging within the entire DORA program, help reduce differences in average compression, and allow patients a comparable sequential experience, and potentially greater responsiveness to the DORA prevention program.

Uvod: Rak dojke je eden najpogostejših rakov pri ženkah. Zaradi tako veliko primerov raka so v Sloveniji uvedli presejalni program DORA. Presejalni programi za raka so javnozdravstveni ukrep, pri katerih se s preprostimi preiskavami med ljudmi, ki nimajo nobenih kliničnih težav, išče tiste, ki že imajo predinvazijsko ali zgodnjo - invazijsko obliko raka. Da je program učinkovit, se ga mora udeležiti vsaj 70 % ciljane populacije. Presejanje nam omogoča zgodnje odkrivanje in diagnosticiranje raka dojk s pomočjo mamografije. Program DORA je namenjen ženskam med 50 in 69 letom starost in se izvaja na 22 lokacijah po Sloveniji. Najpomembnejši dejavniki tveganja za nastanek raka dojke so: ženski spol, višja starost, nizka starost ob prvi menstruaciji, visoka starost pri zadnji menstruaciji, hormonska terapija in kontracepcija, debelost, alkohol. Bolj ogrožene so ženske, ki nimajo otrok in tiste, ki so prvič rodile po 30. letu, tiste, ki imajo v družini raka dojke in tiste, ki so ga že prebolele. Namen: Raziskati ozaveščenost o programu DORA med zaposlenimi ženskami na Zdravstveni fakulteti. Na podlagi pregledane literature smo si zastavili 10 raziskovalnih vprašanj. Metode dela: Uporabili smo deskriptivno metodo. Pregledali smo internetno in knjižnično literaturo. V drugem delu smo uporabili kvantitativno metodo in podatke pridobili s pomočjo pilotnega anketnega vprašalnika. Za statistično analizo smo uporabili Hi kvadrat test. Rezultati: Odzivnost na vprašalnik je bila 52,6 %. Ob obdelavi podatkov smo ugotovili, da ne prihaja do statistično značilnih razlik med mlajšimi in starejšimi, med ženskami z različnimi stopnjami izobrazbe in med ženskami z različnim delovnim mestom. Vse anketirane ženske vedo, kaj je program DORA in čemu je namenjen. Na splošno so dobro seznanjene z dejavniki tveganja. Kljub temu se ženske še vedno ne samopregledujejo dovolj pogosto. Od 50 anketiranih žensk se jih 47 je, ali pa se še bo odzvalo na program DORA (94 %). Razprava in zaključek: S primerjavo podobnih raziskav smo ugotovili, da so ženske, zaposlene na Zdravstveni fakulteti, precej bolje ozaveščene kot ženske v tujini. Prav tako se ozaveščenost skozi leta v Sloveniji zvišuje. Ozaveščenost zaposlenih žensk na Zdravstveni fakulteti je dobra, a po našem mnenju so ženske še vedno premalo ozaveščene o pomembnosti zgodnjega odkrivanja raka in o dejavnikih tveganja, ki pomembno vplivajo na nastanek raka. Introduction: Breast cancer is one of the most common cancers among the females. Due to such large number of cases the DORA screening program was established in Slovenia. Cancer screening programs are a public health measure that through simple screening among people who have no clinical problems, search those who already have a pre-invasive or early-invasive form of cancer. For the program to be effective, at least 70% of the target population must participate. Screening allows us to detect and diagnose breast cancer with the help of mammography. The DORA program is intended for women between the ages of 50 and 69 and is performed at 22 locations across Slovenia. The most important risk factors for breast cancer are: female gender, older age, low age at first menstruation, high age at last menstruation, hormone therapy and contraception, obesity, alcohol. More at risk are women who do not have children and those who gave birth for the first time after the age of 30, those who have breast cancer in the family and those who have already overcome it. Purpose: To research the awareness of the DORA program among employed women at the Faculty of Health Sciences. Based on the reviewed literature, we stated 10 research questions. Methods: Descriptive method was used to review the internet and library literature. In the second part, we used the quantitative method to acquire the data with the help of pilot survey questionnaire. We used the Chi square test for statistical analysis. Results: Response to the questionnaire was 52.6%. While processing the data, we found that there are no statistically significant differences between young and old, between women with different levels of education and between women with different types of job. All surveyed women know what the DORA program is and what it is for. In general, they are well acquainted with risk factors. Nevertheless, women still do not self-examine often enough. Of the 50 women surveyed, 47 did respond or will be responding to the DORA program (94%). Discussion and conclusion: Comparisons with similar research have shown that women employed at the Faculty of Health Sciences are much more aware than women abroad. Awareness has also been rising in Slovenia over the years. The awareness of employed women at the Faculty of Health Sciences is good, but in our opinion, women are still insufficiently aware of the importance of early detection of cancer and the risk factors that significantly influence the development of cancer.

