Quality assurance and quality control in mammography: a review of available guidance worldwide

Objectives - Review available guidance for quality assurance (QA) in mammography and discuss its contribution to harmonise practices worldwide. Methods - Literature search was performed on different sources to identify guidance documents for QA in mammography available worldwide in international bodies, healthcare providers, professional/scientific associations. The guidance documents identified were reviewed and a selection was compared for type of guidance (clinical/technical), technology and proposed QA methodologies focusing on dose and image quality (IQ) performance assessment. Results - Fourteen protocols (targeted at conventional and digital mammography) were reviewed. All included recommendations for testing acquisition, processing and display systems associated with mammographic equipment. All guidance reviewed highlighted the importance of dose assessment and testing the Automatic Exposure Control (AEC) system. Recommended tests for assessment of IQ showed variations in the proposed methodologies. Recommended testing focused on assessment of low-contrast detection, spatial resolution and noise. QC of image display is recommended following the American Association of Physicists in Medicine guidelines. Conclusions - The existing QA guidance for mammography is derived from key documents (American College of Radiology and European Union guidelines) and proposes similar tests despite the variations in detail and methodologies. Studies reported on QA data should provide detail on experimental technique to allow robust data comparison. Countries aiming to implement a mammography/QA program may select/prioritise the tests depending on available technology and resources.

Equipment quality control

Mammography equipment must be evaluated to ensure that images will be of acceptable diagnostic quality with lowest radiation dose. Quality Assurance (QA) aims to provide systematic and constant improvement through a feedback mechanism to address the technical, clinical and training aspects. Quality Control (QC), in relation to mammography equipment, comprises a series of tests to determine equipment performance characteristics. The introduction of digital technologies promoted changes in QC tests and protocols and there are some tests that are specific for each manufacturer. Within each country specifi c QC tests should be compliant with regulatory requirements and guidance. Ideally, one mammography practitioner should take overarching responsibility for QC within a service, with all practitioners having responsibility for actual QC testing. All QC results must be documented to facilitate troubleshooting, internal audit and external assessment. Generally speaking, the practitioner’s role includes performing, interpreting and recording the QC tests as well as reporting any out of action limits to their service lead. They must undertake additional continuous professional development to maintain their QC competencies. They are usually supported by technicians and medical physicists; in some countries the latter are mandatory. Technicians and/or medical physicists often perform many of the tests indicated within this chapter. It is important to recognise that this chapter is an attempt to encompass the main tests performed within European countries. Specific tests related to the service that you work within must be familiarised with and adhered too.

Microbiological assessment of indoor air quality at different hospital sites

Poor hospital indoor air quality (IAQ) may lead to hospital-acquired infections, sick hospital syndrome and various occupational hazards. Air-control measures are crucial for reducing dissemination of airborne biological particles in hospitals. The objective of this study was to perform a survey of bioaerosol quality in different sites in a Portuguese Hospital, namely the operating theater (OT), the emergency service (ES) and the surgical ward (SW). Aerobic mesophilic bacterial counts (BCs) and fungal load (FL) were assessed by impaction directly onto tryptic soy agar and malt extract agar supplemented with antibiotic chloramphenicol (0.05%) plates, respectively using a MAS-100 air sampler. The ES revealed the highest airborne microbial concentrations (BC range 240-736 CFU/m(3) CFU/m(3); FL range 27-933 CFU/m(3)), exceeding, at several sampling sites, conformity criteria defined in national legislation [6]. Bacterial concentrations in the SW (BC range 99-495 CFU/m(3)) and the OT (BC range 12-170 CFU/m(3)) were under recommended criteria. While fungal levels were below 1 CFU/m(3) in the OT, in the SW (range 1-32 CFU/m(3)), there existed a site with fungal indoor concentrations higher than those detected outdoors. Airborne Gram-positive cocci were the most frequent phenotype (88%) detected from the measured bacterial population in all indoor environments. Staphylococcus (51%) and Micrococcus (37%) were dominant among the bacterial genera identified in the present study. Concerning indoor fungal characterization, the prevalent genera were Penicillium (41%) and Aspergillus (24%). Regular monitoring is essential for assessing air control efficiency and for detecting irregular introduction of airborne particles via clothing of visitors and medical staff or carriage by personal and medical materials. Furthermore, microbiological survey data should be used to clearly define specific air quality guidelines for controlled environments in hospital settings.

