Collaboration, campaigns and champions for appropriate imaging: feedback from the Zagreb workshop

Abstract

Leading radiologists and representatives from national radiation protection regulatory authorities and health ministries from 19 countries of the European region worked together with five experts at the workshop on justification and appropriate use of imaging in Zagreb, Croatia, from 26 to 28 October 2017 jointly organised by the IAEA and the European Society of Radiology. The workshop served as a forum to exchange information on challenges and solutions for improving justification and the appropriate use of diagnostic imaging. Common barriers to improving the use of imaging referral guidelines were discussed and the need for increased collaboration identified. Examples of good practices were presented, including use of Clinical Decision Support (CDS) systems to facilitate rapid and good justification decisions. The workshop identified some of the needs of European countries for achieving more appropriate imaging proposing wider use of collaboration, campaigns and champions.

Main messages

• Drivers for appropriate imaging in Europe are similar to those elsewhere globally.

• Implementing imaging referral guidelines is the main barrier to more appropriate imaging.

• Clinical Decision Support systems (CDS) facilitates good referral practice and justification decisions.

• Collaboration, campaigns and champions may improve awareness, appropriateness and audit.

Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures, can provide safeguards to reduce the risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional x-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation, and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin, and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than the calculation of numerical values, as these are misleading when applied to individuals.

Secretary of State's POPUMET Inspectorate: the first six years

The first six years work of the Secretary of State for Health's Inspectorate for regulation 4 of the Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 is described. The regulations are colloquially known by the acronym POPUMET, and implement European Directive 84/466 EURATOM in Great Britain. This laid down basic measures for the protection of persons undergoing medical examination or treatment involving ionising radiation. The POPUMET regulations are applicable to all health care settings, public or private sector, but exclude research. Regulation 4 is intended to prevent unnecessary or excessive medical exposure to radiation. Of 68 reported incidents, 54 (79%) were relevant to regulation 4, comprising 20 (37%) incidents in radiotherapy, 21 (39%) in radiology, 11 (20%) in nuclear medicine and 2 (4%) in dental radiology. Allowing for the denominator number of NHS departments in England, the greatest frequency of incidents were reported from radiotherapy departments, followed by nuclear medicine and then radiology departments. Of the 54 incidents investigated, 42 (78%) required a site visit; 39 (72%) resulted in advice from the Inspectorate; 13 (24%) required no action following investigation and 2 (4%) were still under investigation as at 31 May 1994. No enforcement notices were issued and there were no prosecutions.