Uvod: DORA je program za zgodnje odkrivanje raka dojk. Zdravstveni delavci v programu DORA opravljajo storitve po predpisanih zahtevah programa. Za doseganje kakovosti mamografskih slik se enkrat do dvakrat letno ocenjujejo kakovosti mamogramov. Na Onkološkem inštitutu v Ljubljani za nadzor kakovosti dela radioloških inženirjev slike ocenjuje odgovorni radiološki inženir. Namen: Namen je ugotoviti, kakšen je vpliv subjektivnosti ocenjevanja in ali se ocene mamografskih slik po enakem kriteriju razlikujejo med različnimi ocenjevalci. Metode dela: Uporabili smo retrospektivno analizo podatkov. Najprej smo pridobili 1000 mamografskih slik, narejenih na DORI na Onkološkem inštitutu v Ljubljani med leti 2011 in 2013. Pridobljene slike so že imele podano oceno po modificirani PGMI lestvici s strani odgovorne osebe na DORI, nato pa smo celoten sklop slik ocenili še 4 ocenjevalci. S pomočjo Kappa koeficienta in točnosti končnih ocen, smo prikazali ujemanje oz. neujemanje ocen med ocenjevalci ter kakšen je vpliv subjektivnosti. Rezultati in razprava: Raziskava je pokazala statistično značilne razlike med ocenjevalci in vpliv subjektivnosti. Rezultati so pokazali, da se v 300 slikah med ocenjevalci 1, 3 in 5 najbolje ujemajo v CC projekciji s Kappa koeficientom 0,244 ter točnostjo 68 %. Najslabše ujemanje v CC projekciji je s Kappa 0,07 in točnostjo 41 %. V MLO projekciji je najboljše ujemanje s Kappa 0,326 in točnostjo 61 %, medtem ko je najslabše v MLO s Kappa 0,098 in točnostjo 40 %. Med 300 ocenjenimi mamogrami ocenjevalcev 2, 4 in 5 je najboljše ujemanje v CC projekciji s Kappa 0,193 in točnostjo 66 %. Najslabše ujemanje v CC projekciji je s Kappa 0,04 in točnostjo 37 %. Najboljše ujemanje v MLO projekciji je s Kappa koeficientom 0,288 in točnostjo 67 %, najslabše ujemanje v MLO pa je s Kappa vrednostjo -0,007 in točnostjo 29 %. Medtem ko je pri 200 skupnih slikah med vsemi ocenjevalci najboljše ujemanje v CC projekciji s Kappa koeficientom 0,433 in točnostjo 66 %, je v MLO projekciji najboljše ujemanje s Kappa koeficientom 0,374 in točnostjo 68 %. Zaključek: S statistično analizo smo ugotovili, da je ujemanje med ocenjevalci slabo, tako v CC kot v MLO projekciji. Predvidevamo, da na končno oceno mamografskih slik vpliva ocenjevalčeva subjektivnost, različno strokovno in praktično znanje, kritičnost ocenjevalca, slabo definirani kriteriji ocenjevanja in različni pogoji ocenjevanja (ločljivost, kontrast, svetlost monitorja, svetlost v prostoru). Introduction: DORA is a breast cancer screening programme. Healthcare professionals in the DORA programme provide services in accordance with the prescribed requirements of the programme. To achieve the quality of mammographic images, the quality of mammograms is evaluated once or twice each year. Quality control of the work of radiological engineers is performed at the Institute of Oncology in Ljubljana where the images are evaluated by the responsible radiological engineer. Purpose: The purpose is to establish the influence of the subjectivity of reading and whether the readings of mammographic images done by different readers following the same criteria differ from one another. Methods: We used the method of retrospective data analysis. First, we obtained 1000 mammographic images recorded within the DORA programme at the Institute of Oncology in Ljubljana in the time period from 2011 to 2013. The obtained images had already been evaluated according to the modified PGMI scoring system by a responsible person in the DORA programme: then, the entire set of images was evaluated by us (4 readers). By using the Kappa coefficient and the accuracy of final readings, we demonstrated the congruence/incongruence of results between the readers and the influence of subjectivity. Results and discussion: The research showed statistically significant differences between the readers and the influence of subjectivity. The results have shown that in 300 images evaluated by readers 1,3, and 5, the highest level of congruence in the CC projection with Kappa coefficient of 0.244 and 68% accuracy. The lowest level of congruence in the CC projection is with Kappa of 0.07 and 41% accuracy. In the MLO projection, the highest level of congruence is with Kappa of 0.326 and 61% accuracy, while the lowest level in the MLO projection is with Kappa of 0.098 and 40% accuracy. In 300 mammograms evaluated by readers 2, 4, and 5, the highest level of congruence is in the CC projection with Kappa of 0.193 and 66% accuracy. The lowest level of congruence in the CC projection is with Kappa of 0.04 and 37% accuracy. The highest level of congruence in the MLO projection is with Kappa coefficient of 0.288 and 67% accuracy, and the lowest level of congruence in MLO is with Kappa of -0.007 and 29% accuracy. While in 200 images evaluated by all readers, the highest level of congruence is in the CC projection with Kappa coefficient of 0.433 and 66% accuracy, the highest level of congruence in the MLO projection is with Kappa coefficient of 0.374 and 68% accuracy. Conclusion: By using the statistical analysis, we have established that the level of congruence between the readers is low, both in the CC and MLO projection. It is our assumption that the final assessment of mammographic images is influenced by the readers’ subjectivity, varying professional and practical knowledge, the readers’ criticality, poorly defined reading criteria, and different reading conditions (resolution, contrast, monitor brightness, brightness in the room).

