Transcript Remedios Cairo Objectives - International Atomic Energy Agency

African Regional Workshop on
Imaging Referral Guidelines
Setting the scene: Objectives & Overview
Denis Remedios
Clinical Radiologist,
Northwick Park Hospital, UK
On behalf of the IAEA
African Regional Workshop on Imaging Referral
Guidelines: Cairo, 13-16 December 2015
With thanks to:
International Atomic Energy Agency
World Health Organization
Egyptian Atomic Energy Authority
Acknowledgement:
The need for radiation protection
Diagnostic radiology in USA
accounts for as much radiation
than natural causes (15% in 1980
to 48% in 2006) NCRP 160
http://www.ncrponline.org/
CT exams have increased at 10%
pa in USA from 3-80 million since
1980
44% of CT exams not justified in
USA
Hadley JL, Agola J, Wong P. AJR 2006; 186: 937-942
http://www.ncbi.nlm.nih.gov/pubmed/16554560
Low level of knowledge of dose;
only 1:3 doctors received formal
training in radiation protection
Soye & Paterson. BJR 81 (2008),725-729
http://bjr.birjournals.org/cgi/content/abstract/81/969/725
“Awareness, Appropriateness & Audit”
Triple A
http://www.ncbi.nlm.nih.gov/pubmed/21343316
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Joint Position Statement by the IAEA and WHO
Criteria for choice of
investigations
Investigations are recommended
according to the following criteria:
1. Clinical effectiveness (evidence-
based diagnostic/therapeutic impact)
2. Effective dose (effective low or no
dose investigations preferred)
3. Cost-effectiveness (cheaper equally
effective investigation preferred)
Essential for uniformity of practice
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The Basic Safety Standards and “Justification”
Appropriate Imaging
“The best test first”
Investigation should answer the clinical question posed
Must be a justified investigation: benefit>>risk
Recommendations should give latitude for equipment
and expertise
• Appropriate imaging should take into account overutilisation of imaging in some member states but underutilisation of imaging in others
• Cost savings come from avoidance of unhelpful
investigations
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Justification and clinician
involvement: Issues
Overloaded knowledge base
Medical and technical advances
Competition for inclusion in curricula/CPD
Time challenged
Fastest test with shortest wait best?
Mixed messages
Different guidance from different sources?
Patient expectations
Historical or geographical bias
Unreliable evidence base from the web
Justification and clinician
involvement : challenges
Dissemination of Referral Guidelines
Widely and freely available to end-users
“If they haven’t heard it you haven’t said it” McLuhan
Implementation of guidance
decision support tools?
“We shape our tools and thereafter our tools shape us” McLuhan
Uptake
need buy-in by users and preferably ownership
“Computers can do better than ever what needn’t be done at all. Making sense is still a human monopoly”
McLuhan
Monitoring
clinical audit, feedback and education
“We drive into the future using only our rearview mirror ” McLuhan
Justification and clinician
involvement: possible solutions
Education
Undergraduate and Continuing
Professional Development.
Requests not orders
Referral
Guidelines
from a trusted source,
in line with clinical guidance,
+/- clinical decision support
Monitor with
clinical audit
External
control
Local internal audit (bottom up)
External audit (top down)
by payers
legislation
African Regional Workshop on Imaging Referral
Guidelines: Overview
Day 1 Setting the scene- why do we need referral
guidelines, what are they, who should use them, what
improvements may we get?
Day 2 Current status- what measures are in place in
African countries; what good practices can be shared
Day 3 Strategies for improvement- existing, wanted
and needed. Visit to the National PACS.
Day 4 The way forward- recommendations for
national and international help
Break out Groups, Day 2 and Day 3
• To enable all participants to share experiences and good
practices
• 2 streams, one in the French language, one in English
• Chairman and Rapporteur for each group
• Chair will lead structured discussion
• Rapporteur will feedback to all participants and provide a
framework for recommendations
Group 1: Barriers and solutions to appropriate imaging
Group 2: Strategies and tools for adopting/adapting,
implementing, using and monitoring Imaging Referring
Guidelines
African Regional Workshop on Imaging Referral
Guidelines: Objectives
1. Understand benefits of imaging referral guidelines
2. Guideline implementation: Adopting and adapting for
appropriate imaging
3. Introduction to methods for monitoring / audit of
appropriate imaging
Secondary objectives are:
a. To strengthen justification in diagnostic imaging;
b. Reduction in unnecessary radiation dose to patients.
c. To promote awareness among referrers, radiologists,
radiographer and regulators. Clinical champions.
d. To address country-specific problems.
Awareness, Appropriateness and Audit
Referrers, Radiologists, Radiographer and Regulators