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Background: The Southeast European (SEE) region of 10 countries and about 43 million people differs from Western Europe in that most SEE countries lack active cancer registries and have fewer diagnostic imaging devices and radiotherapy (RT) units. The main objective of this research is to initiate a common platform for gathering SEE regional cancer data from the ground up to help these countries develop common cancer management strategies. Methods: To obtain detailed on-the- ground information, we developed separate questionnaires for two SEE groups: a) ONCO - oncologists regarding cancer treatment modalities and the availability of diagnostic imaging and radiotherapy equipment ; and b) REG - national radiation protection and safety regulatory bodies regarding diagnostic imaging and radiotherapy equipment in SEE facilities. Results: Based on responses from 13/17 ONCO participants (at least one from each country) and from 9/10 REG participants (all countries but Albania), cancer incidence rates are higher in those SEE countries that have greater access to diagnostic imaging equipment while cancer mortality-to-incidence (MIR) ratios are higher in countries that lack radiotherapy equipment. Conclusion: By combining unique SEE region information with data available from major global databases, we demonstrated that the availability of diagnostic imaging and radiotherapy equipment in the SEE countries is related to their economic development. While immediate diagnostic imaging and radiation therapy capacity building is necessary, it is also essential to develop both national and SEE- regional cancer registries in order to understand the heterogeneity of each country’s needs and to establish regional collaborative strategies for combating cancer

Purpose Patients with hematuria and renal colic often undergo CT scanning. The purpose of our study was to assess variations in CT protocols and radiation doses for evaluation of hematuria and urinary stones in 20 countries. Method The International Atomic Energy Agency (IAEA) surveyed practices in 51 hospitals from 20 countries in the European region according to the IAEA Technical cooperation classification and obtained following information for three CT protocols (urography, urinary stones, and routine abdomen-pelvis CT) for 1276 patients: patient information (weight, clinical indication), scanner information (scan vendor, scanner name, number of detector rows), scan parameters (such as number of phases, scan start and end locations, mA, kV), and radiation dose descriptors (CTDIvol, DLP). Two radiologists assessed the appropriateness of clinical indications and number of scan phases using the ESR Referral Guidelines and ACR Appropriateness Criteria. Descriptive statistics and Student’s t tests were performed. Results Most institutions use 3-6 phase CT urography protocols (80%, median DLP 1793-3618 mGy.cm) which were associated with 2.4-4.9-fold higher dose compared to 2-phase protocol (20%, 740 mGy.cm) (p < 0.0001). Likewise, 52% patients underwent 3-5 phase routine abdomen- pelvis CT (1574-2945 mGy.cm) as opposed to 37% scanned with a single-phase routine CT (676 mGy.cm). The median DLP for urinary stones CT (516 mGy.cm) were significantly lower than the median DLP for the other two CT protocols (p < 0.0001). Conclusions Few institutions (4/13) use low dose CT for urinary stones. There are substantial variations in CT urography and routine abdomen- pelvis CT protocols result in massive radiation doses (up to 2945-3618 mGy.cm).

Purpose: The objective is to study mammography practice from an optimisation point of view by assessing the impact of simple and immediately implementable corrective actions on image quality. Materials and methods: This prospective multinational study included 54 mammography units in 17 countries. More than 21,000 mammography images were evaluated using a three-level image quality scoring system. Following initial assessment, appropriate corrective actions were implemented and image quality was re-assessed in 24 units. Results: The fraction of images that were considered acceptable without any remark in the first phase (before the implementation of corrective actions) was 70% and 75% for cranio-caudal and medio-lateral oblique projections, respectively. The main causes for poor image quality before corrective actions were related to film processing, damaged or scratched image receptors, or film-screen combinations that are not spectrally matched, inappropriate radiographic techniques and lack of training. Average glandular dose to a standard breast was 1.5mGy (mean and range 0.59-3.2 mGy). After optimisation the frequency of poor quality images decreased, but the relative contributions of the various causes remained similar. Image quality improvements following appropriate corrective actions were up to 50 percentage points in some facilities. Conclusions: Poor image quality is a major source of unnecessary radiation dose to the breast. An increased awareness of good quality mammograms is of particular importance for countries that are moving towards introduction of population-based screening programmes. The study demonstrated how simple and low-cost measures can be a valuable tool in improving of image quality in mammography. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Purpose: To investigate status of imaging technology and practice in five countries in Eastern-European region (Bosnia and Herzegovina, Croatia, FYR of Macedonia, Montenegro and Serbia) and evaluate the impact of IAEA projects on radiation protection of patients. Method: Information collected included: status of technology used in diagnostic radiology as age of units, type of generators, availability of CT units, mammography units, and digital imaging equipment, use of fluoroscopy for positioning, photofluorography, chest fluoroscopy, radiography technique, CT protocols used and patterns of dealing with pregnancy in diagnostic radiology. Using standardized IAEA protocol for dose measurements, patient doses in interventional procedure, conventional radiography, mammography and Ct were assessed. Results: In diagnostic radiology, the number of digital units is increasing, but single phase generators or units older than 30 year are still in use (more than 40% in some countries). Obsolete practice of use of fluoroscopy for positioning, photofluorography, chest fluoroscopy and soft-beam technique for chest radiography is occasionally or regularly in use. On the other hand, modern units such as mulitislice CT or digital mammography are available in all participating countries, however, adult CT protocol is still in use for examination of children and there is lack of adequate medical physics support in hospitals. In two countries, the awareness of pregnancy issues following exposure and necessity for termination is not adequate. Results on patient dose measurements in interventional radiology, conventional radiography, mammography and CT as a first efforts to reflect the actual practice in the participating countries, were in line with similar studies in other countries, however, dose variation indicated a significant scope for optimization. Based on dose measurement results, points were optimisation is needed were identified, corrective measures proposed and appropriate follow up actions were taken. Conclusions: The IAEA project was a learning process and experience for all participants. The work helped in creating awareness of radiation protection issues and initiation of actions to improve the situation of radiation protection in diagnostic and interventional radiology in all participating countries.