Uvod: Mamografija je osnovna diagnostična metoda za odkrivanje bolezenskih nepravilnosti dojk. Doseganje optimalne kakovostne slike pri mamografiji je za radiološkega inženirja tehnično zelo zahtevno. Redno ocenjevanje kvalitete mamografskih slik omogoča sprotno odkrivanje napak in iskanje rešitev za odpravo le-teh. Ker je lahko ocenjevanje slik zamudno, hkrati pa je ocenjevanje dokaj subjektivno, bi uporaba avtomatskih postopkov segmentacije precej skrajšala celoten proces. Segmentacija je postopek določitve homogenega področja (ROI) in razmejitev le-tega od ozadja. V osnovi ločimo segmentacijske metode na postopke določanja homogenih območij na sliki in na postopke določanja robov med območji. Namen: Namen magistrske naloge je teoretični pregled obstoječih postopkov segmentacije po posameznih vrstah diagnostičnega postopka. Z željo po postavitvi programa za avtomatsko ocenjevanje mamografskih slik smo v nalogi izvedli prvi korak, in sicer smo izvedli postopke segmentacije za detekcijo določenih elementov, ki se uporabljajo za ocenjevanje radioloških inženirjev na programu DORA. Na podlagi testiranja na bazi slik smo določili, kako uspešna je uporaba avtomatskih in polavtomatskih postopkov segmentacije za detekcijo prsne mišice na slikah. Metode dela: Na 250 mamografskih MLO slikah smo najprej ročno označili pektoralno mišico in dojko. Nato smo izvedli avtomatične postopke segmentacije, s katerimi smo poskušali čim bolj natančno označiti pektoralno mišico in dojko. Za označevanje dojke smo uporabili upragovljanje, za segmentacijo pektoralne mišice pa metodo povečevanja območij in rojenje. Predvsem nas je zanimala razlika v ploščinah krivulj med dobljeno in referenčno sliko. Rezultati: Z metodo upragovljanja smo ločili ozadje od objekta. Prišlo je do minimalnih odstopanj, in sicer je povprečna vrednost deleža relativne napake znašala 1,13 %. Pri segmentaciji pektoralne mišice je prišlo do večjih napak. Pri metodi povečevanja območij je povprečna vrednost deleža relativne napake znašala 22,83 %, pri metodi rojenja pa 32,7 %. Razprava in zaključek: Zaradi velike razlike v kontrastnosti med ozadjem in objektom, torej celotno dojko, je upragovljanje primerno za segmentacijo celotne dojke. Če primerjamo metodi za segmentacijo pektoralne mišice, je ustreznejša metoda povečevanja območij. Do večjih odstopanj prihaja zaradi tehnično neustrezne slike in večje količine žleznega tkiva. Introduction: Mammography has recently become the main diagnostic method for detecting breast abnormalities. Achieving an optimal image quality in mammography is very technically difficult for radiologic technologist. With regular assessment of the quality of mammographic images technical errors can be discovered and improved. However, since image estimation can be time consuming, and at the same time estimation is quite subjective, the use of automatic segmentation would significantly shorten the whole process. Segmentation is the process of determining a homogeneous region of interest (ROI) and demarcating it from the background. Basically, we divide the segmentation methods into methods, that are based on combining the pixels into homogeneous areas and the methods based on determining the edges between areas. Purpose: The purpose of the master's thesis is a theoretical overview of existing segmentation methods by individual types of diagnostic procedure. In the next step we will try to perform segmentation procedures for the detection of certain elements used to evaluate radiological engineers in the DORA program. Based on image testing, we will determine how successful the use of automatic and semi-automatic segmentation procedures in detection of pectoral muscle in images is. Methods: in 250 mammographic MLO images, we will first manually mark the breast and the pectoral muscle. Then we will perform the automatic segmentation of breast and pectoral muscle. We will use thresholding to mark the breast and the region growing and clustering for segmentation of the pectoral muscle. We will be mainly interested in the difference in the areas of the curves between the obtained and the reference image. Results: We used thresholding to separate the background from the object. There were minimal deviations, namely the average value of the relative error rate was 1.13 %. Bigger errors occurred in pectoral muscle segmentation. In the method of region growing, the average value of the relative error rate is 22,83 %, and in the method of clustering 32,7 %. Discussion and conclusion: Due to a big difference in contrast between the background and the breast, the thresholding is suitable for segmentation of the entire breast. However, if we compare the methods for segmentation of the pectoral muscle, the region growing method is more appropriate. Major deviations occur due to a technically inadequate picture and a larger amount of glandular tissue.