Burn wood influence on outdoor air quality in a small village: Foros de Arrão, Portugal

One Plus Sequential Air Sampler—Partisol was placed in a small village (Foros de Arrão) in central Portugal to collect PM10 (particles with an aerodynamic diameter below 10 μm), during the winter period for 3 months (December 2009–March 2010). Particles masses were gravimetrically determined and the filters were analyzed by instrumental neutron activation analysis to assess their chemical composition. The water-soluble ion compositions of the collected particles were determined by Ion-exchange Chromatography. Principal component analysis was applied to the data set of chemical elements and soluble ions to assess the main sources of the air pollutants. The use of both analytical techniques provided information about elemental solubility, such as for potassium, which was important to differentiate sources.

Indoor air quality in primary schools

Clean air is a basic requirement of life. The Indoor Air Quality (IAQ) has been the object of several studies due to an increasing concern within the scientific community on the effects of indoor air quality upon health, especially as people tend to spend more time indoors than outdoors. The quality of air inside homes, offices, schools or other private and public buildings is an essential determinant of healthy life and people’s well-being. People can be exposed to contaminants by inhalation, ingestion and dermal contact. In the past, scientists have paid much attention to the study of exposure to outdoor air contaminants, because they have realised the seriousness of outdoor air pollution problems. However, each indoor microenvironment has unique characteristics, determined by the local outdoor air, specific building characteristics and indoor activities. Indeed, hazardous substances are emitted from buildings, construction materials and indoor equipment or due to human activities indoors.

Indoor air quality in Portuguese archives: a snapshot on exposure levels

Indoor air quality recently entered legislation in Portugal. Several parameters must be evaluated and kept within limits in order to obtain a certification for air quality and energy consumption. Certification parameters were analyzed in two Portuguese archives in order to assess indoor air quality both for people attending or working on these premises and for maintenance of a written heritage that must be retained for future generations. Carbon monoxide (CO) and carbon dioxide (CO2), formaldehyde, and fungal counts were kept within stipulated limits. Relative humidity (RH), volatile organic compounds (VOC), particulate matter (PM10), and ozone (O3) showed values above legislated levels and justified the implementation of corrective measures. In terms of conservation, studies on the limit values are still needed, but according to the available international guidelines, some of the analyzed parameters such as PM10, O3, and RH were also above desirable values. Corrective measures were proposed to these institutions. Although this study was only of a short duration, it proved valuable in assessing potential eventual problems and constitutes the first Portuguese indoor air quality assessment taking into consideration both aspects of an archive such as human health and heritage safekeeping.

Integration of biomonitoring and instrumental techniques to assess the air quality in an industrial area located in the coastal of Central Asturias, Spain

