Optimization of radiation protection for x-ray procedures outside the ...

EUROPEAN WORKSHOP ON OPTIMISATION
OF RADIATION PROTECTION IN MEDICINE
Billrothhaus, Vienna, Austria
7-9 June 2012
Optimization of radiation protection for x-ray
procedures outside the radiology department
Conclusions from the working group
Rapporteurs: Renato Padovani, Anders Widmark

X-ray procedures performed outside
radiological departments
• Areas in order of relevance for patient & staff exposures
– Vascular surgery
– Gastroenterology
– Urology
– Orthopaedics
– Neurosurgery
– Anaesthesiology
– General surgery
– Gynaecology
– X-rays at bedside
• Neonatology
• Dental (Conebeam CT)
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Optimization of x-ray procedures outside
radiology: priorities
1. Data collection on frequency of procedures,
patient and staff doses
• Fluoroscopy guided procedures are “special
practices” according to MED Directive . The
requested patient dose monitoring is not a
common practice.
European scientific societies can have a role
in promoting, via their national members,
national data collections
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Optimization of x-ray procedures
outside radiology: priorities
2. There is a need to assess Diagnostic Reference Levels
(DRLs) for the most frequent and high dose procedures
• Pragmatic approach to assess DRLs from limited samples of
data is accepted to provide preliminary refernces
European scientific societies have to be involved
to assess DRLs
EC should promote such a action (e.g. updating
present and quite old recommended DRLs)
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Optimization of x-ray procedures
outside radiology: priorities
3. Optimisation actions of these practices can be
supported by a EC guideline
EC should consider the opportunity to address a
RP Guideline for the optimisation of practices
outside radiology department (draft structure
suggested by EMAN)
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Optimization of x-ray procedures
outside radiology: priorities
4. Staff monitoring requires harmonisation.
Countries have different standards or some don’t
have at all.
To develop a European recommendation to
promote harmonisation (with HERCA)
To promote the use of additional active dosimeters
for educational purposes
To identify the high dose practices requiring hand
and eye lens dosimetry
To promote the adoption of ambient dosimetry (e.g.
part of x-ray equipment)
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Optimization of x-ray procedures
outside radiology: priorities
Dosimetry databases: specialisation and
radiological workload should be added to individual
dose data to allow extracting dose history for group
of specialist (HERCA).
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Optimization of x-ray procedures
outside radiology: priorities
5. Inadequate mobile fluoroscopy equipment are frequently
used to perform complex and long procedures in surgical
theathers
International standards should require specific
characteristics to reduce patient and staff doses in
mobile units, including staff shieldings (COCIR, IEC)
Hospitals should provide adequate shielding to
mobile fluoroscopy units with high workload
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Optimization of x-ray procedures
outside radiology: priorities
Equipment must have KAPmeter (or other means to
inform on patient dose) as required by MED Directive
and National regulation (COCIR)
Hospitals should adopt patient dose information
systems to automatically collect patient doses for a
better monitoring of the practices (IHE standard)
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Optimization of x-ray procedures
outside radiology: priorities
6. Educations and training is seen as a priority. Most of
practitioner have little or no education in radiation
protection and optimisation methods. Specific
methodologies are required to reach the large number of
practitioners (medical specialists, nurses, radiographers
and medical physicists).
MEDRAPET recommendations will properly address
on the methodology and contents (KSC)
Knowledge can be conveniently provided via
distance learning tools (EMAN)
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Optimization of x-ray procedures
outside radiology: priorities
Hospitals should provide proper skill via practical
exercises
EMAN should offer educational sessions at the
European congresses of the different specialities
It is recommended the setup in the hospital of proper
multidisciplinary “Core team” to support
optimisation
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Optimization of x-ray procedures
outside radiology: priorities
7. Clinical audit
Clinical audit methodology should be developed
EMAN should setup multidisciplinary teams to
propose to hospitals
Clinical audit should be added to existing
accreditation systems
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Optimization of x-ray procedures
outside radiology: priorities
8. Inspections activity
HERCA should promote inspections on these
practices
EMAN can support the development of guidelines
(refer to EAN Workshop recommendations and
experience of joint inspections from ERPAN), the
education and training of inspectors (KSC)
http://www.eman-network.eu/

Optimization of x-ray procedures
outside radiology: priorities
9. Stakeholders involvement in EMAN
The experience and the agreement with
ESGE is taken as a model to propose to
other specialities. Cardiology societies
involvement is seen as a priority.
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