Uvod: DORA je preventivni državni presejalni program za zgodnje odkrivanje raka dojk. V program so povabljene vse ženske starostne skupine 50 – 69 let, ki prejmejo vabilo vsaki dve leti. Za zagotavljanje kakovosti mamografskih slik se 1 do 2-krat letno ocenjujejo mamogrami vseh DRI. V Sloveniji imamo svoj sistem za ocenjevanje, ki združuje merila PGMI in Dokustufen. Namen: Predstaviti najpogostejše napake, ki se pojavljajo pri CC in MLO projekcijah, kakšen je njihov delež in raziskati, ali se kakovost mamografskih slik zaradi kontrole kvalitete z leti izboljšuje. Metode dela: Zajemajo pregled literature in retrospektivno analizo podatkov. Zbrali smo podatke iz 4928 mamogramov, narejenih med leti 2011 in 2013. Za ocenjevanje smo uporabili PGMI lestvico. Rezultati in razprava: Ugotovili smo, da se je na slikah v MLO projekciji pojavilo za 22,08 % več napak kot na slikah v CC projekciji. Največ napak pri CC projekciji se je pojavilo pri nepravilnem prikazu prsne bradavice, kožne gube, PNL, pojav asimetrije in pojav neustreznega prikaza lateralnega parenhima. Pri MLO projekciji pa se je pojavilo največ napak pri prikazu inframamarne gube, kožne gube, neustrezni asimetriji in prikazu prsne bradavice. Prav tako smo ugotovili, da se je pri večini napak najpogosteje pojavijo napake 2. stopnje. Zaključek: Med leti 2011 in 2013 nismo zaznali večjega upada ali porasta pojavljanja napak, saj je Slovenija šele leta 2013 dobila svoj sistem in uvedla ločeno ocenjevanje projekcij ter bolje izobrazila kader. Introduction: Slovenian breast cancer screening programme, called DORA, is an organized popoulation based programme. It provides screening mammography every two years for all women in Slovenia aged 50 - 69 years old. In order to ensure the quality of mammograms in DORA programme, the mammograms of all radiographers are assessed once or twice a year. In Slovenia, we have our own evaluation system, which is a combination of PGMI criteria and Dokustufen. Purpose: To present the most common errors that occur in the CC and the MLO projections and also to investigate whether the quality control brings improvement of mammographic images. Methods: The methods of work comprise a literature review and the retrospective analysis. We collected data of 4928 mammograms that were made between 2011 and 2013. We used PGMI evaluation system. Results and discussion: We presented the results and comparisons in the tables and graphs for CC and MLO projections. We found that there were 22.08 % more errors on the MLO projections. The most common errors in the CC projection of both breasts were incorrect display of the nipple, skin folds, PNL, apperance of asymmetry and the apperance of inadequate display of the lateral parenchyma. The most common errors in the MLO projection of the both breasts were also skin fold, apperance of asymmetry and the incorrect display of the nipple. We also found that the most common erros were evaluated as level 2 errors. Conclusion: Between the years of 2011 and 2013, we did not notice any major increase or decrease of errors in mammograms. It is important to say, that Slovenia got its own evaluation system in the year of 2013 and also needed some time to educate all the radiographers working in screening programme DORA.