Throughout the world, epidemiological studies were established to examine the relationship between air pollution and mortality rates and adverse respiratory health effects. However, despite the years of discussion the correlation between adverse health effects and atmospheric pollution remains controversial, partly because these studies are frequently restricted to small and well-monitored areas. Monitoring air pollution is complex due to the large spatial and temporal variations of pollution phenomena, the high costs of recording instruments, and the low sampling density of a purely instrumental approach. Therefore, together with the traditional instrumental monitoring, bioindication techniques allow for the mapping of pollution effects over wide areas with a high sampling density. In this study, instrumental and biomonitoring techniques were integrated to support an epidemiological study that will be developed in an industrial area located in Gijon in the coastal of central Asturias, Spain. Three main objectives were proposed to (i) analyze temporal patterns of PM10 concentrations in order to apportion emissions sources, (ii) investigate spatial patterns of lichen conductivity to identify the impact of the studied industrial area in air quality, and (iii) establish relationships amongst lichen conductivity with some site-specific characteristics. Samples of the epiphytic lichen Parmelia sulcata were transplanted in a grid of 18 by 20 km with an industrial area in the center. Lichens were exposed for a 5-mo period starting in April 2010. After exposure, lichen samples were soaked in 18-MΩ water aimed at determination of water electrical conductivity and, consequently, lichen vitality and cell damage. A marked decreasing gradient of lichens conductivity relative to distance from the emitting sources was observed. Transplants from a sampling site proximal to the industrial area reached values 10-fold higher than levels far from it. This finding showed that lichens reacted physiologically in the polluted industrial area as evidenced by increased conductivity correlated to contamination level. The integration of temporal PM10 measurements and analysis of wind direction corroborated the importance of this industrialized region for air quality measurements and identified the relevance of traffic for the urban area.

Statistical analysis of quality control measurements in IMRT for head and neck and prostate cancer

Intensity Modulated Radiotherapy (IMRT) is a technique introduced to shape more precisely the dose distributions to the tumour, providing a higher dose escalation in the volume to irradiate and simultaneously decreasing the dose in the organs at risk which consequently reduces the treatment toxicity. This technique is widely used in prostate and head and neck (H&N) tumours. Given the complexity and the use of high doses in this technique it’s necessary to ensure as a safe and secure administration of the treatment, through the use of quality control programmes for IMRT. The purpose of this study was to evaluate statistically the quality control measurements that are made for the IMRT plans in prostate and H&N patients, before the beginning of the treatment, analysing their variations, the percentage of rejected and repeated measurements, the average, standard deviations and the proportion relations.

RFID together with multi-agent systems to control global value chains

Nowadays, the cooperative intelligent transport systems are part of a largest system. Transportations are modal operations integrated in logistics and, logistics is the main process of the supply chain management. The supply chain strategic management as a simultaneous local and global value chain is a collaborative/cooperative organization of stakeholders, many times in co-opetition, to perform a service to the customers respecting the time, place, price and quality levels. The transportation, like other logistics operations must add value, which is achieved in this case through compression lead times and order fulfillments. The complex supplier's network and the distribution channels must be efficient and the integral visibility (monitoring and tracing) of supply chain is a significant source of competitive advantage. Nowadays, the competition is not discussed between companies but among supply chains. This paper aims to evidence the current and emerging manufacturing and logistics system challenges as a new field of opportunities for the automation and control systems research community. Furthermore, the paper forecasts the use of radio frequency identification (RFID) technologies integrated into an information and communication technologies (ICT) framework based on distributed artificial intelligence (DAI) supported by a multi-agent system (MAS), as the most value advantage of supply chain management (SCM) in a cooperative intelligent logistics systems. Logistical platforms (production or distribution) as nodes of added value of supplying and distribution networks are proposed as critical points of the visibility of the inventory, where these technological needs are more evident.

Relatório de estágio em gabinete de engenharia na componente de climatização

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Mecânica com especialização em Energia, Climatização e Refrigeração

Formaldehyde in indoor air: a public health problem?

Formaldehyde was the first air pollutant, which already in the 1970s emerged as a specifically non-industrial indoor air quality problem. Yet formaldehyde remained an indoor air quality issue and the formaldehyde level in residential indoor air is among the highest of any indoor air contaminant. Formaldehyde concentrations in 4 different indoor settings (schools, office buildings, new dwellings and occupied dwellings) in Portugal were measured using Photo Ionization Detection (PID) equipment (11,7 eV lamps). All the settings presented results higher than the reference value proposed by Portuguese legislation. Furthermore, occupied dwellings showed 3 units with results above the reference. We could conclude that formaldehyde presence is a reality in monitored indoor settings. Concentration levels are higher than the Portuguese reference value for indoor settings and these can indicate health problems for occupants.

