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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. |
