ISRRT-DEC-2017_WEB

ISRRT NEWSLETTER DECEMBER 2017
Protection which will be held at the 20th ISRRT World Congress in
Port of Spain which the ISRRT is cosponsoring and coordinating
with the ASRT. I want to personally thank Sal Martino CEO for
sponsoring four excellent speakers for this workshop along with the
lunch for all attendees. Please think about coming as the ISRRT will
be updating members about the outcome of the Bonn meeting from
December.
Action 9: Foster improved radiation benefit-risk dialogue
I want to report out that we have finished contributing to the WHO
document “Communication radiation risks in pediatric imaging:
Information to support health care discussions about benefit and
risk”. This document is intended to be a tool for health care providers
to communicate about risks associated with pediatric imaging
procedures. The document is available to download and distribute
and use in our everyday practices of radiology as professional.
You can easily find this document on the ISRRT website under the
professional practice tab. We are encouraging all member societies to
download this document and make it available for all members to be
used in daily practice.
Action 10:
Strengthen implementation of safety requirements globally
I want to report that in July of 2017 as Director of Professional
Practice I was asked to review the document called “Guidelines
for best practice: Imaging for age estimation in the living from the
International Association of Forensic Radiographers. The document
was reviewed by Professional Practice, Education and Public
Relations committees of the ISRRT as well as the ISRRT Board of
Directors. All reviewers were asked to read and give feedback from
the draft guideline relating to scope and completeness as well as
quality and clarity. The reviewers were also asked to determine if the
draft reflected current consensus and contained supportive evidence
for global practice, the last item the reviewers were asked to present
were any gaps in practice that might be missing in the document. The
comments written by reviewers were grouped as a general comment
which pertains to the entire document or a specific comment that is
specific to a section, the specific section has the page number and
paragraph it pertains along with draft suggestions to consider. ISRRT
general comments received regarding the document.
Some of the general comments about the guidelines themselves
were that the document was written fluidly and organised in a manner
that is quick to reference and logical to follow. With the exception of
a few sentence structures, the document is well written with cohesive
paragraphs strongly supported by literature. Of particular merit is
the attention paid to welfare of the multidisciplinary team involved
in the imaging and analysis of bone age. Inclusion of radiographers
as one of the main objected audiences. In my experience, bone age
examination in the living is most commonly performed in a clinical
setting and as such, more commonly performed by non-forensically
trained Radiographers. The manuscript offers a much-needed
collection of guidelines to start the discussion of best practices in
age estimation of the living. As technology advances and the
capabilities of diagnostic imaging continue to unfold, so too will the
applications of diagnostic imaging in age estimation in both the living
and the dead.
Rarely in scientific literature are the needs and interest of the
team itself discussed or brought to light and I applaud the guidelines’
inclusion of counseling and debriefing recommendations.
Regardless of the circumstances surrounding the question of child
age, the degree of malnutrition or disease exposure must be taken
into consideration for an accurate bone age analysis to be concluded.
Research and literature continuously demonstrate the correlation
between malnutrition and disease and a decrease in bone age
compared to chronological age.
Another potential flaw in the proposed guidelines for best
practice is the projection towards ‘Forensic Radiographers’ as
opposed to ‘Radiographers’ or ‘Medical Radiologic Technologists’.
Being that these age estimations are concerning those living, it is
predicted the majority of these examinations will be occurring in
clinical settings such as private radiology clinics, hospitals and
urgent cares as opposed to morgues, coroners, medical examiner’s
offices, court houses or prisons. With this being said, the chances
that the radiographer in the clinical setting has additional forensic
radiography or forensic science training are rare. As a clinical and
forensic radiographer, I appreciate where additional forensic training
is most beneficial. I fear with these guidelines focused mainly
towards forensic radiographers, the larger more affected population
of Radiographers are missing out on valuable, pertinent information
that directly influences their practice. These guidelines highlight
the role of the forensic radiographer and the education and training
expected for the role of performing age estimation imaging; yet the
large majority of radiographers involved in age estimations in the
living are not forensically trained. Demonstrates how disease and/or
malnutrition can negatively influence the development of dentition,
bone and overall growth and should be taken into consideration when
imaging for age estimation in the living.
Some of the specific detail is listed:
ISRRT specific suggesting to be consider:
Pg3 & 4 Introduction/ preamble as against context
Pg 4 “These guidelines include therefore an overview of the
requirements…….” - consider- “Therefore, these guidelines
offer an overview of the requirements……”
Pg 5 all definitions e.g. Bone age should have in text citations
(references)
Pg 5&7 the subtitles should not be questions title like other subtitles
in pg. 9,15, 18, 22 etc. Consistency should be maintained.
Pg 7 Role of Forensic Radiographer- (who has undertaken further
postgraduate education in forensic radiography) regarding
this information from the paragraph - (This is not the case in
the USA. Those who perform forensic radiography have no
formalized training in how to perform this imaging, and there
are no post-graduate courses offered.
For those radiographers who are members of DMORT
(Disaster Mortuary Operational Response Teams), ideally,
that radiographer would have some exposure to forensic /
medicolegal radiography, but that is not always required.
Pg 7 Role of Forensic Radiographer paragraph two (With the
ALARA Principle) Exclusively referring to post mortem
imaging only:
From my Perspective, we are to perform the highest quality
imaging, maintaining ALARA, for the occupational workers
performing the imaging. At some facilities I have worked
at, we employ techniques that are generally higher mAS
setting in order to create imaging that was of higher quality,
and were not necessarily the same dose that a living patient
would receive. This is especially true of our post mortem CT
protocol we used, as this was a thin slice imaging and of the
whole body.
Pg 7 Regarding this paragraph- (The IAFR recognises that
Forensic Radiography uses diagnostic imaging to answer
questions of the law and therefore may be performed on
live individuals) This is a bit divergent in the US. We do
not receive requests such as these for all cases that could be
considered forensic. An example: we do receive orders for
skeletal surveys on paediatric patients in the living, clinical
setting. We perform the x-rays as per the protocol, but do not
have the same documentation as would be seen I systems u
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