Transcript RADIATION PROTECTION IN EUROPE - MIIT

RADIATION MONITORING
STRATEGY IN EUROPE
Guy FRIJA
TORONTO, May 2013
Professor of Radiology and Consultant in Paris
Hôpital Européen Georges Pompidou
Oncologic , Cardiovascular and Trauma center
FACTS
 European regulatory background
 European heterogeneity
 Referral Guidelines : underuse
EUROPEAN REGULATORY
BACKGROUND
 Euratom Directive, 1997
optimisation, DRL
justification
maintenance
clinical audit
 New BSS in preparation
EUROPEAN REGULATORY
BACKGROUND

Into National Law

National Regulatory Body

HERCA
EUROPEAN HETEROGENEITY
DOSE DATAMED 2, 2013

Heterogeneity in :
Demographics, Equipments,
Practices
1
1
OECD-2012
1
1
COLLECTIVE DOSE
COLLECTIVE DOSE
 UNSCEAR, 2008
World
Australia
USA
 Europe, 2013
1.9 mSv
2.2 mSv
3.3 mSv
1.1 mSv
REFERRAL GUIDELINES
 European survey by the ESR
 Availability of RG (~ 70%)
 Production: UK and France
 Adopted and adaptated: others
EUROPEAN REFERRAL
GUIDELINES
 Evidence based
 Almost 400 situations
 Recommendations, textual format

“ In Belgium we have referral guidelines; in fact, nobody really
takes them into account ”…

“ Referral guidelines for diagnostic imaging in general are not in
use in Hungary ”…


“ They are not used in the Netherlands ”…
“ Although we have several official referral guidelines published
(in Spain), they are not used generally speaking ”…

“ In Italy the referral guidelines were published in 2004 by the
Ministry of Health. Unfortunately they are not always
followed
in clinical practice ”…

“ There is no official guide line enforcement in the State service
in Ireland ”…


“ In Germany, the guidelines are note routinely used ”…
“ In France, there are guidelines, but they are not used ”…
CHANGE IN PARADIGM
Producing
Using
CHANGE IN PARADIGM
Producing EBM
Using EBM
CDS
European Projects
 ESR – CDS Project
 ESR – ACR co-operation
 ESR – HERCA co-operation
ESR – CDS PROJECT
 Principle approved by the EC and
by HERCA
 RCR, SFR, ESR: common approach
 NDSC and ACR experiences
ESR – CDS PROJECT
 Initially limited to the top 10-20
clinical situations
 Potentially extended to
paediatric, cardiovascular and
others…
ESR – ACR : Globalisation
 MOU in 2013
 Cross-relations in the professional
field, including R.P. and CDS
 Global Summitt
ESR – HERCA
 Common understanding of the
challenges
 Shared strategies
Justification: CDS
Optimisation: CT
Public awareness
New solutions : WHY ?
Regulation only: failed
 Fragmented approach
- by topics
- by stakeholders
 Theories on behavioural changes
Total Quality Monitoring of RP
 GPS Approach
 Clinical audit
 Public campaign
… and regulation !!!
Total Quality Monitoring
 Global
All the steps
All the stakeholders
 Personalised
Patient centric
Clinical setting
 Safe
Justification
Optimisation
Technological improvements
GPS
ALL THE STEPS
GPS
Protocol
Order
Scheduling
Examination
Justification
Risk factor
Report
IT SUPPORT!!!!!
Dose exposure
GPS
STAKEHOLDERS
PERSONALISED
G PS
 Patient centric
Individual risk-benefit
No dose threshold
Individual Risk-Benefit
G PS
Prediction
Oncology
Screening
PERSONALISED
G PS
Dose recording management
Tailored
Clinically relevant
Tailored Dose recording
Courtesy of Quaelum
TOTAL SAFETY MONITORING
GPS
 Avoid unnecessary tests
 Record the Dose (CT)
 Optimise the protocols
 Track the perls
 Optimise the equipments (CT)
Wrong arm position
DLPmax. = 994 mGy.cm
PERFORMANCE QUALITY
CONTROL
 Correct patient positioning
Scout view
Isocentre of the Gantry
 Over scanning - Overlapping
CLINICAL AUDIT
 Developing a model adapted to
this global approach
 Tool potentially useful
PUBLIC CAMPAIGN
 Image Gently: behavioural
changes
 Paediatric campaign in Europe,
with the ESPR
IMPORTANCE OF IT
Justification
CDS
Patient data
CPOE
Traceability
Follow-up
Dose recording
IT
Compliance
DRL
Audit
Profiling
STAKEHOLDERS
 Medical board
 Administrative staff
 Radiographers
 Radiologists
 Medical physicists
 IT department
SAFETY
 Technological improvements
CT dose reduction
CT Dose Reduction
 New softwares : iterative reconstruction
Dose decrease up to 70-90 % !!!!
 Policy of Equipment upgrade
Immediate Benefit !!!!!
TAKE HOME
 Holistic approach
 Patient centric
 Appropriate IT tools
CONCLUSION
Beyond dose exposure
 The best use of imaging
resources for the patients
and the society benefits
THANK YOU!!!!