Uvod: Presejalni program DORA je bil ustanovljen z namenom zmanjšanja umrljivosti žensk za rakom dojk. Za diagnostiko se uporablja mamografsko slikanje, ki ga izvaja diplomirani radiološki inženir po vnaprej določenem protokolu, skladnem z evropskimi smernicami in standardi kakovosti. Kakovost dela inženirjev se zagotavlja z rednim ocenjevanjem mamogramov. Namen: Namen diplomskega dela je ugotoviti, kako se kakovost dela diplomiranih radioloških inženirjev razlikuje v različnih DORA centrih glede na čas odprtja in primerjati protokol slikanja v najbolje ocenjenem DORA centru s strani Onkološkega inštituta z evropskimi smernicami. Metode dela: V prvem delu diplomske naloge smo uporabili kvantitativno analizo podatkov o ocenah dela radioloških inženirjev v posameznih DORA centrih. Tekom drugega smo uporabili pregled literature in kvalitativno metodo, intervju, s katerima smo pridobili podatke za primerjavo protokola slikanja v Zdravstvenem domu dr. Adolfa Drolca Maribor z evropskimi smernicami. Rezultati: S prvim delom diplomske naloge smo pridobili naslednje rezultate o povprečni oceni v ocenjevalnem obdobju 2017–2018 za CC projekcijo na Onkološkem inštitutu Ljubljana 93,7 %, v Univerzitetnem kliničnem centru Maribor 92,4 % in v Splošni bolnišnici Celje 96,1 %. Za mediolateralno projekcijo je povprečna ocena Onkološkega inštituta Ljubljana 87,3 %, v Univerzitetnem kliničnem centru Maribor 82,3 % in v Splošni bolnišnici Celje 88,4 %. V drugem delu diplomske naloge smo ugotovili, da se primerjana protokola slikanja dojk razlikujeta v predstavljanju z imenom in priimkom radiološkega inženirja pacientu, kar je v DORA centru Zdravstvenega doma dr. Adolfa Drolca Maribor individualna odločitev inženirja. Razlika je prisotna tudi v nastavitvi kota za mediolateralno projekcijo, ki naj bi se po evropskih smernicah individualno prilagajal. V evropskih smernicah brisanje dojk pred preiskavo in uporaba gonadnega predpasnika nista omenjena, kar v Zdravstvenem domu dr. Adolfa Drolca Maribor izvajajo. Razprava in zaključek: Kakovost dela radiološkega inženirja se bistveno ne razlikuje med posameznimi centri. Prisotne so razlike, vendar je delo na vseh DORA centrih na visokem nivoju. Primerjava protokolov je pokazala razliko le v štirih podrobnostih, ki pa bistveno ne vplivajo na sam potek in rezultat mamografije. Introduction: The DORA screening program has been created to reduce the mortality rate of women in connection with breast cancer. For the purposes of diagnosis, a radiographer performs a mammographic imaging according to the prescribed protocol based on the European guidelines and quality standards. The quality of his work is assured by regular evaluation of mammograms. Purpose: The goal of this diploma work is to determine whether the quality of the radiographers' work in different DORA centers vary, taking into account how long the centers have been operating, and compare the screening protocol in the best rated DORA center according to the Institute of Oncology Ljubljana with European guidelines. Methods: For the purposes of this diploma work in first part we have used quantitative analysis of data regarding the evaluation radiographers' work in different DORA centers. In second part we have used literature review and qualitative method (an interview) to obtain information for comparison the imaging protocol in the Health Center of Adolf Drolc in Maribor with the European guidelines. Results: Whit the first part of the diploma work we obtained the following results on the average scores for the 2017-2018 assessment period in relation to the CC projection are 93.7% for the Oncology Institute of Ljubljana (OI LJ), 92.4% for the University Medical Center Maribor (UMC MB) and 96.1% for the General Hospital Celje (GH CE). Regarding the MLO projection, the average scores amount to 87.3% for OI LJ, 82.3% for UMC MB and 88.4% for GH CE. In the second part we found out that the breast imaging protocols compared in this theses differ from European guidelines on the following points: first, in DORA Center of Community Health Centre of Adolf Drolc in Maribor a radiographer decides about introducing himself to the patient with his name and surname, and second, a different setting of the angle for the MLO projection, which should be individually adapted according to the European guidelines. Furthermore, in line with European guidelines it is not necessary to wipe the breasts before the procedure and use a gonadal apron, though that is a common practice in Maribor. Discussion and conclusions: The quality of work of radiographers does not differ significantly between the centers. The work in all DORA centers is of high quality, though we have noticed a few differences. Comparison between the protocols revealed only four minor disparities without significant influence on the procedure itself or the results of mammography.

Izhodišča: Presejanje je pregledovanje navidezno zdravih ljudi, za zgodnje odkrivanje bolezni in hitro ukrepanje. S presejalnimi programi na ginekološkem področju pregledujejo ženske s preprostimi preiskavami ali testi, da bi med njimi odkrili tiste, ki že imajo predstopnjo ali začetno obliko raka materničnega vratu in/ali raka dojk. V Sloveniji na ginekološkem področju delujeta dva presejalna programa, in sicer program DORA, za odkrivanje raka dojk in program ZORA, za odkrivanje raka materničnega vratu. Namen zaključnega dela je ugotoviti osveščenost žensk v Pomurju o ginekoloških presejalnih programih. Raziskovalne metode: Uporabili smo deskriptivno metodo dela in kvantitativno metodologijo raziskovanja. Raziskavo smo izvedli v enem izmed nakupovalnih centrov v Pomurju. Izvedli smo anketo, v kateri je sodelovalo 100 žensk, in sicer 50 anketiranih žensk živi na podeželju in 50 anketirank je iz mestnih območij. Rezultati: Ugotovili smo, da ženske, ne glede na lokacijo bivanja, dobro poznajo glavni namen presejalnih programov, vendar je raziskava pokazala, da ženske iz mest bolj poznajo podroben namen program ZORA in DORA, kot ženske s podeželja. Večina žensk je tudi že dobila vabilo na presejalnih program, in se ga tudi udeležila, to pa bi storile tudi v prihodnje. Diskusija in zaključek: Presejalni programi so odlični preventivni programi, pri katerih s pomočjo testov, preiskav lahko bolezen odkrijemo v zgodnji fazi in so tako možnosti za ozdravitev visoke. Prišli smo do spoznanja, da so ženske v Pomurju dobro osveščene o namenu