Indoor school environment: easy and low cost to assess inorganic pollutants

Total particulate matter (TPM) was passively collected inside two classrooms of each of five elementary schools in Lisbon, Portugal. TPM was collected in polycarbonate filters with a 47 mm diameter, placed inside of uncovered plastic petri dishes. The sampling period was from 19 May to 22 June 2009 (35 days exposure) and the collected TPM masses varied between 0.2 mg and 0.8 mg. The major elements were Ca, Fe, Na, K, and Zn at μg level, while others were at ng level. Pearson′s correlation coefficients above 0.75 (a high degree of correlation) were found between several elements. Soil-related, traffic soil re-suspension and anthropogenic emission sources could be identified. Blackboard chalk was also identified through Ca large presence. Some of the determined chemical elements are potential carcinogenic. Quality control of the results showed good agreement as confirmed by the application of u-score test.

Caracterização tecnológica da mamografia digital em Portugal: progresso de um projeto em implementação

Introdução – A mamografia é o principal método de diagnóstico por imagem utilizado no rastreio e diagnóstico do cancro da mama, sendo a modalidade de imagem recomendada em vários países da Europa e Estados Unidos para utilização em programas de rastreio. A implementação da tecnologia digital causou alterações na prática da mamografia, nomeadamente a necessidade de adaptar os programas de controlo de qualidade. Objetivos – Caracterizar a tecnologia instalada para mamografia em Portugal e as práticas adotadas na sua utilização pelos profissionais de saúde envolvidos. Concluir sobre o nível de harmonização das práticas em mamografia em Portugal e a conformidade com as recomendações internacionais. Identificar oportunidades para otimização que permitam assegurar a utilização eficaz e segura da tecnologia. Metodologia – Pesquisa e recolha de dados sobre a tecnologia instalada, fornecidos por fontes governamentais, prestadores de serviços de mamografia e indústria. Construção de três questionários, orientados ao perfil do médico radiologista, técnico de radiologia com atividade em mamografia digital e técnico de radiologia coordenador. Os questionários foram aplicados em 65 prestadores de serviços de mamografia selecionados com base em critérios de localização geográfica, tipo de tecnologia instalada e perfil da instituição. Resultados – Foram identificados 441 sistemas para mamografia em Portugal. A tecnologia mais frequente (62%) e vulgarmente conhecida por radiografia computorizada (computed radiography) é constituída por um detector (image plate) de material fotoestimulável inserido numa cassete de suporte e por um sistema de processamento ótico. A maioria destes sistemas (78%) está instalada em prestadores privados. Aproximadamente 12% dos equipamentos instalados são sistemas para radiografia digital direta (Direct Digital Radiography – DDR). Os critérios para seleção dos parâmetros técnicos de exposição variam, observando-se que em 65% das instituições são adotadas as recomendações dos fabricantes do equipamento. As ferramentas de pós-processamento mais usadas pelos médicos radiologistas são o ajuste do contraste e brilho e magnificação total e/ou localizada da imagem. Quinze instituições (em 19) têm implementado um programa de controlo de qualidade. Conclusões – Portugal apresenta um parque de equipamentos heterogéneo que inclui tecnologia obsoleta e tecnologia “topo de gama”. As recomendações/guidelines (europeias ou americanas) não são adotadas formalmente na maioria das instituições como guia para fundamentação das práticas em mamografia, dominando as recomendações dos fabricantes do equipamento. Foram identificadas, pelos técnicos de radiologia e médicos radiologistas, carências de formação especializada, nomeadamente nas temáticas da intervenção mamária, otimização da dose e controlo da qualidade. A maioria dos inquiridos concorda com a necessidade de certificação da prática da mamografia em Portugal e participaria num programa voluntário. ABSTRACT - Introduction – Mammography is the gold standard for screening and imaging diagnosis of breast disease. It is the imaging modality recommended by screening programs in various countries in Europe and the United States. The implementation of the digital technology promoted changes in mammography practice and triggered the need to adjust quality control programs. Aims –Characterize the technology for mammography installed in Portugal. Assess practice in use in mammography and its harmonization and compliance to international guidelines. Identify optimization needs to promote an effective and efficient use of digital mammography to full potential. Methodology – Literature review was performed. Data was collected from official sources (governmental bodies, mammography healthcare providers and medical imaging industry) regarding the number and specifications of mammography equipment installed in Portugal. Three questionnaires targeted at radiologists, breast radiographers and the chief-radiographer were designed for data collection on the technical and clinical practices in mammography. The questionnaires were delivered in a sample of 65 mammography providers selected according to geographical criteria, type of technology and institution profile. Results – Results revealed 441 mammography systems installed in Portugal. The most frequent (62%) technology type are computerized systems (CR) mostly installed in the private sector (78%). 12% are direct radiography systems (DDR). The criteria for selection of the exposure parameters differ between the institutions with the majority (65%) following the recommendations from the manufacturers. The use of available tools for post-processing is limited being the most frequently reported tools used the contrast/ brightness and Zoom or Pan Magnification tools. Fifteen participant institutions (out of 19) have implemented a quality control programme. Conclusions – The technology for mammography in Portugal is heterogeneous and includes both obsolete and state of the art equipment. International guidelines (European or American) are not formally implemented and the manufacturer recommendations are the most frequently used guidance. Education and training needs were identified amongst the healthcare professionals (radiologists and radiographers) with focus in the areas of mammography intervention, patient dose optimization and quality control. The majority of the participants agree with the certification of mammography in Portugal.

