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RADIATION MONITORING STRATEGY IN EUROPE

RADIATION MONITORING STRATEGY IN EUROPE. Guy FRIJA TORONTO, May 2013. Professor of Radiology and Consultant in Paris Hôpital Européen Georges Pompidou Oncologic , Cardiovascular and Trauma center. FACTS.  European regulatory background  European heterogeneity

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RADIATION MONITORING STRATEGY IN EUROPE

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  1. RADIATION MONITORING STRATEGY IN EUROPE Guy FRIJA TORONTO, May 2013

  2. Professor of Radiology and Consultant in Paris Hôpital Européen Georges Pompidou Oncologic , Cardiovascular and Trauma center

  3. FACTS Europeanregulatorybackground Europeanheterogeneity ReferralGuidelines : underuse

  4. EUROPEAN REGULATORY BACKGROUND  Euratom Directive, 1997 optimisation, DRL justification maintenance clinical audit  New BSS in preparation

  5. EUROPEAN REGULATORY BACKGROUND  Into National Law  National Regulatory Body  HERCA

  6. EUROPEAN HETEROGENEITY DOSE DATAMED 2, 2013 Heterogeneity in : Demographics, Equipments, Practices

  7. 11 11 OECD-2012

  8. COLLECTIVE DOSE

  9. COLLECTIVE DOSE UNSCEAR, 2008 World 1.9 mSv Australia 2.2 mSv USA 3.3 mSv  Europe, 2013 1.1 mSv

  10. REFERRAL GUIDELINES Europeansurvey by the ESR Availability of RG (~ 70%)  Production: UK and France Adopted and adaptated: others

  11. EUROPEAN REFERRAL GUIDELINES  Evidence based Almost 400 situations Recommendations, textual format

  12. “ In Belgium we have referral guidelines; in fact, nobody really takes them into account ”… “ Referral guidelines for diagnostic imaging in general are not in use in Hungary ”… “ They are not used in the Netherlands ”… “ Although we have several official referral guidelines published (in Spain), they are not used generally speaking ”… “ In Italy the referral guidelines were published in 2004 by the Ministry of Health. Unfortunately they are not always followed in clinical practice ”… “ There is no official guide line enforcement in the State service in Ireland ”… “ In Germany, the guidelines are note routinely used ”… “ In France, there are guidelines, but they are not used ”…

  13. CHANGE IN PARADIGM Producing Using

  14. CHANGE IN PARADIGM Producing EBM Using EBM CDS

  15. European Projects  ESR – CDS Project  ESR – ACR co-operation  ESR – HERCA co-operation

  16. ESR – CDS PROJECT  Principle approved by the EC and by HERCA  RCR, SFR, ESR: common approach  NDSC and ACR experiences

  17. ESR – CDS PROJECT  Initially limited to the top 10-20 clinical situations Potentially extended to paediatric, cardiovascular and others…

  18. ESR – ACR : Globalisation  MOU in 2013  Cross-relations in the professional field, including R.P. and CDS  Global Summitt

  19. ESR – HERCA  Common understanding of the challenges Sharedstrategies Justification: CDS Optimisation: CT Public awareness

  20. New solutions : WHY ? Regulationonly: failed Fragmentedapproach - by topics - by stakeholders Theories on behavioural changes

  21. Total Quality Monitoring of RP  GPS Approach  Clinical audit  Public campaign … and regulation !!!

  22. Total Quality Monitoring Global All the steps All the stakeholders Personalised Patient centric Clinical setting Safe Justification Optimisation Technologicalimprovements GPS

  23. ALL THE STEPS GPS Protocol Examination Order Scheduling Justification Risk factor Report Dose exposure IT SUPPORT!!!!!

  24. GPS STAKEHOLDERS

  25. PERSONALISED GPS Patient centric Individual risk-benefit No dose threshold

  26. Individual Risk-Benefit GPS Prediction Oncology Screening

  27. PERSONALISED GPS • Dose recording management Tailored • Clinically relevant

  28. Tailored Dose recording Courtesy of Quaelum

  29. TOTAL SAFETY MONITORING GPS Avoidunnecessary tests  Record the Dose (CT)  Optimise the protocols Track the perls  Optimise the equipments (CT)

  30. Wrong arm position DLPmax. = 994 mGy.cm

  31. PERFORMANCE QUALITY CONTROL Correct patient positioning Scout view Isocentre of the Gantry  Over scanning - Overlapping

  32. CLINICAL AUDIT Developing a model adapted to this global approach Toolpotentiallyuseful

  33. PUBLIC CAMPAIGN  Image Gently: behavioural changes Paediatriccampaign in Europe, with the ESPR

  34. IMPORTANCE OF IT Justification Patient data CPOE CDS CDS IT Compliance DRL Audit Profiling Traceability Follow-up Dose recording

  35. STAKEHOLDERS Medicalboard  Administrative staff Radiographers Radiologists Medicalphysicists  IT department

  36. SAFETY Technological improvements CT dose reduction

  37. CT Dose Reduction  New softwares : iterative reconstruction Dose decrease up to 70-90 % !!!!  Policy of Equipment upgrade Immediate Benefit !!!!!

  38. TAKE HOME  Holistic approach  Patient centric  Appropriate IT tools

  39. CONCLUSION Beyond dose exposure The best use of imagingresources for the patients and the society benefits

  40. THANK YOU!!!!

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