fps health, food chain safety and environmentfps public health, food chain safety and environment...
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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 !