FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENTFPS PUBLIC HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Medical ImagingFederal initiative

Dr Aldo Perissino (internal medicine and public health)

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Organisers

Federal Public Health Service

National Insurance Institute

Federal Agency Nuclear Control

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Imaging techniques

RadiologyConventional radiology

CT scan

Interventional radiology

Nuclear medicine

Mixed Modality (CT + PET,…)

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Position of the problem

Widespread access

Appropriateness of chosen examinationsThe exposure to ionising radiations grew drastically these last years.

Belgium is among the greatest “irradiating countries”

1 person in 5 has a CT each year Every person in Belgium has one X-ray examination each

year (2008)

Positioning the problemMean exposure to medical irradiation in various countries

Source: UNSCEAR rapport 2008

X 1,5

X 4

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Target

Framework: a set of initiatives aiming at the optimisation of the use of medical imaging

Workgroups: Accreditation and optimisation Guidelines Awareness campaign

Inform Raise awareness

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Campaign: target groups

The populationIndirect impact on prescribers and professionals

The prescribers

The performers

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Target group: Population and patients

Inform on the opportunity of medical imaging

Call upon awareness and stimulate it: An examination must have an indication When indicated, an examination has to be

performed

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Target group: Prescribers

Family practitioners and specialists Better choice of examinations: guidelines and “folia”

Improve communication with patients: indirect effect of the campaign

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Target group: Performers

Radiologists, Technicians, Nurses: accreditation and optimisation directives

Performers = gatekeeper

Better communication between performers and prescribers: Indirect effect of the campaign and the spreading of information

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Target group: Performers

Interventional procedures: awareness of impact and doses delivered

Dosimetry

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Key points

Justification: every procedure must be indicated

Provided that the indication is correct, irradiation is a secondary matter, on behalf of what follows:

Optimisation: limit irradiation strictly to the need (ALARA)

If a non-irradiating technique of equal value is available, it should be preferred

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Key points

Protect frail groups:

pregnancy children

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Campaign themes Quality !

Awareness

Reduction of unnecessary exposure

No compulsion

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Radiation protection of staff in fluoroscopy

Radiation protection of staff in fluoroscopy

Radiation protection of patient in fluoroscopy

http://rpop.iaea.org

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Radiation protection of patient in fluoroscopy

1. Maximise distance between patient and tube to the extent possible

2. Minimise distance between patient and image receptor

3. Minimise fluoroscopy time

4. Use pulsed fluoroscopy with the lowest frame rate possible to obtain images of acceptable quality

5. Avoid exposing the same area of the skin in different projections

6. Larger patients or thicker body parts trigger an increase in entrance surface dose (ESD)

7. Oblique projections also increase ESD

8. Avoid the use of magnification

9. Minimize number of frames and cine runs to clinically acceptable level

10. Use collimation

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Radiation protection of staff in fluoroscopy

http://www-ns.iaea.org/tech-areas/communication-networks/norp/isemir-web.htm

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Radiation protection of staff in fluoroscopy

1. Use protective devices

2. Make good use of time-distance-shielding (TDS) principle

3. Use ceiling suspended screens, lateral shields and table curtains

4. Keep hands outside the primary beam unless totally unavoidable

5. Only 1% - 5% of radiation falling on the patient’s body exits the other side

6. Keep X ray tube under the patient table and not over it

7. Use personal dosimetry - Use at least two dosimeters

8. Update your knowledge about radiation protection

9. Address your concerns about radiation protection to radiation protection specialists

10. REMEMBER! Quality – Equipment - Injectors

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Conclusion

Reduce (suppress?) useless examinations

Part of a broader action plan

Awareness

Communication

Patient empowerment

FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT

Thanks for listening !