ginekoloških presejalnih programov in da se večina odzove vabilu na program. Introduction: Screening is medical testing of apparently healthy people, aimed at early detection of diseases and quick action. Gynaecologic screening programmes consist of simple medical examinations or tests designed to detect women with precancerous conditions or early stages of cervical and/or breast cancer. Slovenia carries out two gynaecologic screening programmes the DORA programme, aimed at detecting breast cancer, and the ZORA programme, aimed at detecting cervical cancer. The purpose of this diploma thesis is to present the level of awareness of women in the Pomurje region about gynaecologic screening programmes. Methodology of research: We used the descriptive work method and the quantitative research method. The research was carried out in a shopping centre in the Pomurje region. We conducted a survey on 100 women, of which 50 are living in rural areas and 50 are living in urban areas. Results: We found out that regardless of where they live, women are well informed about the main purpose of screening programmes, however, the research shows that women living in urban areas have better knowledge about the ZORA and DORA programmes than women living in rural areas. The majority of women have already received an invitation to take part in a screening programme and participated in it, and they are willing to do it also in the future. Discussion and conclusion: Screening programs are excellent prevention programmes aimed at detecting diseases in early stages through medical tests and examinations, thus leading to high recovery rates. Our conclusion is that women in the Pomurje region are well informed about the purpose of gynaecologic screening programmes and that the majority of them take part in the programmes.

Uvod: Rak dojke je v zahodnem svetu najpogostejše maligno obolenje žensk v srednji starostni skupini. Z mamografijo odkrivamo bolezenske spremembe v dojki. Mamografijo opravimo v dveh projekcijah: polstranski (MLO) in kraniokavdalni (CC). Za zagotavljanje kakovosti mamografskih slik je pomembno pravilno pozicioniranje dojk. Za oceno kakovosti uporabljamo slovensko klasifikacijo. Namen: Namen magistrske naloge je ugotoviti, ali s spremembo osnovnega kota pri polstranski projekciji dojk v mamografski diagnostiki prikažemo več diagnostično pomembnega tkiva glede na različne konstitucije pacientk. Metode dela: Raziskava je potekala na Onkološkem inštitutu – Slovenski državni presejalni program DORA. S pomočjo slikovnega merila v slikovnem arhivu IMPAX, smo na mamografskih posnetkih izvedli tri meritve: širino kota prsne mišice retromamilarni bazalni (maščobni) del tkiva dojke inframamarni predel (IMF) tkiva dojke. Rezultati: Primerjava izmerjenih vrednosti prikazanega dela pri slikanju dojk med kotom 55° in kotom 45° nam potrdi, da pri slikanju pod kotom 55° prikažemo več tkiva dojke. Z uporabo kota 55° prikažemo več tkiva dojke v vseh treh meritvah (širina prsne mišice, meritev bazalnega/maščobnega in inframamarnega predela dojke). Z rezultati meritev MLO projekcij pod kotom 35° in 45° dokažemo, da z uporabo kota 35° prikažemo več tkiva dojke pri bazalnem/maščobnem in spodnjem narastiščem dojke v primerjavi s standardnim kotom 45°. Pri slikanju dojk s kotom 45° pa prikažemo več širine prsne mišice v primerjavi pri slikanju dojk s kotom 35°. Razprava in zaključek: Z uporabo kota 55° prikažemo več milimetrov tkiva dojke v vseh treh meritvah pri širini prsne mišice, meritve bazalnega in inframamarnega predela. S spremembo kota 35° smo dokazali, da prikažemo več tkiva dojke pri bazalnem/maščobnem in spodnjem narastiščem dojke v primerjavi s standardnim kotom 45°. Pri meritvah širine prsne mišice je kot 45° podoben projekcijah z uporabo kota 55° in kota 35° (pri različni anatomiji/konstitucije preiskovanke) prikažemo več tkiva dojke. Introduction: Breast cancer is one of the most common malignant disease in the western world amongst middle aged women. With mammography we discover diseased breast changes. Mammography is completed with two projections (images): Mediolateral-oblique (MLO) and Cranial Caudal (CC) view. For providing the quality assurance of mammographic images, correct breast positioning, is important. For the evaluation of the quality we utilize Slovene Classifications. Purpose: The purpose of the master´s degree is to discover, if a change of the basic MLO angle (45°) maximizes the amount of the breast tissue seen on image, by examining different body shapes of patients.Work methods: The research was conducted at the Institute of Oncology – Slovenian Breast Cancer Screening Program DORA. With the help of the image criterion in the Picture Archive IMPAX, three measurements were performed on mammographic images: the width of the pectoral muscle retromammary space (fatty tissue) inframammary part (IMF) of the breast.Results: The comparison of the measured values of examined part of the breast with concave sternum, between the angle 55° and 45°, confirms that imaging at an angle 55 °captures more breast tissue. Furthermore, when using an angle 55°, more breast tissue is shown in all three measurements (the width of the pectoral muscle, the measurement of retromammary /fatty tissue and inframammary part of the breast). With the results of the MLO projection of the breast with convex sternum at an angle 35° and 45° we confirm that, by using an angle 35° we show more breast tissue in the retromammary/fatty and inframammary part, than a basic 45° angle. Whereas, an imaging of breasts at an angle 45°, shows more width of the pectoral muscle, if comparing with an angle 35°. Discussion and conclusion: With the utilization of an angle 55°, when convex sternum, a greater area (millimetres) of the breast tissue can be seen when considering all three measurements the width of the pectoral muscle, the measurements of retromammary and inframammary part. With the alteration to an angle 35°, when concave sternum, we proved that retromammary and inframammary tissue of the breast is visible better, than at a standard angle 45°. When measuring the width of the pectoral muscle, the angle 45° gives similar results like the angle 35°. With the results of the measurements we can confirm that, when imaging in MLO projection at an angle 55°and 35° (using it on a different anatomy/body shapes of patients) we show/capture a larger part of the breast tissue.