Occupational exposure to aflatoxin (AFB1) in poultry production

Aflatoxin B1 (AFB1) has been recognized to produce cancer in human liver. In addition, epidemiological and laboratory studies demonstrated that the respiratory system was a target for AFB1. Exposure occurs predominantly through the food chain, but inhalation represents an additional route of exposure. The present study aimed to examine AFB1 exposure among poultry workers in Portugal. Blood samples were collected from a total of 31 poultry workers from six poultry farms. In addition, a control group (n = 30) was included comprised of workers who undertook administrative tasks. Measurement of AFB1 in serum was performed by enzyme-linked immunosorbent assay (ELISA). For examining fungi contamination, air samples were collected through an impaction method. Air sampling was obtained in pavilion interior and outside the premises, since this was the place regarded as the reference location. Using molecular methods, toxicogenic strains (aflatoxin-producing) were investigated within the group of species belonging to Aspergillus flavus complex. Eighteen poultry workers (59%) had detectable levels of AFB1 with values ranging from <1 ng/ml to4.23 ng/ml and with a mean value of 2 ± 0.98ng/ml. AFB1 was not detected in the serum sampled from any of the controls. Aspergillus flavus was the fungal species third most frequently found in the indoor air samples analyzed (7.2%) and was the most frequently isolated species in air samples containing only Aspergillus genus (74.5%). The presence of aflatoxigenic strains was only confirmed in outdoor air samples from one of the units, indicating the presence of a source inside the building in at least one case. Data indicate that AFB1 inhalation represents an additional risk in this occupational setting that needs to be recognized, assessed, and prevented.

Digital radiology and Picture Archiving and Communication System (PACS)

Plain radiography still accounts for the vast majority of imaging studies that are performed at multiple clinical instances. Digital detectors are now prominent in many imaging facilities and they are the main driving force towards filmless environments. There has been a working paradigm shift due to the functional separation of acquisition, visualization, and storage with deep impact in the imaging workflows. Moreover with direct digital detectors images are made available almost immediately. Digital radiology is now completely integrated in Picture Archiving and Communication System (PACS) environments governed by the Digital Imaging and Communications in Medicine (DICOM) standard. In this chapter a brief overview of PACS architectures and components is presented together with a necessarily brief account of the DICOM standard. Special focus is given to the DICOM digital radiology objects and how specific attributes may now be used to improve and increase the metadata repository associated with image data. Regular scrutiny of the metadata repository may serve as a valuable tool for improved, cost-effective, and multidimensional quality control procedures.