Teoretična izhodišča: Presejalni programi so, namenjeni zgodnjemu odkrivanju bolezni. S presejalnimi programi v Sloveniji se išče osebe, ki so zbolele za rakom dojke, za rakom na materničnem vratu in za rakom debelega črevesa in danke. Z redno udeležbo v presejalnih programih, lahko pri navidezno zdravi populaciji odkrijejo predrakave spremembe. Ob zgodnjem odkritju je njihovo zdravljenje hitrejše in pusti manj posledic. V Sloveniji potekajo trije presejalni programi, in sicer DORA, ZORA in Svit. Naš namen je bil predstaviti ozaveščenost ljudi o presejalnih programih. Metodologija raziskovanja: Uporabljena je bila deskriptivna in kvantitativna metodologija raziskovanja. Podatke smo zbirali s pomočjo anonimnega anketnega vprašalnika, ki je vseboval 14 vprašanj. V raziskavi je sodelovalo 80 naključno izbranih oseb, starejših od 30 let. Raziskavo smo izvedli v nakupovalnem centru v Murski Soboti. Podatke, ki smo jih pridobili z anketnim vprašalnikom, smo obdelali, rezultate pa grafično prikazali s programom Microsoft Excel in jim s programom Microsoft Word ustrezno komentirali. Rezultati: Na podlagi pridobljenih rezultatov smo ugotovili, da anketirane osebe dobro poznajo presejalne programe. Največ jih pozna preventivni program Svit, dobro pa poznajo tudi ostala dva programa. Anketiranci prav tako dobro poznajo namen presejalnih programov in za katere bolezni je posamezni program namenjen. Večina od anketirancev je že prejela vabilo v presejalni program in se nanj tudi odzvala. Pri tistih, ki se niso odzvali je bil najpogostejši razlog, da temu niso posvečali velike pozornosti. Velika večina anketirancev se namerava v prihodnje odzvati na vabilo v presejalni program. Sklep: Podatki, pridobljeni z anketo, nakazujejo, da so anketiranci dobro ozaveščenih o presejalnih programih, da vedo kaj je presejanje in kakšen namen ima posamezni presejalni program. Razveseljivo je dejstvo, da se jih je večina že odzvala na vabilo, in da se bodo v večini odzvali na vabilo v presejalni program tudi v prihodnje. Theoretical starting points: Screening tests are aimed at early detection of different diseases. In Slovenia they are used for identification of people who are suffering from breast cancer, cancer of the cervix and cancer of the colon and rectum. With regular participation in screening programs we are able to identify pre-cancerous lesions within apparently healthy population. At the early discovery their treatment is faster and leaves less impact. In Slovenia, there are three screening programs, namely DORA, Zora and Svit. Our purpose was to present people's awareness of screening programs. Research methodology: Descriptive and quantitative research methodology were used. Data were collected using an anonymous questionnaire containing 14 questions. The study included 80 randomly selected people aged over 30 years. The research was carried out in a shopping center in Murska Sobota. The information we have obtained through a questionnaire were processed and the results are visualized with Microsoft Excel and commented with Microsoft Word. Results: Based on the obtained results, we found that respondents have good knowledge of screening programs. Most of them know the preventive program Svit, but they also know the other two programs. Respondents are also well aware of the purpose of screening programs and for early detection of which specific disease they are intended. Most of the respondents had already received an invitation to the screening program and to respond to them. For those who have not responded, the most common reason is the lack of attention. The vast majority of respondents in the future intends to respond to an invitation to participate in the screening program. Conclusion: The data obtained from the survey indicate that respondents are well-informed about the screening programs, know what screening programs are and what the purpose of a specific screening program is. The fact that most of them have already responded to the invitation is gratifying. Majority of people involved in the study will in the future respond to an invitation to the screening program.

Teoretična izhodišča: Rak dojk je po svetu najpogostejši rak pri ženskah. S starostjo se ta bolezen veča. Z rednim samopregledovanjem dojk, hitrim prepoznavanjem sprememb na dojkah ter poznavanjem dejavnikov tveganja lahko ženske hitro prepoznajo bolezen. Namen: Namen diplomskega dela je bil ugotoviti, kolikšna je osveščenost žensk o samopregledovanju dojk v Pomurski regiji. Metodologija raziskovanja: Raziskava je temeljila na kvantitativni metodologiji. Podatke smo pridobili s pomočjo anketnega vprašalnika, ki je vseboval 15 vprašanj zaprtega tipa. Raziskovalni vzorec je zajemal 100 naključno izbranih žensk. Rezultati: Rezultati raziskave so pokazali, da so anketirane ženske seznanjene s pravilno tehniko samopregledovanja dojk, saj si 86 % žensk dojke samopregleduje stoje pred ogledalom, vendar pa samo 22 % žensk samopregledovanje izvaja redno, enkrat na mesec. Znanje tehnike za samopregledovanje dojk je 34 % žensk pridobilo od svojega ginekologa in prav tako 34 % žensk iz strokovnih člankov, samo 6 % pa od medicinske sestre. Anketiranke tudi premalo poznajo dejavnike tveganja, ki povzročajo raka dojke. Sklep: Ženske se morajo zavedati, da je rak dojk ozdravljiva bolezen, če je le odkrita pravočasno. Največ lahko storijo same, s samopregledovanjem dojk ter poznavanjem dejavnikov tveganja. V Sloveniji uspešno deluje tudi državni program presejanja za raka dojk DORA, ki vabi vse ženske med 50. in 69. letom na mamografski pregled vsaki dve leti. Theoretical base: Breast cancer is the most widespread cancer and the numbers of this form of cancer increase with age. Women can easily detect this form of cancer with regular self-exams, recognition of changes in a normal breast and with getting to know the risk factors. Aim: The aim of this paper is to research the level of self-exam awareness of women in the Pomurje region in Slovenia. Research methodology: The research is based on quantitative methodology. The results were gathered with a questionnaire which contained 15 closed questions. Samples were taken from 100 randomly chosen women. Results: The results have shown that the women were aquatinted with the correct technique of breast self-examining. 86% of the women perform the breast self-exams in an upright position in front of a mirror but only 22% have said to do that regularly, once per month. 34% of the women learned the technique from their gynecologist and did 34% learn it from professional articles. Only 6% learned it from a medical nurse. Fact is though that the women participating in the survey were not informed about the risk factors which cause breast cancer well enough. Conclusion: Women should be aware of the fact that breast cancer is curable, if diagnosed in time. The most can be done by women themselves with regular breast self-exams and with the knowledge about the risk factors. The national programme of breast cancer testing is running successfully in Slovenia and invites women aged between 50 to 69 years to a mammogram check up every two years.

Konec marca 2008 so v okviru državnega presejalnega programa za raka dojk Dora prve ženske iz Mestne občine Ljubljana prejele vabilo na presejalno mamografijo v presejalni center na Onkološkem inštitutu Ljubljana (OI). Spomladi 2010 sta poleg presejalne enote na OI postopoma začeli delovati še dve mobilni presejalni enoti. Ob vzpostavljanju novih presejalnih enot bomo v okviru centraliziranega državnega programa vabljenje razširili na širše območje Slovenije. Kakovostno organiziran program presejanja je bistven za zgodnje odkrivanje raka dojk in zmanjšanje umrljivosti. Ključni elementi takega programa so ustrezna izobraženost in strokovna usposobljenost kadra (predvsem radiologov in radioloških inženirjev, pa tudi ostalega kadra, vključenega v nadaljnjo diagnostiko in zdravljenje), zagotavljanje dvojnega odčitavanja mamografskih slik, interdisciplinarno sodelovanje, ustrezna tehnična kakovost mamografskih naprav, vzpostavitev ustreznega informacijskega sistema ter določitev, spremljanje in preverjanje kazalcev kakovosti programa. Poleg vsega omenjenega pa je treba določiti ciljno populacijo žensk, ki bodo organizirano in sistematično vabljene na presejalno mamografijo, ter med njimi s kompleksnimi metodami doseči ustrezno odzivnost. Od 2008 do konca julija 2010 smo na presejalno mamografijo povabili 11.503 žensk. Vabilu se je odzvalo 9686 žensk, kar predstavlja 84,2-odstotno udeležbo. V tem času smo med slikanimi odkrili 86 rakov dojk. Program Dora izpolnjuje vsa merila Evropskih smernic za zagotavljanje kakovosti presejanja za raka dojk in zdravljenja in že daje prve rezultate.